What is it about?
There is uncertainty what is the best way to manage hypertension in oldest old. This could lead to a clinical variation in General Practitioners (GPs) when facing patients older than 80 years with an elevated blood pressure. We used case vignettes of oldest-old differing in level of blood pressure, cardiovascular history and frailty and asked >2000 GPs in 29 countries in Europe, Brazil, Israel and New Zealand to decide if they would start antihypertensive treatment. We found a large variation across countries but independently, in frail patients, GPs mostly favored no treatment.
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Why is it important?
This calls for high-quality cohort studies or (ideally) new hypertension trials specif- ically including frail patients to acquire evidence as to whether frailty is indeed an important factor when treating hypertension in oldest-old patients. Also future studies should investigate whether treatment variation might be explained by e.g. the recommendations in guidelines that individual GPs follow. Finally, future hypertension guidelines should stratify their recommendations not only for age, blood pressure level and cardiovascular comorbid- ity, but also for frailty.
Perspectives
This project provided a unique opportunity to collaborate with colleagues across almost 30 countries to answer a question that is important to all of us GPs. I am deeply grateful to all the support I have received to conduct this study and specifically want to thank each GP that participated.
Professor Sven Streit
Institute of Primary Health Care (BIHAM), University of Bern
Read the Original
This page is a summary of: Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries, BMC Geriatrics, April 2017, Springer Science + Business Media,
DOI: 10.1186/s12877-017-0486-4.
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