Hypertension management and control among English adults aged 65 years and older in 2000 and 2001.

Objective: To describe blood pressures, and hypertension and its management among older people.

Design: Two combined annual cross-sectional surveys.

Setting: England 2000 and 2001.

Participants: Nationally-representative sample of 3513 non-institutionalized people aged more than 64 years (elderly).

Main Outcome Measures: (1). Use of antihypertensive agents, and hypertension according to two definitions: receiving blood pressure decreasing treatment, or either: systolic blood pressure > or= 160 mmHg or diastolic blood pressure > or= 90 mmHg (old); or systolic blood pressure > or= 140 mmHg or diastolic blood pressure > or=90 mmHg (new). (2). Rates of treatment and control (old: < 160/90 mmHg; new: < 140/85 mmHg). (3). Isolated systolic hypertension stage 1 (systolic blood pressure > or= 140-159 mmHg and diastolic blood pressure < 90 mmHg), or stage 2 (systolic blood pressure > or= 160 mmHg and diastolic blood pressure < 90 mmHg).

Results: In 2000/2001, 62 and 81% of elderly adults were hypertensive according to the old and new definitions, respectively. Among those with hypertension (new definition) treatment and control rates were 56 and 19% (control rates among those treated were 36% in men and 30% in women). Of those treated, 54% were receiving one drug, 35% were receiving two, and 10% were receiving three or more drugs. Among untreated hypertensive individuals, 23% had increased systolic and diastolic pressures, 76% had isolated systolic hypertension and 1% had isolated diastolic hypertension.

Conclusions: These data suggest that, according to current guidelines more than 67% of older English adults should receive antihypertensive medication. To pre-empt this situation, population-based strategies to reduce the current rate of increase in blood pressure throughout adult life should be urgently implemented. Only then will the current epidemic of hypertension among the elderly, with the huge cost associated with its management and adverse cardiovascular sequelae, be averted.