The impact of implementing national hypertension guidelines on prevalence and workload in primary care: a population-based survey of older people

Abstract

upon Tyne, UKRecently revised UK and US hypertension guidelines have reduced thresholds for both diagnosis and treatment and differ in their recommendations. We have used data from a random, stratified community-based sample of 4784 people aged 65 years and over to compare the prevalence of treatable hypertension and the potential impact on patients and primary care from using current guidelines. BHS, NICE and JNC7 guidelines were applied to blood pressures obtained from primary care medical records (94%) or measured at a screening clinic (6%). Risk factors were obtained by questionnaire and from medical records, supplemented by epidemiological data. Workload was estimated for a representative practice population of 10 000 patients. Blood pressures were obtained on 4514 patients (94%). Prevalence of treatable hypertension was over 67%. Compared to BHS4, prevalence estimates using NICE guidelines were comparable for men but significantly lower for women (Po0.05). They were significantly higher using JNC7 compared with BHS4 and NICE guidance (Po0.05). A general practice of 10 000 patients could expect 1287 older hypertensive patients using BHS4 guidelines and 1231 patients using NICE guidelines. Under BHS4, an extra 94 patients will require annual, rather than 5-yearly review compared with that using the previous guideline. In conclusion, implementation of BHS4 guidelines, with their revised thresholds for diagnosis, will not add materially to the prevalence of treatable hypertension compared to previous BHS3 guidelines but will have a major impact on practice workload. Use of NICE guidelines in preference to BHS4 will result in GPs treating fewer patients and reviewing untreated patients less often.

Current Status and Characteristics of Hypertension Control in Community Resident Elderly Korean People: Data from a Korean Longitudinal Study on Health and Aging (KLoSHa Study)

“…It is well known that calcium channel blockers and thiazide diuretics are initial choices for the treatment of elderly hypertensive patients (19,20). Nevertheless, newly developed angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) also have clinical benefits in elderly hypertensive patients (21).…”

Hypertension and Common Complications - Analysis of the Ambulatory Treatment Cost

“…To examine the influence of the complications and weighed monthly cost on the ambulatory hypertension cost we performed a one way sensitivity analysis by varying the weighed monthly cost and probability of the hypertension and its complications within the ±30% interval. Abbreviations used: 1 NHIF -National health insurance fund; 2 AH -arterial hypertension; 3 AP -angina pectoris; 4 SCD -sequellae of cerebrovascular disease; 5 HF -heart failure; 6 WMC -weighed monthly cost; 7 AH -arterial hypertension…”

“…Overall, 26.4% of the adult population in 2000 had hypertension and it is expected that 26.1% of women, and 29.2% of men will have this condition by 2025 year worldwide (1). In Europe the hypertension was found to be more prevalent than in USA and Canada and poor controlled (2)(3)(4)(5). Hypertension is a major global economic burden because of an increased risk for cardiovascular events and inadequately controlled high blood pressure raises the medical, economic, and human costs.…”

Optimal treatment of hypertension in the elderly: A Korean perspective

“…It has been well known that calcium channel blockers and thiazide diuretics are recommended as the initial choice for elderly hypertensive patients. 32 A recently published clinical study has clearly demonstrated that using newly developed antihypertensive medications have clinical benefit over the older drugs such as betablockers and diuretics in terms of reduction in cardiovascular and cerebrovascular events. 33 Furthermore, newly developed angiotensin-converting enzyme inhibitors or angiotensin receptor blockers also have clinical benefit in elderly hypertensive patients.…”