Prevalence, clinical correlates, and treatment of hypertension in elderly nursing home residents
Prevalence, clinical correlates, and treatment of hypertension in elderly nursing home residents
复制标题
DOI：
10.1001/archinte.158.21.2377
复制
发表时间：
1998-11-23
影响因子：
--
通讯作者：
Bernabei, R
中科院分区：
文献类型：
--
作者：
Gambassi, G;Lapane, K;Bernabei, R
背景：高血压在老年人中普遍存在，但关于老年人、体弱者和长期护理中患有复杂疾病的个体的信息差距仍然存在。目的：分析老年住院患者抗高血压药物治疗模式，阐明其与共识指南的符合性。研究对象和方法：我们使用了一个长期护理数据库，该数据库合并了1992年至1994年间美国5个州收治的近30万名患者的社会人口统计学、功能、临床和治疗信息。结果：80206例患者被诊断为高血压，平均年龄82.7±7.8岁。女性和黑人的患病率更高。约四分之一的患者有6种或更多的合并症；分别有26%、22%和29%的患者同时被诊断为冠心病、充血性心力衰竭和脑血管疾病。70%的患者接受了药物治疗。钙通道阻滞剂是最常见的药物（2%），其次是利尿剂（25%），血管紧张素转换酶抑制剂（22%）和受体阻滞剂（8%）。这些药物的相对使用根据其他心血管疾病的存在而改变。调整潜在混杂因素后，老年受试者（大于或等于85岁：优势比为0.85；95%可信区间为0.81-0.89）和身体功能明显受损（优势比为0.77；95%可信区间为0.73-0.81）和认知功能明显受损（优势比为0.67；95%可信区间为0.64-0.70）接受降压治疗的相对几率显著降低。结论：高龄、体弱的高血压患者在养老院的治疗模式似乎没有遵循推荐的指南；年龄、功能状态和合并症似乎是治疗选择的重要决定因素。
Background: Hypertension is prevalent in the elderly, but an information gap remains regarding the old, frail, individuals with complex conditions living in longterm care.Objective: To analyze the patterns of antihypertensive drug therapy among elderly patients living in nursing homes to elucidate their conformity with consensus guidelines.Subjects aad Methods: We used a long-term care database that merged sociodemographic, functional, clinical, and treatment information on nearly 300 000 patients admitted to the facilities of 5 US states between 1992 and 1994.Results: Hypertension was diagnosed in 80 206 patients (mean age, 82.7 +/- 7.8 years). The prevalence was higher among women and among blacks. About one fourth of patients had 6 or more comorbid conditions; 26%, 22%, and 29% had concomitant diagnoses of coronary heart disease, congestive heart failure, and cerebrovascular disease, respectively. Seventy percent of patients were treated pharmacologically. Calcium channel blockers were the most common agents (2%), followed by diuretics (25%), angiotensin-converting enzyme inhibitors (22%), and beta-blockers (8%). The relative use of these drugs changed according to the presence of other cardiovascular conditions. Adjusting for potential confounders, the relative odds of receiving antihypertensive therapy were significantly decreased for the oldest subjects (greater than or equal to 85 years old: odds ratio, 0.85; 95% confidence interval, 0.81-0.89) and those with marked impairment of physical (odds ratio, 0.77; 95% confidence interval, 0.73-0.81) and cognitive (odds ratio, 0.67; 95% confidence interval, 0.64-0.70) function.Conclusions: Among very old, frail hypertensive patients living in nursing homes, the pattern of treatment seems not to follow recommended guidelines; age, functional status, and comorbidity appear to be important determinants of treatment choice.