ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

Aronow, Wilbert S.; Fleg, Jerome L.; Pepine, Carl J.; Artinian, Nancy T.; Bakris, George L.; Brown, Alan S.; Ferdinand, Keith C.; Forciea, Mary Ann; Frishman, William H.; Jaigobin, Cheryl; Kostis, John B.; Mancia, Giuseppi; Oparil, Suzanne; Ortíz, Eduardo; Reisin, Efrain; Rich, Michael W.; Schocken, Douglas D.; Weber, Michael A.; Wesley, Deborah J.

doi:10.1016/j.jacc.2011.01.008

Cited by 409 publications

(160 citation statements)

References 696 publications

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“…Antihypertensive adherence might be a particular concern for older adults who have multiple chronic conditions 4, 5, 6, 8, 20. Many studies have examined major barriers and predictors of nonadherence among hypertensive patients,5, 7, 9, 11, 44, 45 and some focused on older adults 6, 46. Potential barriers to adherence among older adults can be classified into 3 categories: (1) patient‐related factors, including sociodemographics, psychosocial factors, comorbidities, cognitive ability, and health beliefs; (2) medication‐related factors, including the number of medications taken, adverse side effects, and complex medication regimens; and (3) other factors, including the patient‐prescriber relationship, access to medication and cost, and social support 6, 46.…”

Section: Discussionmentioning

confidence: 99%

“…Many randomized, control trials demonstrated the benefit of antihypertensive medications (antihypertensives) on reduction of risk for CVD morbidity and mortality 2, 3. Despite the benefit of antihypertensive therapies, many studies suggested suboptimal adherence to these medications, particularly among older adults with multiple chronic conditions 4, 5, 6, 7, 8, 9, 10, 11. Nonadherence to antihypertensives is associated with increased risk for CVD, hospitalization, and healthcare costs 5, 12, 13, 14, 15, 16, 17.…”

Section: Introductionmentioning

confidence: 99%

“…Assessing antihypertensive adherence and CVD outcomes among older adults with newly diagnosed hypertension might have important public health implications 7, 8. It is estimated that the proportion of the US population aged ≥65 years will increase from 13.7% (43 million) in 2012 to 21.0% (80 million) in 2040 21.…”

Section: Introductionmentioning

confidence: 99%

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Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population‐Based Cohort Study

Yang

Chang

Ritchey

et al. 2017

JAHA

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BackgroundAntihypertension medication (antihypertensive) adherence lowers risk of cardiovascular disease (CVD); few studies have examined this association among older adults.Methods and ResultsWe assessed this association among Medicare fee‐for‐service beneficiaries aged 66 to 79 years who were newly diagnosed with hypertension and initiated on antihypertensives in 2008–2009 (n=155 597). We calculated proportion of days covered (PDC) during follow‐up, using proportional subdistribution hazard models, to examine association between antihypertensive adherence and a composite CVD outcomes, including first incident of fatal/nonfatal acute myocardial infarction, ischemic heart disease, stroke/transient ischemic attack, and heart failure. During follow‐up (median 5.8 years and 798 621 person‐years), we documented 47 198 CVD events. Among beneficiaries, 60.8%, 30.3%, and 8.9% had PDC ≥80%, 40% to 79%, and <40%. Crude incidence of CVD events were 40.1 (95% CI, 40.0–40.1), 93.9 (93.8–93.9), and 98.1 (98.1–98.2) per 1000 person‐years for PDC ≥80%, 40% to 79%, and <40%, respectively. Adjusted hazard ratios for CVD events were 1.0 (<40% as reference), 1.0 (0.97–1.03) for 40% to 79%, and 0.44 (0.42–0.45) for ≥80% (P<0.001). Dose‐response analysis suggested a nonlinear relationship between PDC and risk for CVD events with a protective effect of ≥80%. The pattern of associations between PDC and ischemic heart disease, stroke/transient ischemic attack, and heart failure were largely consistent as for CVD events and across different groups.ConclusionsAntihypertensive adherence was associated with a significantly lower risk of CVD events among older adults. There appeared to be a threshold effect in reducing CVD events at around PDC 80%, above which the risk for CVD reduced substantially.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population‐Based Cohort Study

Yang

Chang

Ritchey

et al. 2017

JAHA

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“…2,3 The exact location of where the critical diastolic J point has been reported to be progressively lower from Stewart's initial report using 100 mm Hg with the fourth Korotkoff sound, 1 to 85 mm Hg, 4 then to 70 mm Hg, 5 and now to 65 mm Hg, 6 all using the fifth Korotkoff sound. The reasons why the level has apparently fallen over the years include the larger size of the populations studied in the trials, with the inclusion of many more patients with existing diabetes mellitus 7 or coronary artery disease 8,9 in whom more coronary events would more likely occur, the increase in reporting of diastolic levels in the publications of trial results, and the use of more cardioprotective drugs.…”

