Treating hypertension in elderly patients with frailty offers survival benefit

  • Rea F & al.
  • Hypertension
  • 8 Jun 2020

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Elderly patients with hypertension who stick to their antihypertensive medication regimen may see a survival benefit even if they also have frailty.
  • Patients with good clinical status fare even better, however.

Why this matters

  • Although a benefit with good clinical status likely was predictable, the (lesser) benefit for patients with frailty may be a green light for encouraging adherence in this population.

Key results

  • Clinical status tracked with mortality probability during 7 years:
    • 16% with good status vs
    • 64% with very poor status.
  • The all-cause mortality difference between high adherence (>75% of the time) and low adherence (
  • Good: −44%.
  • Medium: −43%.
  • Poor: −40%.
  • Very poor: −33%.
  • Ptrend=.046.
  • Even patients with very poor clinical status had better survival with greater adherence, however.
    • ORs (95% CIs) for all-cause mortality with >75% adherence, by clinical status:
      • Good: 0.56 (0.53-0.60).
      • Medium: 0.57 (0.54-0.60).
      • Poor: 0.60 (0.58-0.62).
      • Very poor: 0.67 (0.63-0.72).
  • The pattern for cardiovascular mortality was similar.
  • Study design

    • Data from Lombardy Region of Italy database covering 1,283,602 residents age ≥65 (mean age, 76) years with ≥3 antihypertensive prescriptions, 2011-2012.
    • Funding: Italian Ministry of Education, University and Research; Italian Ministry of Health.

    Limitations

    • Based on database prescription information.
    • Some confounding possible, e.g., from “health-seeking behavior” bias among healthier, more adherent patients.