Dataset Information

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

ABSTRACT:

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.

SUBMITTER: Streit S

PROVIDER: S-EPMC5399328 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Publications

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

Streit Sven S Verschoor Marjolein M Rodondi Nicolas N Bonfim Daiana D Burman Robert A RA Collins Claire C Biljana Gerasimovska Kitanovska GK Gintere Sandra S Gómez Bravo Raquel R Hoffmann Kathryn K Iftode Claudia C Johansen Kasper L KL Kerse Ngaire N Koskela Tuomas H TH Peštić Sanda Kreitmayer SK Kurpas Donata D Mallen Christian D CD Maisoneuve Hubert H Merlo Christoph C Mueller Yolanda Y Muth Christiane C Šter Marija Petek MP Petrazzuoli Ferdinando F Rosemann Thomas T Sattler Martin M Švadlenková Zuzana Z Tatsioni Athina A Thulesius Hans H Tkachenko Victoria V Torzsa Peter P Tsopra Rosy R Canan Tuz T Viegas Rita P A RPA Vinker Shlomo S de Waal Margot W M MWM Zeller Andreas A Gussekloo Jacobijn J Poortvliet Rosalinde K E RKE

BMC geriatrics 20170420 1

<h4>Background</h4>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-o ...[more]

PMID: 28427345

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Project description:BACKGROUND:Recent findings suggest that Alzheimer's disease (AD) neuropathological features (neuritic plaques and NFTs) are not strongly associated with dementia in extreme old (over 90 years of age) and compel a search for neurobiological indices of dementia in this rapidly growing segment of the elderly population. We sought to characterize transcriptional and protein profiles of dementia in the oldest-old. METHODS AND FINDINGS:Gene and protein expression changes relative to non-demented age-matched controls were assessed by two microarray platforms, qPCR and Western blot in different regions of the brains of oldest-old and younger old persons who died at mild or severe stages of dementia. Our results indicate that: i) consistent with recent neuropathological findings, gene expression changes associated with cognitive impairment in oldest-old persons are distinct from those in cognitively impaired youngest-old persons; ii) transcripts affected in young-old subjects with dementia participate in biological pathways related to synaptic function and neurotransmission while transcripts affected in oldest-old subjects with dementia are associated with immune/inflammatory function; iii) upregulation of immune response genes in cognitively intact oldest-old subjects and their subsequent downregulation in dementia suggests a potential protective role of the brain immune-associated system against dementia in the oldest-old; iv) consistent with gene expression profiles, protein expression of several selected genes associated with the inflammatory/immune system in inferior temporal cortex is significantly increased in cognitively intact oldest-old persons relative to cognitively intact young-old persons, but impaired in cognitively compromised oldest-old persons relative to cognitively intact oldest-old controls. CONCLUSIONS:These results suggest that disruption of the robust immune homeostasis that is characteristic of oldest-old individuals who avoided dementia may be directly associated with dementia in the oldest-old and contrast with the synaptic and neurotransmitter system failures that typify dementia in younger old persons.

Dataset Information

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

Background

Methods

Results

Conclusions

Publications

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

Similar Datasets

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