The treatment of hypertension in care home residents: a systematic review of observational studies

Welsh, Tomas; Gladman, John R.F.; Gordon, Adam L.

Abstract

Aim: To describe the prevalence of hypertension in care home residents, its treatment, change in
treatment over time, and the achievement of blood pressure (BP) control.
Method: The PubMed, Cochrane, Embase, and PsychINFO databases were searched for observational
studies involving care home residents with a diagnosis of hypertension. The search was limited to
English language articles involving adults and humans published from 1990 onward. Abstracts and titles
were reviewed with eligible articles read in full. Bibliographies were examined for further relevant
studies. The final selection of studies was then analyzed and appraised.
Results: Sixteen articles were identified for analysis, of which half were studies carried out in the United
States. The prevalence of hypertension in care home residents was 35% (range 16%e71%); 72% of these
were on at least 1 antihypertensive (mean 1.5 antihypertensives per individual), with diuretics being the
most common. The prevalence of hypertension in study populations was greater in more recent studies
(P ¼ .004). ACEi/ARBs (P ¼ .001) and b-blockers (P ¼ .04) were prescribed more frequently in recent
studies, whereas use of calcium-channel blockers and diuretics remained unchanged over time. The
number of antihypertensives prescribed per patient was higher (correlation 0.332, P ¼ .009), whereas
fewer patients achieved target BP (correlation 0.671, P ¼ .099) in more recent studies.
Conclusion: Hypertension is common in care home residents and is commonly treated with antihypertensive
drugs, which were prescribed more frequently in more recent studies but with no better BP
control. These studies indicate a tendency toward increasing polypharmacy over time, with associated
risk of adverse events, without demonstrable benefit in terms of BP control.
Copyright 2014 - American Medical Directors

Citation

Welsh, T., Gladman, J. R., & Gordon, A. L. (2014). The treatment of hypertension in care home residents: a systematic review of observational studies. Journal of the American Medical Directors Association, 15(1), https://doi.org/10.1016/j.jamda.2013.06.012

• Journal Article Type: Article
• Publication Date: Jan 1, 2014
• Deposit Date: Apr 10, 2014
• Publicly Available Date: Apr 10, 2014
• Journal: Journal of the American Medical Directors Association
• Print ISSN: 1525-8610
• Electronic ISSN: 1525-8610
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 15
• Issue: 1
• DOI: https://doi.org/10.1016/j.jamda.2013.06.012
• Public URL: https://nottingham-repository.worktribe.com/output/997745
• Publisher URL: http://www.jamda.com/article/S1525-8610(13)00383-6/