Prevalence and management of uncontrolled hypertension in French patients aged over 80 years

Background. - The rate of uncontrolled hypertensives aged >80 years is not well known. The available literature on this topic has used the threshold <140/90 mmHg, whereas there is now a consensus for a different target: systolic blood pressure (SBP) < 150 mmHg. Aims. - This prospective observational population-based study sought to assess the frequency and management of uncontrolled hypertension in French patients aged >= 80 years. Methods. - Nine hundred and seventy-one treated hypertensive outpatients were evaluable (204 recruited by cardiologists, 767 by general practitioners [GPs]; mean age 84.8 +/- 3.8 years; 57.8% women). Results. - The frequency of SBP >= 150 mmHg was 36.6% (44.6% in cardiologists' patients and 34.4% in GPs' patients). The frequency of satisfaction with SBP >= 150 mmHg was 22.0% for cardiologists (32.6% if diastolic blood pressure [DBP] <90 mmHg and 9.5% if >= 90 mmHg; P = 0.008) and 30.4% for GPs (51.7% if DBP < 90 mmHg and 13.2% if >= 90 mmHg; P < 0.0001). Non-diabetic status (for cardiologists) and DBP < 90 mmHg (for cardiologists and GPs) were independent determinants of SBP being considered acceptable. Accordingly, in patients with an SBP level >= 150 mmHg that was considered too high, treatment was reinforced more often if DBP was >= 90 mmHg (82.3%) than <90 mmHg (68.5%). Conclusion. - In France, hypertension is uncontrolled in more than one in three elderly hypertensives. Physicians are aware that SBP should be lowered to < 150 mmHg in patients aged > 80 years, but when the target is not reached they are less likely to increase treatment if DBP is <90 mmHg. (C) 2014 Elsevier Masson SAS. All rights reserved.