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confidence: 95%

The Diastolic J Curve

Kaplan¹

2011

Hypertension

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Abstract-The occurrence of additional cardiovascular events when the diastolic blood pressure is lowered below a critical level is referred to as "the diastolic J curve." Although the critical level of diastolic blood pressure where the J curve begins is not certain, increasingly strong evidence from prospective, controlled studies has confirmed the existence of such a J curve. With the likely addition of more patients who will be treated more vigorously, in particular, elderly subjects with isolated systolic hypertension, the potential for an increase in the number of adverse cardiovascular events must be considered and caution used to avoid too low a diastolic blood pressure. (Hypertension. 2011;58:751-753.)Key Words: diastolic blood pressure Ⅲ J curve Ⅲ coronary risk A s we eagerly await delivery of the long delayed report of the eighth Joint National Committee, questions have emerged as to what may be advocated in the report. Among these questions is whether there will be recognition of the existence, significance, and prevention of a diastolic J curve, that is, the occurrence of additional cardiovascular events when the diastolic blood pressure is lowered beyond the level needed to maintain perfusion of vital organs.Over the years since it was first described by Stewart in 1979, 1 the J curve has been recognized to exist almost exclusively for the diastolic blood pressure level and mostly in patients with existing coronary artery disease. 2,3 The exact location of where the critical diastolic J point has been reported to be progressively lower from Stewart's initial report using 100 mm Hg with the fourth Korotkoff sound, 1 to 85 mm Hg, 4 then to 70 mm Hg, 5 and now to 65 mm Hg, 6 all using the fifth Korotkoff sound. The reasons why the level has apparently fallen over the years include the larger size of the populations studied in the trials, with the inclusion of many more patients with existing diabetes mellitus 7 or coronary artery disease 8,9 in whom more coronary events would more likely occur, the increase in reporting of diastolic levels in the publications of trial results, and the use of more cardioprotective drugs. The logical reasons for the almost exclusive occurrence of coronary events rather than strokes below the diastolic J point include the nature of coronary perfusion occurring only during diastole and the greater capacity of the cerebral circulation to autoregulate blood flow at lower blood pressure levels. 10 The Critical IssueAs Bryan Williams has written 11 :That there is a J-curve relationship between the level of blood pressure and risk is not in doubt, because there must come a point at which [blood pressure] BP becomes too low to sustain adequate perfusion to vital organs and life itself. Thus, the essence of the debate is whether this curve exists in the range of BP at which patients might be exposed to further blood pressure lowering by treatment. . . This is a hugely important clinical dilemma, worthy of closer inspection and debate, not least of all because these analyses creat...

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“…Side effects of anti-hypertensive drugs are common and may be so severe or undesirable that the patient does not comply with the therapy [7,8]. Patient and caregiver teaching, changing the drug or decreasing the dosage may help the patient adhere to therapy.…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing Compliance to Therapeutic Regimen Among Patients With Hypertension

Dharan

2017

Asian J Pharm Clin Res

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Objectives: The objectives of the study were to identify the level of compliance to therapeutic regimen, assess the factors promoting and interfering compliance, and to find the association between level of compliance and factors influencing it in patients with hypertension in a Tertiary Care Hospital, Kochi, with a view to develop an information booklet.Methods: Nonprobability convenience sampling technique was used to collect data from 150 individuals attending outpatient departments. Data on compliance were assessed through interview using standardized Hill And Bone High Blood Pressure Compliance. Scale and factors promoting and interfering compliance were assessed using self-developed semi-structured questionnaire.Results: Only 55 (36.7%) had good compliance, while 52 (34.7%) had average and 43 (28.7%) had poor compliance to anti-hypertensive therapeutic regimen. The major factors promoting compliance were found as patient-prescriber relationship 146 (97.3%), family support 133 (88.7%), motivation 125 (83.3%), communication with healthcare providers 122 (81.3%), health literacy 104 (69.3%), and patient satisfaction 75 (50%). The factors interfering with compliance were lack of self-esteem 136 (90.7%), long-term adherence 129 (86%), misconceptions and erroneous beliefs 122 (81.3%), cost of therapy and income 100 (80%), forgetfulness 107 (71.3%), difficulty in adjustment to dietary change 82 (54.7%), and fear of side effects 70 (50%). A significant association between the level of compliance and factors promoting and interfering with compliance to therapeutic regimen (p<0.01) was noted. Level of compliance with therapeutic regimen was found to be lower in patients with associated comorbidities such as diabetes mellitus (c 2 =9.52, p<0.01) and coronary artery disease (c 2 =6.737, p<0.05). Conclusion:The study concludes the significance of developing systems to tack and ensure compliance to therapy among hypertensives with a focus on factors promoting compliance not only from the patient perspective but also from the perspective of family and society.

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ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

Cited by 409 publications

References 696 publications

Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population‐Based Cohort Study

Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population‐Based Cohort Study

The Diastolic J Curve

Factors Influencing Compliance to Therapeutic Regimen Among Patients With Hypertension

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