ArticleBMC geriatrics2017
Variation in GP decisions on antihypertensive treatment in oldest-old and frail individuals across 29 countries.
Article in BMC geriatrics, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 170 citations in OpenAlex.
- Recommendations for (Discontinuation of) Statin Treatment in Older Adults: Review of Guidelines.Journal of the American Geriatrics Society · 2020Pooled it
- Hypertension management in the oldest-old: a survey of physicians in Swedish primary health care.Scandinavian journal of primary health care · 2026Article
- Prescriptions of Essentially Placebo Treatments Among General Practitioners in 21 Countries.JAMA network open · 2025Article
- Evaluation of deprescription by general practitioners in elderly people with different levels of dependence: cross-sectional study.BMC primary care · 2024Article
- Therapeutic inertia.Australian prescriber · 2024Review
- Factors influencing blood pressure control in patients with atrial fibrillation and hypertension in Australian primary care.Heart (British Cardiac Society) · 2023Article
- Article
- Atrial fibrillation incidence and outcomes in two cohorts of octogenarians: LiLACS NZ.BMC geriatrics · 2023Article
- Hypertension treatment in the oldest-old: focus group interviews with Swedish general practitioners.Scandinavian journal of primary health care · 2022Article
- Assessment of the appropriateness of cardiovascular preventive medication in older people: using the RAND/UCLA Appropriateness Method.BMC geriatrics · 2022Article
- General practitioners' deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries.BMC geriatrics · 2021Article
- Managing hypertension in frail oldest-old-The role of guideline use by general practitioners from 29 countries.PloS one · 2020Article
- Patient Characteristics and General Practitioners' Advice to Stop Statins in Oldest-Old Patients: a Survey Study Across 30 Countries.Journal of general internal medicine · 2019Article
- Article
- Hypertension management: experiences, wishes and concerns among older people-a qualitative study.BMJ open · 2019Article
- Challenges for clinical practice and research in family medicine in reducing the risk of chronic diseases. Notes on the EGPRN Spring Conference 2017 in Riga.The European journal of general practice · 2018Article
- How general practitioners would deprescribe in frail oldest-old with polypharmacy - the LESS study.BMC family practice · 2018Article
- Prescribing and deprescribing antihypertensive medication in older people by Dutch general practitioners: a qualitative study.BMJ open · 2018Article
- Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old.Scandinavian journal of primary health care · 2018Article
- Medicine Availability and Prescribing Policy for Non-Communicable Diseases in the Western Balkan Countries.Frontiers in public health · 2017Article
Corrections and comments
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Authors and funding
38 authors at 20 institutions in 24 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent guidelines, mainly based on systolic blood pressure (SBP), cardiovascular disease (CVD) but not on frailty despite the high prevalence in oldest-old. This may lead to variation how General Practitioners (GPs) treat hypertension. Our aim was to investigate treatment variation of GPs in oldest-olds across countries and to identify the role of frailty in that decision.
methodsUsing a survey, we compared treatment decisions in cases of oldest-old varying in SBP, CVD, and frailty. GPs were asked if they would start antihypertensive treatment in each case. In 2016, we invited GPs in Europe, Brazil, Israel, and New Zealand. We compared the percentage of cases that would be treated per countries. A logistic mixed-effects model was used to derive odds ratio (OR) for frailty with 95% confidence intervals (CI), adjusted for SBP, CVD, and GP characteristics (sex, location and prevalence of oldest-old per GP office, and years of experience). The mixed-effects model was used to account for the multiple assessments per GP.
resultsThe 29 countries yielded 2543 participating GPs: 52% were female, 51% located in a city, 71% reported a high prevalence of oldest-old in their offices, 38% and had >20 years of experience. Across countries, considerable variation was found in the decision to start antihypertensive treatment in the oldest-old ranging from 34 to 88%. In 24/29 (83%) countries, frailty was associated with GPs' decision not to start treatment even after adjustment for SBP, CVD, and GP characteristics (OR 0.53, 95%CI 0.48-0.59; ORs per country 0.11-1.78).
conclusionsAcross countries, we found considerable variation in starting antihypertensive medication in oldest-old. The frail oldest-old had an odds ratio of 0.53 of receiving antihypertensive treatment. Future hypertension trials should also include frail patients to acquire evidence on the efficacy of antihypertensive treatment in oldest-old patients with frailty, with the aim to get evidence-based data for clinical decision-making.
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