Morbidity and mortality among elderly ambulatory hypertensive patients

Abstract

A cohort of 1002 elderly (> 65 years) ambulatory hypertensive patients who received care at six Family Practice Residency Clinics in Iowa was studied with an historical prospective design, that is followed progressively through medical records, for nearly four years. All six clinics utilize problem-solving medical records and classify diagnoses according to the International Classification of Health Problems in Primary Care (ICHPPC). A patient was considered to be hypertensive if his/her medical record revealed a diagnosis of hypertension which included the ICHPPC code for hypertension. The fatal events included 102 over-all deaths. Seventy-two of these were cardiovascular deaths according to the Eighth International Classification of Disease A code numbers 390–458. The morbid events were the 37 cerebravascular accidents (CVA) and 27 myocardial infarctions (MI) that also occurred in the cohort during the study or follow-up period. Survival analysis showed that the adjusted risk of CVA is greater than for any other event for the total cohort, those with a potential for systolic hypertension, i.e. diastolic blood pressure less than 90 mm Hg at the beginning of the follow-up period and those above and below 75 years of age. This risk is proportional to increasing levels of both systolic and diastolic blood pressure at the beginning of the follow-up period. In agreement with the major studies of hypertension in all age groups, this study confirms the strong association between blood pressure and stroke in an elderly ambulatory population.