Diagnosis and control of arterial hypertension in the elderly (urban/rural comparison)

Abstract

Hypertension (HTA) is a chronic disease ofhigh prevalence and morbimortality. In Costa Rica, there is no prevalence study for the whole country; there is only one, carried out in the Cantón de Desamparados, where a prevalence of 15.4% was found in the population of 15 years ormore. In relation with the elderly, there is a population study of a Cantón " The Third Age Study of Coronado" that showed a self-reported prevalence of 38.4%, very similar to that of developed countries.

The present work shows a comparison of the diagnosis and control of hypertension in the elderly adults of an urban and a rural zone of the Central Plateau of Costa Rica, and is part of the study "Determinants of healthy ageing" that took place in the health area of Desamparados.

The self-reported hypertension had a prevalence of 33.3% in urban zone and of 34.5% in rural zone, (p=872); it was most prevalent in the femenine sex with 52.9% and for the masculine sex, (p=O.OOOOI). In both zones, the great majority (80%) had medical control and were under treatment. The medications most commonly used were alfa-metildopa (22%), betablockers (22%) and hidroclorotiazide ( 18%), and more than half (54%) had monotherapy.

The systolic blood pressure was over the normal limit (139 Hg [mm]) in 42. I % with a higher prevalence in women (49.4%) than in men (34.5%), (p=0.048). The mean ofthe systolic blood pressure sitting down was less in the urban zone (130.6 Hg [mm]) that for the rural zone (138.9 Hg [mm]), (p=0.013).

The diastolic blood pressure was over the normal limit (89 Hg [mm]) in 33.3%, being similar for both sexes. The average diastolic pressure sitting down was less in the urban zone (80.4 Hg [mm]) that for the rural zone (82.3 Hg [mm]), but without showing significant difference. There was a bad control in more than half the patients that were known hypertensive: systolic >139 (58.9%) and diastolic >89 (53,8%). Twenty three percent of the persons who did not acknowledge having HTA had elevated blood pressure systolic: 33%, diastolic: 22.3%, This demonstrates a poor ornon adecuate control of hypertension in the elderly and a deficient capacity to diagnose it.

Possible causes for these results are discussed, as could be the quality Ofthe blood pressure measure, the possible ignorance of the new classification of HTAin relation with systolic HTA and the access to health services.