gms | German Medical Science

15. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

20.11. - 21.11.2008, Bonn

Assessment of pharmacotherapy and evaluation of blood pressure control in patients above age 65 with hypertension in German primary care: Results of the DETECT study

Medikamentöse Therapie der Hypertonie älterer Patienten mit dem DETECT-Datensatz

Meeting Abstract

  • corresponding author Alexander Labeit - Klinische Pharmakologie Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Germany
  • Jens Klotsche - Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Germany
  • Lars Pieper - Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Germany
  • Martin Wehling - Klinische Pharmakologie Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Germany
  • Hans-Ulrich Wittchen - Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 15. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Bonn, 20.-21.11.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. Doc08gaa03

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/gaa2008/08gaa03.shtml

Veröffentlicht: 6. November 2008

© 2008 Labeit et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background and aim: Hypertension has an estimated prevalence of 60%-75% for individuals above age 65 in Germany. The first aim was the assessment of pharmacotherapy and evaluation of blood pressure control in elderly hypertensives in German primary care practices. The second aim was to determine differences in prescribing behaviour of antihypertensive agents for hypertensive patients above and under age 65.

Material and method: DETECT (‘Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment’; http://www.detect-studie.de) is a large-scale, nationally representative, cross-sectional clinical-epidemiological study with a prospective-longitudinal component in primary care. Based on a sample of 3,188 physicians and over 55,519 patients the clinical and therapeutic profiles were evaluated. As part of the assessment, prevalence of hypertension, comorbid disease, risk factors and medication were recorded by primary care physicians.

Results: Hypertension was diagnosed by physicians in 60.6% of these patients. 20.2 % of these patients also had diabetes mellitus, 52.0% dyslipidemia, 18.9% coronary heart disease. 40.4% of patients had blood pressure levels above 140/90 mmHg. 93.6% of hypertensive patients received antihypertensive medication (31.7% monotherapy, 61.9% combination therapy). Significant positive predictors of antihypertensive medication were age (odds ratio (OR) 1.03, 95%-confidence interval (CI) 1.02-1.03), BMI above 25 kg/m² (OR 1.22, 95%-CI 1.06-1.40), physical activity (OR 1.16, 95%-CI 1.03-1.31), coronary heart disease (OR 1.36, 95%-CI 1.12-1.65) and previous myocardial infarction (OR 2.28, 95%-CI 1.55-3.37). Significant negative predictors of antihypertensive medication were positive smoking status (OR 0.75, 95%-CI 0.65-0.87). Sex, dyslipidemia and diabetes mellitus had no significant influence on receiving antihypertensive medication. Positive predictors of inadequate blood pressure control (≥ 130/85 mmHg) were age (OR 1.02, 95%-CI 1.01-1.02), male sex (OR 1.19, 95%-CI 1.08-1.30) and BMI above 25 kg/m² (OR 1.42, 95%-CI 1.28-1.57). Negative predictors were coronary heart disease (OR 0.66, 95%-CI 0.59-0.75), and previous myocardial infarction (OR 0.62, 95%-CI 0.52-0.74). Smoking status, physical activity, dyslipidemia, diabetes mellitus and antihypertensive medication had no significant association with blood pressure control. There was a statistically positive association between age above 65 and prescription of calcium-channel blockers (adjusted OR 1.64, 95%-CI 1.52-1.78), diuretics (ad. OR 1.61, 95%-CI 1.50-1.73) and ACE-Inhibitors (ad. OR 1.37, 95%-CI 1.28-1.47) and there was a negative association for Beta-Blockers (ad. OR 0.74, 95%-CI 0.70-0.80). There was no association for AT1-antagonists.

Conclusion: In elderly hypertensives, only certain risk factors such as coronary heart disease and previous myocardial infarction, but not diabetes mellitus or dyslipidemia were positively associated with antihypertensive medication and adequate blood pressure control. As latter risk factors are not less severe in negative outcome prediction than the former ones, it is concluded that the awareness for diabetes and dyslipidemia in an overall risk assessment needs to be increased to more consistently trigger adequate therapeutic responses in regard to hypertension. Also patients above age 65 were getting a different antihypertensive medication than younger patients with an increased usage of calcium-channel blockers, diuretics and ACE-Inhibitors.