Multiprofessional treatment of high blood pressure in very elderly patients

Abstract

BackgroundAs the world population ages, patients older than 80 years, known as very elderly, are more frequently found. There are no studies in this age group aimed at analyzing the multidisciplinary intervention in the treatment of systemic arterial hypertension (SAH) and some comorbidities.ObjectivesTo assess the effect of a multidisciplinary approach in very elderly hypertensives cared for at a specialized service.MethodsLongitudinal retrospective cohort study in a multidisciplinary service specialized in the SAH treatment in the Brazilian West-Central region. Patients aged 80 years and older by June 2015 were included. Data from the first (V1) and last visit (Vf) were assessed. Anthropometric variables, blood pressure (BP), renal function, pharmacological treatment, lifestyle, comorbidities and cardiovascular events were studied, comparing data from V1 and Vf. Controlled BP was defined as systolic blood pressure (SBP) lower than 140 mm Hg and diastolic blood pressure (DBP) lower than 90 mm Hg. Statistical analyses were performed with SPSSR software, version 21.0. Values of p<0,05 were considered significant.ResultsData of 71 patients were assessed with a mean follow-up time of 15,22 years. Their mean age at V1 was 69.2 years, and, at Vf, 84.53 years, and 26.8% of them were males. There was a significant reduction in mean SBP (157.3 x 142.1 mm Hg; p<0.001) and DBP (95.1 x 77.8 mm Hg; p<0.001), with an increase in BP control rates from V1 to Vf (36.6 x 83.1%; p<0.001). The number of antihypertensive drugs used increased (1.49 x 2.85; p<0.001), with an increase in the use of angiotensin-converting enzyme inhibitors (22.5 x 46.5%; p=0.004), angiotensin II receptor blockers (4.2 x 35.2%; p<0.001) and calcium-channel blockers (18.3 x 67.6%; p<0.001). There was a reduction in total cholesterol (217.9 x 191 mg/dL; p<0.001) and LDL-cholesterol (139.6 x 119.0 mg/dL; p<0.001), but worsening of the glomerular filtration rate (62.5 x 45.4 mL/min; p<0.001).ConclusionThe multidisciplinary intervention in very elderly hypertensives increased BP control rate, with optimization of the pharmacological treatment.

Multidisciplinary treatment of patients with diabetes and hypertension: experience of a Brazilian center

“…Although our multidisciplinary service has always focused on the overall patient management it is primarily specialized in hypertension treatment, which can explain this finding. Previous studies conducted in the same setting also showed good results in blood pressure management [ 11 , 21 ] which must be simultaneously seen as extremely positive and as a call for action to improve management of other co-morbidities.…”

“…Since the beginning of this multidisciplinary service, consultations have been registered in a standardized form. All healthcare professionals directly involved in patients care are routinely trained to fill this form, ensuring data reliability and reproducibility throughout the follow-up years [ 11 ].…”

Perception of nursing workers on the care of hypertension in older adult

“…Interventions based on such a frame extrapolate the biomedical, hegemonic model. Focusing on disease, the biomedical model subordinates social, economic, and subjective aspects in determining the healthdisease process and is characterized by reductionism, by treating complex phenomena as simple primary principles, and by mind-body dualism (29) .…”

Fatores associados à adesão de adultos/idosos ao tratamento da hipertensão arterial na atenção básica [Factors associated with adult/elderly adherence to the treatment of arterial hypertension in primary care] [Factores asociados con la adherencia de adultos/ancianos al tratamiento de la hipertensión arterial en atención primaria]

“…Estudo realizado com 135 hipertensos, acompanhados pela ESF, mostrou que a atuação das equipes do programa Hiperdia obteve resultados positivos no manejo da comorbidade em questão e na gestão de algumas condições de risco relacionados a agravos cardiovasculares. O referido estudo evidenciou que a redução dos níveis pressóricos esteve associada à adesão ao tratamento farmacológico e não farmacológico desenvolvido para aquela população 22 .…”