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Hypertension magnitude and management in the elderly population of Spain

Banegas, José Ra; Rodríguez-Artalejo, Fernandoa; Ruilope, Luis Mb; Graciani, Auxiliadoraa; Luque, Manuelc; de la Cruz-Troca, Juan Ja; García-Robles, Rafaeld; Tamargo, Juane; Rey-Calero, Juana

Original Papers: Epidemiology

Objective : The present study assessed the prevalence, awareness, treatment and control of hypertension among the elderly population of Spain.

Design : Based on a nationally representative sample of 4009 individuals aged 60 years, two sets of six blood pressure measurements were obtained by trained observers at each subject's home, using standardized methods. In each set, three mercury-based measurements were alternated with three automated measurements.

Results : The mean systolic blood pressure (SBP)/diastolic blood pressure (DBP) was 143/79 mmHg, and the pulse pressure was 64 mmHg. The prevalence rate of hypertension (SBP 140 mmHg, DBP 90 mmHg, or current drug treatment) was 68.3%. No result obtained was sensitive to a particular measurement device. Of the hypertensives, 65% were aware of their condition, 55.3% were treated and 16.3% were controlled. Among treated hypertensives, SBP control (32.2%) was much lower than DBP control (82.3%). Control was lower in men than in women, in older than in younger subjects, and in those with lowest than in those with higher educational levels. About 57% of uncontrolled treated hypertensives were on monotherapy. Weight loss was among the least heeded items of advice (39% among overweight hypertensives).

Conclusions : Hypertension is a major public health problem in elderly Spaniards. Most hypertensives had their hypertension uncontrolled. Greater emphasis should be laid on the most disadvantaged (the older, men, and those with lowest education) in terms of hypertension management, and on reinforcing weight loss and combining drugs for enhanced hypertension control.

aDepartment of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain, bHypertension Unit, Doce de Octubre Hospital, Madrid, Spain, cHypertension Unit, San Carlos Hospital, Madrid, Spain, dRamón y Cajal Hospital, Madrid, Spain and ePharmacology Department, School of Medicine, Universidad Complutense, Madrid, Spain.

Sponsorship: The main funding for this study was obtained from Bristol-Myers Squibb through an unrestricted educational grant. This work was also partially funded by grants FIS 01/0355 and CAM 08.4/0011/2000.

Correspondence and requests for reprints to José R. Banegas, Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Avda. Arzobispo Morcillo s/n, 28029 Madrid, Spain. Tel: +34 91 3975425; fax: +34 91 3975353; e-mail:

Received 22 March 2002 Revised 7 June 2002 Accepted 9 July 2002

© 2002 Lippincott Williams & Wilkins, Inc.