PREVALENCE, AWARENESS, TREATMENT AND CONTROL OF HYPERTENSION IN A POPULATION OVER THE AGE OF 65 YEARS - RESULTS FROM THE STARNBERG STUDY ON EPIDEMIOLOGY OF PARKINSONISM AND HYPERTENSION IN THE ELDERLY (STEPHY)

Objective: To assess the prevalence of hypertension and isolated systolic hypertension and the level of awareness, treatment and control of hypertension, in a population aged over 65 years. Design: Cross-sectional survey of the total population aged greater than or equal to 65 years of two Bavarian villages with a representative age distribution. Patients: From a total of 1190 inhabitants aged greater than or equal to 65 years, 982 (394 male, 588 female) participated (response rate 82.5%). Methods: All of the participants were visited at home by physician observers. After a standardized questionnaire, blood pressure was measured three times on one occasion with the subject in the sitting position, using a standard mercury sphygmomanometer. 'Actual' hypertension was defined as systolic blood pressure (SBP) greater than or equal to 160 or diastolic blood pressure (DBP) greater than or equal to 95 mmHg, or both, or current use of antihypertensive drugs given for the indication hypertension in patients with blood pressure <160/95 mmHg. Isolated systolic hypertension was defined as SBP greater than or equal to 160 and DBP <90 mmHg. All 'actual' hypertensives were further classified as 'unaware' of hypertension, 'aware' (but not treated),'treated' (current use of antihypertensive drugs for the indication hypertension and blood pressure greater than or equal to 160/95 mmHg) or 'controlled' (treated and blood pressure <160/95 mmHg). Results: Mean +/- SD blood pressure was 154.5 +/- 24.4/84.9 +/- 11.6 mmHg (when 52 institutionalized participants were excluded, 155.6 +/- 24.4/85.3 +/- 11.6 mmHg). The SBP was significantly higher in females than in males and increased up to the age group 80-84 years both in males and in females. The DBP decreased with age. The prevalence of 'actual' hypertension was 53% and increased up to the age group 75-79 years in males and 80-84 years in females. The prevalence of isolated systolic hypertension was 17% (with patients currently using antihypertensive drugs excluded). Of the patients with 'actual' hypertension, 34% were 'unaware' of the diagnosis, 12% 'aware', 32% 'treated' and 22% 'controlled'. Conclusions: In central Europe hypertension, with a prevalence of >50%, remains the most common cardiovascular risk factor in the elderly. Although most elderly hypertensives are currently treated with antihypertensive agents, less than one-quarter are controlled, and more than one-third are still unaware of the diagnosis. These levels of awareness and control call for better strategies in the diagnosis and treatment of hypertension in the elderly.