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Lloyd-Jones DM, Evans JC, Levy D. Hypertension in Adults Across the Age Spectrum: Current Outcomes and Control in the Community. JAMA. 2005;294(4):466–472. doi:10.1001/jama.294.4.466
Author Affiliations: Department of Preventive
Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
(Dr Lloyd-Jones); and the National Heart, Lung, and Blood Institute’s
Framingham Heart Study, Framingham, Mass (Drs Evans and Levy).
Context Data are sparse regarding current rates of hypertension treatment and
control, and risks associated with hypertension, among persons older than
Objective To determine the prevalence of blood pressure stages, hypertension treatment
and control, and cardiovascular risk among older patients with hypertension.
Design, Setting, and Participants A community-based cohort study in which data were collected during all
Framingham Heart Study examinations attended in the 1990s. Participants were
pooled according to age: younger than 60 years, 60 to 79 years, or 80 years
or older. There were 5296 participants who contributed 14 458 person-examinations
of observation, including 7135 hypertensive person-examinations (4919 treated).
Main Outcome Measures Prevalence of hypertension, its treatment, and its control were compared
across age groups. Risks for incident cardiovascular disease during follow-up
of up to 6 years were estimated as multivariate-adjusted hazard ratios (HRs)
and 95% confidence intervals (CIs) using Cox proportional hazards regression.
Results Prevalence of hypertension and drug treatment increased with advancing
age, whereas control rates were markedly lower in older women (systolic <140
and diastolic <90 mm Hg). For ages younger than 60 years, 60 to 79, and
80 years and older, respectively, control rates were 38%, 36%, and 38% in
men (P = .30) and 38%, 28%, and 23% in
women (P<.001). Relative risks for cardiovascular
disease associated with increasing blood pressure stage did not decline with
advancing age, and absolute risks increased markedly. Among participants 80
years of age or older, major cardiovascular events occurred in 9.5% of the
normal blood pressure (referent) group, 19.8% of the prehypertension group
(HR, 1.9; 95% CI, 0.9-3.9), 20.3% of the stage 1 hypertension group (HR, 1.8;
95% CI, 0.8-3.7), and 24.7% of the stage 2 or treated hypertension group (HR,
2.4; 95% CI, 1.2-4.6).
Conclusions Relative to current national guidelines, rates of blood pressure control
in the community are low, especially among older women with hypertension.
Short-term risks for cardiovascular disease are substantial, indicating the
need for greater efforts at safe, effective risk reduction among the oldest
patients with hypertension.
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