TY  - JOUR
A1  - Streit, Sven
A1  - Verschoor, Marjolein
A1  - Rodond, Nicolas
A1  - Bonfim, Daiana
A1  - Burman, Robert Anders
A1  - Collins, Claire
A1  - Gerasimovska Kitanovska, Biljana
A1  - Gintere, Sandra
A1  - Gómez Bravo, Raquel
A1  - Hoffmann, Kathryn
A1  - Iftode, Claudia
A1  - Johansen, Kasper
A1  - Kerse, Ngaire
A1  - Koskela, Tuomas H.
A1  - Kreitmayer Peštić, Sanda
A1  - Kurpas, Donata
A1  - Mallen, Christian David
A1  - Maisoneuve, Hubert
A1  - Merlo, Christoph
A1  - Müller, Yolanda
A1  - Muth, Christiane
A1  - Šter, Marija Petek
A1  - Petrazzuoli, Ferdinando
A1  - Rosemann, Thomas
A1  - Sattler, Martin
A1  - Švadlenková, Zuzana
A1  - Tatsioni, Athina
A1  - Thulesius, Hans
A1  - Tkachenko, Victoria
A1  - Torzsa, Peter
A1  - Tsopra, Rosy
A1  - Canan, Tuz
A1  - Viegas, Rita P. A.
A1  - Vinker, Shlomo
A1  - Margot W. M. de, Waal
A1  - Zeller, Andreas
A1  - Gussekloo, Jacobijn
A1  - Poortvliet, Rosalinde K. E.
T1  - Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries
T2  - BMC geriatrics
N2  - 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.
KW  - Hypertension
KW  - Oldest-old
KW  - Clinical variation
KW  - General practitioners
KW  - Frailty
KW  - Elderly
Y1  - 2017
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/44118
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-441182
SN  - 1471-2318
N1  - © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated
VL  - 17
IS  - 1, Art. 93
SP  - 1
EP  - 7
PB  - BioMed Central
CY  - London
ER  -