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Age-Related Bias in the Management of Hypertension

A National Survey of Physicians' Opinions on Hypertension in Elderly Adults

^a Department of Internal Medicine, Division of Geriatrics, University of South Carolina School of Medicine/Palmetto Health Alliance, Columbia
^b University of South Carolina School of Medicine, Columbia

Ihab Hajjar, Assistant Professor, Department of Internal Medicine, Division of Geriatrics, University of South Carolina School of Medicine/Palmetto Health Alliance, 9 Medical Park, Suite 230, Columbia, SC 29203 E-mail: ihab.hajjar{at}palmettohealth.org.

Background. This study surveyed opinions and self-reported practices of physicians involved in the care of elderly individuals regarding geriatric hypertension management and included a national random sample (n = 1060) of health care professionals in the United States.

Methods. This is a cross-sectional self-conducted survey using a questionnaire developed to assess the opinions related to blood pressure (BP) and aging, BP selection, BP target, lifestyle modifications, and first-line drug choice. We also tested the impact of the patient's age on the respondents' answers. A national random sample (n = 1060) of health care professionals in the United States was selected.

Results. We received 412 (39%) questionnaires. Thirty-five percent considered that the increase in BP with age is a normal process of aging, and 25% considered treating hypertension in an 85-year-old patient to have more risks than benefits. Sixty-nine percent considered systolic blood pressure to be the most important pressure. Respondents were more likely to start antihypertensive therapy at a lower BP and target a lower BP in 65-year-old patients compared with 85-year-old patients (p < .001). Respondents were more likely to recommend lifestyle modifications in 65-year-old patients compared with 85-year-old patients (p < .001). Only 13–17% recommend higher potassium consumption. Diuretics (p = .032) and beta-blockers (p = .005), but not other antihypertensives, are less likely to be used as first-line drugs by respondents in the very old.

Conclusions. Health care professionals' understanding of BP changes with aging, BP selection and BP target levels, lifestyle modification counseling (especially concerning potassium consumption), and drug selection deviates in some aspects from the national recommendations especially in the very old. Improving these opinions could have a significant impact on the control rates of geriatric hypertension.

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