Streit, S and Verschoor, M and Rodondi, N and Bonfim, D and Burman, RA and Collins, C and Biljana, GK and Gintere, S and Gómez Bravo, R and Hoffmann, K and Iftode, C and Johansen, KL and Kerse, N and Koskela, TH and Peštić, SK and Kurpas, D and Mallen, CD and Maisoneuve, H and Merlo, C and Mueller, Y and Muth, C and Šter, MP and Petrazzuoli, F and Rosemann, T and Sattler, M and Švadlenková, Z and Tatsioni, A and Thulesius, H and Tkachenko, V and Torzsa, P and Tsopra, R and Canan, T and Viegas, RPA and Vinker, S and de Waal, MWM and Zeller, A and Gussekloo, J and Poortvliet, RKE (2017) Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries. BMC Geriatrics, 17 (1). 93 -?. ISSN 1471-2318

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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.

Item Type: Article
Additional Information: This is the final published version of the article (version of record). It first appeared online via BioMed Central at http://dx.doi.org/10.1186/s12877-017-0486-4 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Hypertension, Oldest-old, Clinical variation, General practitioners, Frailty, Elderly
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Related URLs:
Depositing User: Symplectic
Date Deposited: 22 May 2017 11:14
Last Modified: 22 May 2017 11:15
URI: http://eprints.keele.ac.uk/id/eprint/3489

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