Risk Factors in Optimal Management of Hypertension in Elderly Patients Following 2017 American College of Cardiology-American Heart Association Guidelines

Introduction/objectives: The 2017 American Heart Association hypertension management guidelines recommended optimal control of blood pressure under 130/80 mmHg. We aimed to study the factors associated with suboptimal and uncontrolled hypertension in the elderly patients.

Methods: We performed a retrospective review of suburban outpatient records of patients with hypertension, aged 65 years and older, and grouped into optimally controlled (OC; BP <130/80 mmHg), sub-optimally controlled (SOC; BP 130-139/80-89 mmHg), and uncontrolled (UC; BP≥140/90 mmHg) groups; and compared the associations of variables.

Results: Among 1311 patients, there were 610 (46.5%) patients in OC, 391 (29.9%) in SOC, and 310 (23.6%) in UC groups. Mean ages were comparable (OC = 78 ± 8.1, SOC = 77 ± 7.4, UC = 78 ± 7.3 years; P = .760). In all groups, the majority of patients were White followed by BIPOC (Black-indigenous-and-other-people-of-color; OC = 78.5% vs 21.5%, SOC = 78.3% vs 21.7%, and UC = 71% vs 29%, respectively). There were more BIPOC patients in UC compared to OC group (29.0% vs 21.5%; P = .011). Mean body-mass-index (BMI) of patients in SOC and UC groups were greater than OC group (27.9 ± 6.3 vs 26.9 ± 6.3 kg/m²; P = .047; 28.1 ± 6.3 vs 26.9 ± 6.3 kg/m2; P = .027; respectively). There were significantly higher associations of certain comorbidities in SOC compared to OC group, such as transient ischemic attack (12.3% vs 3.6%; P < .001), hyperlipidemia (72.4% vs 56.2%; P < .001), atrial fibrillation (19.2% vs 11%; P < .001), HFpEF (5.4% vs 1.5%; P < .001), osteoarthritis (38.9% vs 30.5%; P = .006), malignancy (32.2% vs 19.5%; P < .001), and left ventricular hypertrophy (LVH; 27.4% vs 15.9%; P < .001). Logistic regression analysis showed that when compared to BIPOC, White race had lower odds of UC (OR = 0.63, 95% CI = 0.45-0.90). For every unit increase in BMI, there were greater odds of SOC (OR = 1.04, 95% CI = 1.01-1.06) and UC (OR = 1.04, 95% CI = 1.01-1.16). Patients with hyperlipidemia and LVH had greater odds of SOC (OR = 1.72, CI = 95% 1.25-2.37; and OR = 2.13, 95% CI = 1.02-4.43; respectively).

Conclusion: In patients with sub-optimal and uncontrolled hypertension, there is a significantly higher association of BIPOC race, elevated BMI, hyperlipidemia, and left ventricular hypertrophy.