TY - JOUR
T1 - Hierarchical linear and logistic modeling of outcomes of antihypertensive treatment in elderly patients
T2 - Findings from the PREVIEW study
AU - Abraham, Ivo
AU - Demosthenes, Lynnette
AU - MacDonald, Karen
AU - Lee, Christopher S.
AU - Reel, Sally
AU - Brié, Heidi
AU - Hermans, Christine
AU - Vancayzeele, Stefaan
AU - Van der Niepen, Patricia
N1 - Funding Information:
The PREVIEW study was funded by Novartis Pharma. Editorial assistance was provided by Matthew Abraham and was supported by this funding. The research reported here was supported by grants from Novartis Pharma. Novartis co-authors participated in the design and implementation of the study, and had right of review of statistical analyses and results. They refrained from undue influence.
PY - 2010/7
Y1 - 2010/7
N2 - Achieving guideline-recommended blood pressure targets is difficult in older adults with hypertension. We completed a subgroup analysis of patients 65 years of age or older enrolled in PREVIEW, a prospective, multicenter, pharmacoepidemiological study of the determinants and outcomes of second-line antihypertensive treatment with valsartan in Belgium. Multilevel modeling was used to identify physician- and patient-level determinants of blood pressure values and practice guideline-derived definitions of blood pressure control. Data on 1560 patients and 504 physicians were used in this analysis. Blood pressure control rates for patients age 65 and over were lower for systolic (34.2% vs. 38.6%) and combined systolic/diastolic blood pressure (31.2% vs. 34.4%) compared to the entire PREVIEW sample. Twenty-seven percent of the variability in systolic, and 32% in diastolic pressure after 90 days of treatment were attributable to such variables as physicians' knowledge and adherence to evidence-based guidelines, practice patterns, and experience; with the remaining variance attributable to various demographic, behavioral, and clinical patient-related factors. Several independent predictors of uncontrolled blood pressure after 90 days of treatment were identified, largely confirming factors identified as determinants of blood pressure values. Recommendations for managing hypertension in the elderly are made in view of these findings.
AB - Achieving guideline-recommended blood pressure targets is difficult in older adults with hypertension. We completed a subgroup analysis of patients 65 years of age or older enrolled in PREVIEW, a prospective, multicenter, pharmacoepidemiological study of the determinants and outcomes of second-line antihypertensive treatment with valsartan in Belgium. Multilevel modeling was used to identify physician- and patient-level determinants of blood pressure values and practice guideline-derived definitions of blood pressure control. Data on 1560 patients and 504 physicians were used in this analysis. Blood pressure control rates for patients age 65 and over were lower for systolic (34.2% vs. 38.6%) and combined systolic/diastolic blood pressure (31.2% vs. 34.4%) compared to the entire PREVIEW sample. Twenty-seven percent of the variability in systolic, and 32% in diastolic pressure after 90 days of treatment were attributable to such variables as physicians' knowledge and adherence to evidence-based guidelines, practice patterns, and experience; with the remaining variance attributable to various demographic, behavioral, and clinical patient-related factors. Several independent predictors of uncontrolled blood pressure after 90 days of treatment were identified, largely confirming factors identified as determinants of blood pressure values. Recommendations for managing hypertension in the elderly are made in view of these findings.
KW - Angiotensin II receptor blocker
KW - Effectiveness of antihypertensive treatment with valsartan
KW - Outcomes of antihypertensive treatment with valsartan
KW - Pharmacoepidemiology in elderly
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U2 - 10.1016/j.archger.2009.07.009
DO - 10.1016/j.archger.2009.07.009
M3 - Article
C2 - 19716190
AN - SCOPUS:77953291995
SN - 0167-4943
VL - 51
SP - 45
EP - 53
JO - Archives of Gerontology and Geriatrics
JF - Archives of Gerontology and Geriatrics
IS - 1
ER -