Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries.

Streit, Sven; Verschoor, Marjolein; Rodondi, Nicolas; Bonfim, Daiana; Burman, Robert A; Collins, Claire; Biljana, Gerasimovska Kitanovska; Gintere, Sandra; Gómez Bravo, Raquel; Hoffmann, Kathryn; Iftode, Claudia; Johansen, Kasper L; Kerse, Ngaire; Koskela, Tuomas H; Peštić, Sanda Kreitmayer; Kurpas, Donata; Mallen, Christian D; Maisoneuve, Hubert; Merlo, Christoph; Mueller, Yolanda; ... (2017). Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries. BMC Geriatrics, 17(1), p. 93. BioMed Central 10.1186/s12877-017-0486-4

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BACKGROUND In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent guidelines, mainly based on systolic blood pressure (SBP), cardiovascular disease (CVD) but not on frailty despite the high prevalence in oldest-old. This may lead to variation how General Practitioners (GPs) treat hypertension. Our aim was to investigate treatment variation of GPs in oldest-olds across countries and to identify the role of frailty in that decision. METHODS Using a survey, we compared treatment decisions in cases of oldest-old varying in SBP, CVD, and frailty. GPs were asked if they would start antihypertensive treatment in each case. In 2016, we invited GPs in Europe, Brazil, Israel, and New Zealand. We compared the percentage of cases that would be treated per countries. A logistic mixed-effects model was used to derive odds ratio (OR) for frailty with 95% confidence intervals (CI), adjusted for SBP, CVD, and GP characteristics (sex, location and prevalence of oldest-old per GP office, and years of experience). The mixed-effects model was used to account for the multiple assessments per GP. RESULTS The 29 countries yielded 2543 participating GPs: 52% were female, 51% located in a city, 71% reported a high prevalence of oldest-old in their offices, 38% and had >20 years of experience. Across countries, considerable variation was found in the decision to start antihypertensive treatment in the oldest-old ranging from 34 to 88%. In 24/29 (83%) countries, frailty was associated with GPs' decision not to start treatment even after adjustment for SBP, CVD, and GP characteristics (OR 0.53, 95%CI 0.48-0.59; ORs per country 0.11-1.78). CONCLUSIONS Across countries, we found considerable variation in starting antihypertensive medication in oldest-old. The frail oldest-old had an odds ratio of 0.53 of receiving antihypertensive treatment. Future hypertension trials should also include frail patients to acquire evidence on the efficacy of antihypertensive treatment in oldest-old patients with frailty, with the aim to get evidence-based data for clinical decision-making.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Streit, Sven and Rodondi, Nicolas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1471-2318

Publisher:

BioMed Central

Language:

English

Submitter:

Beatrice Minder Wyssmann

Date Deposited:

25 Apr 2017 10:39

Last Modified:

09 May 2017 11:47

Publisher DOI:

10.1186/s12877-017-0486-4

PubMed ID:

28427345

Additional Information:

Streit and Verschoor contributed equally to this work

Uncontrolled Keywords:

Clinical variation Elderly Frailty General practitioners Hypertension Oldest-old

BORIS DOI:

10.7892/boris.99457

URI:

https://boris.unibe.ch/id/eprint/99457

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