Isolated systolic hypertension in the elderly: results of a statewide survey of clinical practice in New Jersey.

ABSTRACT

UNLABELLED PURPOSE AND SUBJECTS AND METHODS: The advisability of treating isolated systolic hypertension (ISH) in the elderly is a matter of debate. We therefore surveyed current clinical practices for ISH among members of the New Jersey Academy of Family Physicians and the American College of Physicians-New Jersey Chapter (n = 1,514). To our knowledge, no such survey focusing on ISH had previously been reported. Two rounds of questionnaires were mailed three weeks apart in April and May of 1985, followed by a phone survey of non-respondents in June and July. A third mailing was performed where appropriate. RESULTS: The response rate was 87 percent. For ISH in patients aged 60 and older, 89 percent of the 1,318 respondents reported using drug therapy. A diuretic was chosen as the first-line drug by 67.5 percent of respondents. The most common second-line drug choices were a beta blocker (28 percent), a central alpha agonist (19 percent), and a diuretic (18.5 percent). The patient's age entered strongly into decisions on drug use. Although 55 percent of respondents would use drug therapy at a systolic blood pressure of 160 mm Hg or less for persons aged 60 to 69, only 35 percent would do so for persons aged 70 to 79, and 26 percent for persons aged 80 and older. For all patient age groups, older physicians were more likely to consider drug therapy than were younger physicians. Among specialty groups, general practitioners were the most likely to consider drug therapy and cardiologists the least likely to do so for all patient age groups. Family physicians and general internists appeared to have very similar practice patterns regarding definition and treatment of ISH. CONCLUSION: The overall message of the survey results is that the majority of physicians questioned use drug therapy, usually a diuretic or a beta blocker, for some patients with ISH. However, no widely accepted standard practice on the definition and management of ISH in persons aged 60 and older was observed.