10 - Hypertension

Summary

INTRODUCTION

Hypertension is the single most common outpatient diagnosis in the United States, and older Americans have the highest prevalence of any age group. Therefore, it is vital for clinicians to be comfortable with the classification, treatment, and circumstances unique to the geriatric patient. Adequately treated hypertension has been well documented to help prevent adverse outcomes such as kidney failure, stroke, myocardial infarction, ventricular hypertrophy, and heart failure. Special consideration in older patients, especially those with multiple comorbid illnesses, and frail elders require individualized therapy.

EPIDEMIOLOGY

More than 65 million American adults have hypertension, creating a large public health burden. The overall prevalence of hypertension in the United States is approximately 25%; however, the prevalence for people 60 years or older is much higher at 66%. The Framingham Heart Study indicated the lifetime risk of developing hypertension in this age group to be 90%. The most recent data indicate for patients 60 years and older, 81% of people with hypertension are aware of their diagnosis and approximately 73% of them were treated. Of those treated, only approximately 50% achieved target blood pressure goals. Framingham calculated the lifetime probability of being on antihypertensive medications for patients aged 55–65 years to be 60%. For all people older than 60 years with hypertension, including those not treated, only 36% were at goal, well short of the Healthy People 2010 goal of 50%. Although these statistics are dire, there has been increasing control of hypertension since 1999. Furthermore, the geriatric population is most likely to be aware of their diagnosis, most likely to be treated, and most likely to be at goal.