Hypertension in Long-Term Care Facilities
| Status: | Completed |
|---|---|
| Conditions: | High Blood Pressure (Hypertension) |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 65 - Any |
| Updated: | 6/29/2018 |
| Start Date: | January 26, 2017 |
| End Date: | June 25, 2018 |
Hypertension Prevalence, Treatment Patterns and Outcomes in Long-Term Care Facilities
This study is exploratory in nature and seeks to describe hypertension diagnosis and
management among patients in long-term care (LTC) facilities.
Specifically, the primary objective is to:
• Identify LTC patients who are diagnosed with hypertension and assess the management and
different outcomes of proper control of BP regarding to incidence of falls, cognitive
decline, kidney diseases, cardiovascular diseases and incidence of cerebrovascular accidents
The secondary objectives are to:
Describe treatment patterns of hypertension in LTC facilities
- Identify patients who are receiving non-pharmacological treatment and effectiveness of
this modality of treatment.
- Identify different classes of drugs used to treat hypertension in patients staying at
LTC facility
- Identify different drug adverse effects encountered by patients receiving medical
treatment.
- Identify patients who achieved normal blood pressure according to current guidelines
management among patients in long-term care (LTC) facilities.
Specifically, the primary objective is to:
• Identify LTC patients who are diagnosed with hypertension and assess the management and
different outcomes of proper control of BP regarding to incidence of falls, cognitive
decline, kidney diseases, cardiovascular diseases and incidence of cerebrovascular accidents
The secondary objectives are to:
Describe treatment patterns of hypertension in LTC facilities
- Identify patients who are receiving non-pharmacological treatment and effectiveness of
this modality of treatment.
- Identify different classes of drugs used to treat hypertension in patients staying at
LTC facility
- Identify different drug adverse effects encountered by patients receiving medical
treatment.
- Identify patients who achieved normal blood pressure according to current guidelines
Isolated systolic hypertension is more common in elderly than younger adults. Also blood
pressure (BP) in elderly tends to be very high, difficult to treat. Many studies are done to
understand the mechanism of hypertension in older adults, most of them concluded that the
main mechanisms are chronic inflammation, oxidative stress and endothelial dysfunction.
Hypertension is often called a "silent killer" and it is a major high risk factor of heart,
chronic kidney and cerebrovascular diseases . Systolic BP (SBP) gradually increases from
early adulthood to old age, whilst diastolic BP (DBP) increases until around 50 years of age
then reaches a plateau before decreasing again , causing widening of pulse pressure, and
elevated blood pressure known as Isolated Systolic Hypertension (ISH).
There is a general consensus across international guidelines for a recommended target BP of
SBP ≤ 140 mmHg and DBP≤90 mmHg for the general adult population without diabetes mellitus
(DM) however the treatment of hypertension in the elderly requires further clarification and
further studies as many international guidelines are inconsistent in providing recommendation
on optimal BP for both initiation ant of therapy ad for treatment in the elderly due to the
limited outcome date form randomized controlled trials (RCT) in this population .
The American Heart Association recommendations to initiate treatment starting with lifestyle
changes and then medication if necessary at 140/90 mmHg until age 80, then at 150/90 mmHg for
adults ˃ 80 years old '
The 2014 Joint National Committee's eights report (JNC 8) recommends that in general
population aged ≥60 years, to initiate pharmacologic treatment to lower BP at systolic BP
(SBP) ≥150 mm Hg or diastolic BP (DBP) ≥90 mm Hg and treat to a goal SBP<150 mm Hg and goal
DBP <90 mm Hg . However Reisin et al published a commentary on JNC 8 disagreeing with it,
having a concern that increasing the SBP level requiring treatment in those ≥60 years old to
≥150/≥90 mmHg may adversely affect renal function.
As Per the European society of Cardiology and the European Society of Hypertension: in
elderly patients drug treatment is recommended when systolic BP is ≥160 mmHg, or ≥140 mmHg if
younger than 80 years and treatment is well tolerated. It is not recommended to initiate
antihypertensive treatment at high normal BP and in younger patients with isolated systolic
hypertension.
As per 2011 NICE guidelines the aim for target average blood pressure is <135/85 mmHg for
People <80 years old and <145/85mmHg for people ≥80 years .
pressure (BP) in elderly tends to be very high, difficult to treat. Many studies are done to
understand the mechanism of hypertension in older adults, most of them concluded that the
main mechanisms are chronic inflammation, oxidative stress and endothelial dysfunction.
Hypertension is often called a "silent killer" and it is a major high risk factor of heart,
chronic kidney and cerebrovascular diseases . Systolic BP (SBP) gradually increases from
early adulthood to old age, whilst diastolic BP (DBP) increases until around 50 years of age
then reaches a plateau before decreasing again , causing widening of pulse pressure, and
elevated blood pressure known as Isolated Systolic Hypertension (ISH).
There is a general consensus across international guidelines for a recommended target BP of
SBP ≤ 140 mmHg and DBP≤90 mmHg for the general adult population without diabetes mellitus
(DM) however the treatment of hypertension in the elderly requires further clarification and
further studies as many international guidelines are inconsistent in providing recommendation
on optimal BP for both initiation ant of therapy ad for treatment in the elderly due to the
limited outcome date form randomized controlled trials (RCT) in this population .
The American Heart Association recommendations to initiate treatment starting with lifestyle
changes and then medication if necessary at 140/90 mmHg until age 80, then at 150/90 mmHg for
adults ˃ 80 years old '
The 2014 Joint National Committee's eights report (JNC 8) recommends that in general
population aged ≥60 years, to initiate pharmacologic treatment to lower BP at systolic BP
(SBP) ≥150 mm Hg or diastolic BP (DBP) ≥90 mm Hg and treat to a goal SBP<150 mm Hg and goal
DBP <90 mm Hg . However Reisin et al published a commentary on JNC 8 disagreeing with it,
having a concern that increasing the SBP level requiring treatment in those ≥60 years old to
≥150/≥90 mmHg may adversely affect renal function.
As Per the European society of Cardiology and the European Society of Hypertension: in
elderly patients drug treatment is recommended when systolic BP is ≥160 mmHg, or ≥140 mmHg if
younger than 80 years and treatment is well tolerated. It is not recommended to initiate
antihypertensive treatment at high normal BP and in younger patients with isolated systolic
hypertension.
As per 2011 NICE guidelines the aim for target average blood pressure is <135/85 mmHg for
People <80 years old and <145/85mmHg for people ≥80 years .
Inclusion Criteria:
- Being diagnosed with hypertension
- Be ≥ 60 years of age
- Stays at the LTC facility for at least 3 months
Exclusion Criteria:
- Patients under age of 60 Patients without diagnosis of hypertension Terminally ill
patients and hospice patients
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