The treatment of hypertension in care home residents: a systematic review of observational studies

Welsh, Tomas, Gladman, John R.F. and Gordon, Adam L. (2014) The treatment of hypertension in care home residents: a systematic review of observational studies. Journal of the American Medical Directors Association, 15 (1). pp. 8-16. ISSN 1525-8610

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Aim: To describe the prevalence of hypertension in care home residents, its treatment, change in

treatment over time, and the achievement of blood pressure (BP) control.

Method: The PubMed, Cochrane, Embase, and PsychINFO databases were searched for observational

studies involving care home residents with a diagnosis of hypertension. The search was limited to

English language articles involving adults and humans published from 1990 onward. Abstracts and titles

were reviewed with eligible articles read in full. Bibliographies were examined for further relevant

studies. The final selection of studies was then analyzed and appraised.

Results: Sixteen articles were identified for analysis, of which half were studies carried out in the United

States. The prevalence of hypertension in care home residents was 35% (range 16%e71%); 72% of these

were on at least 1 antihypertensive (mean 1.5 antihypertensives per individual), with diuretics being the

most common. The prevalence of hypertension in study populations was greater in more recent studies

(P ¼ .004). ACEi/ARBs (P ¼ .001) and b-blockers (P ¼ .04) were prescribed more frequently in recent

studies, whereas use of calcium-channel blockers and diuretics remained unchanged over time. The

number of antihypertensives prescribed per patient was higher (correlation 0.332, P ¼ .009), whereas

fewer patients achieved target BP (correlation 0.671, P ¼ .099) in more recent studies.

Conclusion: Hypertension is common in care home residents and is commonly treated with antihypertensive

drugs, which were prescribed more frequently in more recent studies but with no better BP

control. These studies indicate a tendency toward increasing polypharmacy over time, with associated

risk of adverse events, without demonstrable benefit in terms of BP control.

Copyright 2014 - American Medical Directors

Item Type: Article
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Rehabilitation and Ageing
Identification Number:
Depositing User: de Sousa, Mrs Shona
Date Deposited: 10 Apr 2014 10:41
Last Modified: 04 May 2020 20:15

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