Glynn RJ, Broch DB, Harris T, Havlik RJ, Chrischilles EA, Osfeld AM, Taylor JO, Hennekens CH
Use of antihypertensive drugs and trends in blood pressure in the elderly

Arch Intern Med (Sep) 155:1855-1860 1995

A number of early studies involving antihypertensive agents in the diuretic class and, to a lesser extent, in the beta-blocker group, have suggested benefits in the elderly patient. This article was an attempt to assess how such outcomes data have influenced physician practice, choice of drug, and changes in population prevalence of various antihypertensive drug classes as a result of this information. The study patients (n=10,294) were followed from 1981 at 3 and 6 year intervals. They lived in Conneticut, Iowa, and Massachussets, and were all older than 65. Use of all antihypertensives during the time period in question increased by approximately 15-30%. An unexplained but interesting finding was that while mean systolic and diastolic blood pressures and prevalence of systolic hypertension declined in the New England States they were far less improved in Iowa and, amongst females, systolic hypertension actually worsened. Despite published data, there was a decline in the use of thiazides and an increase in ACE inhibitor and calcium channel blocker use. To no one's surprise, elderly patients appear to be more agressively treated for hypertension. However, our choice of therapeutic agents has been driven more by theoretical indications and convenience/side effect profiles than by long term trials demonstrating true reductions in morbidity or mortality. Hopefully, with ongoing studies to be completed in the near future, we can once again claim to be practicing evidence based medicine. (Narsipur)

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H: Diagnosis : Elderly