Abstract 18590: The Underutilization of Guideline Recommended Antihypertensive Agents is Associated with a High Prevalence of Uncontrolled Hypertension in Urban Community Dwelling Older Adults

Abstract

Background: Hypertension (HTN) is a major risk factor for cardiovascular disease. Despite numerous medication options and clear clinical practice guidelines (JNC 7), uncontrolled HTN disproportionately affects the elderly population.

Hypothesis: We hypothesized that blood pressure (BP) control in adult seniors may be affected by their prescribed antihypertensive medication regimen.

Methods: Adults 59-99 years old from two New York City boroughs were enrolled in the NHLBI-funded Cardiovascular Health of Seniors and the Built Environment Study from 2009 to 2011 (n=1,453). At the baseline visit, participants brought their medications and had three BP measurements performed. The average of the 2^nd and 3^rd measurements was recorded. Uncontrolled HTN was defined as a measured BP greater than 140/90 mmHg. Medications were grouped by class including thiazide diuretics, beta blockers (BB), calcium channel blockers (CCB), angiotensin II converting enzyme inhibitors (ACEI), and angiotensin II receptor blockers (ARB). All other agents were grouped together.

Results: The prevalence of hypertension was 68.7%. Hypertension increased with age, affected more women (71%) compared to men (61%); and was higher among African Americans (75%) compared to Whites (63%) or Hispanics (63%). Nearly 70% of the hypertensive participants were treated with at least one medication, but in those with uncontrolled BPs (41%), only 65% were prescribed an antihypertensive agent. CCBs were prescribed most frequently (23%) followed by BBs (21%), ACEIs (17%), ARBs (17%), thiazide diuretics (14%), and second line agents (7%). Thiazide diuretics remained the least prescribed first line drug class regardless of underlying comorbidities (diabetes, heart disease, renal disease) or BP control.

Conclusions: Despite longstanding consensus recommendations, more than a third of participants with uncontrolled HTN in our cohort were not prescribed any antihypertensive medication. Further, thiazide diuretics were prescribed less often than any other first line agent, contrary to the JNC 7 guidelines. Increased attention to the guideline recommended prescription of antihypertensives may have a beneficial population level effect on uncontrolled hypertension.