Predicting Systolic BP Control in the Elderly

Project: Research project

Description

NHANES III data show that fewer than 30% of patients who are hypertensive have
been treated to the goal blood pressure of less than 140/90 mm Hg. Older
patients are more likely to have uncontrolled blood pressure than are younger
patients. The SHIELD Study revealed that 41% of people over the age of 65
years and 65% of African Americans over that age have poorly controlled
hypertension. Poor blood pressure control also disproportionately
causes cardiovascular disease in patient over 60. Systolic blood pressure is
the primary predictor in this age group for the development of stroke,
congestive heat failure (most common reason for hospitalization in the
elderly), renal failure and coronary heart disease. There is even exciting new
data showing that control of systolic blood pressure in the elderly reduces
the risk for the development of Alzheimer?s dementia. Failure to achieve blood
pressure control is determined by three factors: physician practice
(behavior), antihypertensive medication efficacy, and adherence to the
prescribed medications (patient factors). Our study proposes to develop models
that describe each of these factors independently and then develop a model
that encompasses all three factors. Specific Aim 1 will identify and quantify
differences in physician response to elevated systolic blood pressure in
hypertensive patients greater than 60 years of age compared to their younger
counterparts. Specific Aim 2 will analyze the differences in responsiveness of
systolic blood pressure to treatment regimens using one or more
antihypertensive medications. Specific Aim 3 examines adherence and postulates
that adherence is the same between younger and older hypertensives. This study
is to be conducted using a unique clinical database. Over 7,000 patients with
more than 25,000 observations are present in the Mayo Clinic Rochester
Hypertension Continuity Clinic Database. This Sybase database is well
constructed to answer the important questions posed in Aims 1-3 regarding the
management of hypertension. This study will provide significant and
generalizable answers to the question of why control rates for systolic
hypertension remain low and will provide direction for altering clinical
practice to reduce cardiovascular morbidity and mortality among older
hypertensives.
StatusFinished
Effective start/end date9/1/028/31/05

Funding

  • National Institutes of Health: $72,250.00
  • National Institutes of Health: $72,250.00

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Blood Pressure
Databases
Heat Stroke
Physicians
Medication Adherence
Nutrition Surveys
African Americans
Antihypertensive Agents
Renal Insufficiency
Coronary Disease
Dementia
Hospitalization
Cardiovascular Diseases
Age Groups
Hypertension
Morbidity
Mortality

ASJC

  • Medicine(all)