Special articleHypertension guidelines in elderly patients: is anybody listening?☆
Section snippets
Data sources
The Ontario Drug Benefit database was used to identify all elderly residents in Ontario who were newly placed on antihypertensive medication for the treatment of hypertension. All Ontario residents aged 65 years or older receive universal outpatient drug coverage from a minimally restrictive formulary. Potential contraindications and comorbid conditions in these patients were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes
Results
Of the more than 1.2 million elderly people aged 66 years or older in Ontario from January 1, 1993, to December 31, 1998, a total of 179,189 (>12%) were prescribed an antihypertensive medication for the first time for uncomplicated hypertension (approximately 30,000 patients per year).
Discussion
We had a unique opportunity to examine temporal trends in the initial prescribing patterns for elderly patients with hypertension in Ontario, Canada, before and after an extensive effort by the Ministry of Health to increase the use of low-cost diuretic agents and beta-blockers through province-wide dissemination of simplified, user-friendly guidelines. Although diuretic agents were the most commonly prescribed, we found very little change in the proportion of patients who received these
Acknowledgements
We would like to thank Dr. Andreas Laupacis, Dr. Dave Davis, and Dr. Finlay McAlister for their review of this manuscript, Jang Yun for data programming, and Dr. Malcolm Maclure and Dr. Colin Dormuth for providing us with data from British Columbia.
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Cardiovascular Health Awareness Program (CHAP): A community cluster-randomised trial among elderly Canadians
2008, Preventive MedicineCitation Excerpt :Table 4 summarizes the validation studies of the primary outcome measure derived from these databases. Secondary outcome measures include mortality due to CVD and coronary artery disease (CAD), and all-cause mortality; hospitalisations for stroke and CAD; differences in rates of initiation of antihypertensive drug therapy (Tu et al., 2002); differences in rates of hypertension drug treatment (one antihypertensive drug versus polytherapy) (Campbell et al., 2007); and health service utilisation and cost-benefit analysis (Drummond et al., 2005). The sample size was fixed, as there were only 39 Ontario communities of 10,000 to 60,000 residents that met our eligibility criteria.
The Canadian Hypertension Education Program - A unique Canadian initiative
2006, Canadian Journal of CardiologyA multicenter, case-control study of the effects of antihypertensive therapy on orthostatic hypotension, postprandial hypotension, and falls in octo- and nonagenarians in residential care facilities
2003, Current Therapeutic Research - Clinical and ExperimentalImpact of ethnic-specific guidelines for anti-hypertensive prescribing in primary care in England: A longitudinal study
2014, BMC Health Services ResearchPartnership for excellence: Medicine at the university of Toronto and academic hospitals
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Supported by a grant from the Ontario Program for Optimal Therapeutics, Hamilton, Ontario, Canada. Jack V. Tu, MD, PhD, is supported by a Canada Research Chair in Health Services Research.