Changes in antihypertensive treatment in the elderly during the 1980s: The gap between research findings and general practice

Objective and design To assess the development of anti hypertensive therapy th rough the 1980s in a sample of elderly outpatient followed prospectively from 1983 to 1988 by Italian general practitioners, in order to highlight the main changes in antihypertensive treatment in general practice while the results of the first specific trials on the efficacy of treating hypertension in the elderly and new antihypertensive drugs were becoming available. Results A total of 205 general practitioners enrolled a random sample of 1907 outpatients aged 65 years or older (44.2% men, mean age 72.7 +/- 4.8 years), Of the 1246 subjects who completed the 5-year follow-up, 849 (68.1%) had high blood pressure (greater than or equal to 160/90 mmHg) or were prescribed antihypertensive drugs at the baseline assessment and 888 (71.3%) at year 5 of follow-up. Hypertensive patients were only slightly more frequently treated in 1988 than 1983 (79.4 versus 75.9%), The prevalence of treated hypertensives whose condition was well controlled by treatment (blood pressure < 160/90 mmHg) did not change significantly after 5 years and was still disappointingly low in 1988 (30.8% in 1983, 33.0% in 1988), In 1983 and 1988 diuretics were the first-choice drug, although their usage had slightly decreased in 1988 (85.1% of treated hypertensives in 1983 versus 71.6% in 1988). However, calcium antagonists and angiotensin converting enzyme (ACE) inhibitors, prescribed to only 1.7 and 1.2%, respectively, in 1983, were the antihypertensive drugs mast used after diuretics in 1988 (24.8 and 19.0%, respectively) and replaced the older drugs (central adrenergic inhibitors and adrenergic neuron blockers), Conclusions Our study suggests that the positive results of the first trials on the efficacy of antihypertensive treatment in the elderly had marginal epidemiological impact, In the meantime, new drugs, such as calcium antagonists and ACE inhibitors, appear to have replaced the 'old' therapies without really contributing to better control of hypertension.