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- Title
A nagyon idős és esendő állapotú betegek antihipertenzív kezelésének gyakorlata az alapellátásban.
- Authors
PÉTER, TORZSA; LÁSZLÓ, KALABAY; DALMA, CSATLÓS; CSENGE, HARGITTAY; BERNADETT, MÁRKUS; ANDRÁS, MOHOS; MÁTYÁS, SZIGETI; TAMÁS, FERENCI; VERSCHOOR, MARJOLEIN; ROZSNYAI, ZSÓFIA; GUSSEKLOO, JACOBIJN; POORTVLIET, ROSALINDE K. E.; STREIT, SVEN
- Abstract
BACKGROUND - When treating very elderly and frail hypertensive patients, there have to be taken in account the general health condition and frailty of patients, the present cardiovascular diseases (CVD) and values of the systolic blood pressure (SBP). GOALS - In a clinical study performed in 29 countries, we aimed to analyse differences in practical antihypertensive therapy of family doctors among patients older than 80 years; further we sought to answer how much was influenced their therapeutic choice by frailty of the old age. The other goal of our study was to compare Hungarian versus international outcomes. METHODOLOGY - As part of an online survey, family practitioners had to decide about necessity of starting antihypertensive treatment among very elderly patients according to different patterns of frailty, SBP and CVD. The ratio of specific cases with positive treatment decision of family practitioners was compared in all 29 countries. We used a logistic mixed model analysis to multivariately model the role of frailty. RESULTS - 2543 family practitioners participated in the cross-national study; 52% were female; 51% practised in urban environment. In 61% of practices, there was the ratio higher than 10% of very elderly patients. Hungary participated with 247 family practitioners in the study; 52.3% were female; 63.1% practised in urban environment. In 48.8% of practices the ratio of very elderly patients was higher than 10%. In 24 out of the 29 countries (83%), frailty was associated with GPs' negative decision about starting treatment even after adjustment for SBP, CVD, and GP characteristics (odds ratio [OR 0.53]), 95% CI: 0.48-0.59; ORs per country 0.11-1.78). The lowest treatment ratio was in the Netherlands (34.2%; 95% CI: 32.0-36.5%) and the highest one in Ukraine (88.3%; 95% CI: 85.3-90.9%). In Hungary's treatment ratio ranged 50-59%. This country ranked on the 27th place since Hungarian family practitioners chose rather to start antihypertensive treatment despite the frailty of the patient (OR=1.16; 95% CI: 0.85-1.59). Hungarian family practitioners started pharmacotherapy of elderly patients more frequently if they were males (OR= 1.45; 95% CI: 0.81-2.61), were working in their practice for less than 5 years (OR=2.41; 94% CI: 0.51-11.38), and if they had many patients aged over 80 years in their practice (OR=2.18; 95% CI: 0.70-6.80), however these differences were statistically not significant. Among Hungarian family practitioners starting therapy was significantly influenced by cardiovascular disease (OR=3.71; 95% CI: 2.64-5.23) and a SBP over 160 mmHg (OR=190.39; 95% CI: 106.83-339.28). CONCLUSIONS - In our study, there was significant difference between countries in starting antihypertensive treatment for very elderly patients. However, Hungary was among the countries where family practitioners preferred to treat their frail patients. The patients' frailty did not have any impact on starting the therapy; rather cardiovascular disease and a SBP over 160 mmHg decided. It is an important message of the study that there is continuous need to educate family practitioners and trainees about the treatment of frail, elderly hypertensive patients.
- Subjects
HUNGARY; BLOOD pressure; CARDIOVASCULAR diseases; CONFIDENCE intervals; FRAIL elderly; HEALTH status indicators; HYPERTENSION; ANTIHYPERTENSIVE agents; QUESTIONNAIRES; SEX distribution; DECISION making in clinical medicine; PHYSICIAN practice patterns; WORK experience (Employment); DESCRIPTIVE statistics; ODDS ratio; OLD age
- Publication
Lege Artis Medicine (LAM), 2020, Vol 30, Issue 3, p111
- ISSN
0866-4811
- Publication type
Article
- DOI
10.33616/lam.30.011