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Abstract

The study estimated the prevalence of isolated systolic hypertension (ISH) in a group of elderly patients seeking their general practitioner for various reasons. Fifteen centres participated in the study each including 100 consecutive subjects over 60 years of age from a specific date. A total of 1505 patients (886 women, 619 men) with a mean age of 73 years (range: 60-94) were included. Blood pressure was measured by the same automated measuring unit (Omron HEM-705CP) three times after five minutes in the sitting position. Five hundred seventy-one patients (38%) had a previous diagnosis of hypertension with a mean duration of 10.6 years ( 9.7-11.5). Mean values of blood pressure at the initial screening were 143 mmHg (85-213) systolic and 81 mmHg (37-133) diastolic in subjects with no history of hypertension, and 156 mmHg (104-221) systolic and 86 mmHg (51-123) diastolic in subjects with known hypertension. In subjects without previous hypertension and thus untreated, systolic blood pressure showed a slight increase with age from 138 mmHg (60-64 years) to 148 mmHg (90-94 years, p<0.004), whereas diastolic values were independent on age (p=0.364). At the initial screening of subjects with no history of hypertension, 42% were normotensive, 43% had ISH, and 15% had mixed hypertension (grade I-III) according to WHO criteria. Of the patients with known hypertension and without diabetes mellitus, only 18% had reached a blood pressure level <140/<90 mmHg and 50% still had ISH (34% borderline). In the screened population, 185 had diabetes mellitus and 56% of these also had a diagnosis of hypertension. In this group, 24% had reached a diastolic blood pressure <80 mmHg, but only 2% had attained a level <130/<80 mmHg. A second and a third visit were conducted with two weeks intervals repeating blood pressure measurements and successively excluding subjects with normotension or borderline ISH. After the third visit, this procedure had reduced the number of subjects with ISH from 696 (534 borderline) to 101 (34 borderline), and mixed hypertension from 316 to 81. It is concluded that blood pressure levels are subject to minor age-related changes in the elderly and that ISH is present in a high percentage of subjects over the age of 60 years irrespective of whether they have a previous diagnosis of hypertension or not. It is furthermore concluded that optimal treatment goals are attained in a small minority of elderly hypertensive patients and finally that the described strategy of repeated blood pressure measurements greatly reduces the number of elderly subjects requiring antihypertensive treatment.

Classification of hypertension, old age, Isolated systolic hypertension
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© American Journal of Hypertension, Ltd. 2001
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