Management of Hypertension in Community-Dwelling Older People has improved over the Last Decade and is not associated with Increase Risk of Falls, Dizziness or Syncope

McDonald, C; Pearce, MS; Newton, JL; Kerr, SRJ

doi:10.1093/ageing/aft105

Management of Hypertension in Community-Dwelling Older People has improved over the Last Decade and is not associated with Increase Risk of Falls, Dizziness or Syncope

Lookup NU author(s): Dr Claire McDonald, Professor Mark Pearce ORCiD, Emerita Professor Julia Newton, Dr Simon Kerr

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Abstract

Introduction: Over the last decade it has been recognised that effective blood pressure (BP) control reduces morbidity and mortality in all ages. Nevertheless, BP management in older people is often suboptimal. Twenty-four hour ambulatory BP monitoring (ABPM) helps correctly diagnose hypertensive patients and avoids over medication, particularly among older people. Recent NICE guidelines recommend routine use of ABPM and intervention where the mean daytime BP is >135/85.Aim: To examine how the management of hypertension in older-people has changed over the last decade and if there have been associated changes in rates of falls, dizziness or syncope.Methods: In 2002, 122 community-dwelling people aged ≥75 years were recruited from a GP surgery in the north of England. Clinical history was recorded and consenting individuals underwent ABPM. Ten years later a further cohort of 104 individuals aged ≥75 from the same general practice underwent identical assessment.Results: The groups were age matched [median age 79 years (IQ range 76–83)]. Significantly more participants had recognised hypertension at the 2012 assessment (58%) than in 2002 (41%), P = 0.027. ABPM recordings showed significantly fewer undiagnosed hypertensive individuals in 2012 (14%) that in 2002 (28%), P < 0.001. Significantly more hypertensive individuals were optimally treated in 2012, (44%) versus (19%), P < 0.001. Minimum and mean systolic BP were significantly lower in the 2012 cohort, but maximum systolic BP and diastolic BP did not differ. Use of ACE inhibitor, angiotensin receptor blockers and diuretics had significantly increased over the 10-year interval. Patient reported rates of falls, dizziness and syncope had not risen significantly. Ischaemic heart disease was significantly less common in the 2012 cohort, P < 0.05.Conclusion: Hypertension in older people is better recognised and more effectively managed now than 10 years ago. This has not been associated with a significant change in rates of falls, dizziness or syncope.