[en] Objectives: We previously found large variations in general practitioner (GP) hypertension treatment
probability in oldest-old (>80 years) between countries. We wanted to explore whether
differences in country-specific cardiovascular disease (CVD) burden and life expectancy could
explain the differences.
Design: This is a survey study using case-vignettes of oldest-old patients with different comorbidities
and blood pressure levels. An ecological multilevel model analysis was performed.
Setting: GP respondents from European General Practice Research Network (EGPRN) countries,
Brazil and New Zeeland.
Subjects: This study included 2543 GPs from 29 countries.
Main outcome measures: GP treatment probability to start or not start antihypertensive treatment
based on responses to case-vignettes; either low (<50% started treatment) or high (!50%
started treatment). CVD burden is defined as ratio of disability-adjusted life years (DALYs) lost due to ischemic heart disease and/or stroke and total DALYs lost per country; life expectancy at
age 60 and prevalence of oldest-old per country.
Results: Of 1947 GPs (76%) responding to all vignettes, 787 (40%) scored high treatment probability
and 1160 (60%) scored low. GPs in high CVD burden countries had higher odds of treatment
probability (OR 3.70; 95% confidence interval (CI) 3.00–4.57); in countries with low life
expectancy at 60, CVD was associated with high treatment probability (OR 2.18, 95% CI
1.12–4.25); but not in countries with high life expectancy (OR 1.06, 95% CI 0.56–1.98).
Conclusions: GPs’ choice to treat/not treat hypertension in oldest-old was explained by differences
in country-specific health characteristics. GPs in countries with high CVD
Disciplines :
Geriatrics
Author, co-author :
Streit, Sven; University of Bern, Bern, Switzerland > Institute of Primary Health Care (BIHAM)
Gussekloo, Jacobijn; Leiden University Medical Center, Leiden, The Netherlands > Department of Public Health and Primary Care
Burman, Robert A.; Vennesla Primary Health Care Centre, Bergen, Norway
Collins, Claire; Irish College of General Practitioners, Dublin, Ireland
Gerasimovska Kitanovska, Biljana; University Clinical Centre, University St. Cyril and Metodius, Skopje, Macedonia > Department of Nephrology and Department of Family Medicine
Gintere, Sandra; Faculty of Medicine, Riga Stradin¸s University, Riga, Latvia > Department of Family Medicine
Gomez Bravo, Raquel ; University of Luxembourg > Faculty of Language and Literature, Humanities, Arts and Education (FLSHASE) > Integrative Research Unit: Social and Individual Development (INSIDE)
Hoffmann, Kathryn; Medical University of Vienna, Vienna, Austria > Department of General Practice and Family Medicine, Center for Public Health
Iftode, Claudia; Timis Society of Family Medicine, Sano Med West Private Clinic, Timisoara, Romania
Johansen, Kasper L.; Danish College of General Practitioners, Copenhagen, Denmark
Kerse, Ngaire; University of Auckland, Auckland, New Zealand ; School of Population Health
Koskela, Tuomas H.; University of Tampere, Tampere, Finland > Department of General Practice
Kreitmayer Pe"sti!c, Sanda; University of Tuzla, Tuzla, Bosnia and Herzegovina > Family Medicine Department, Health Center Tuzla, Medical School
Kurpas, Donata; Wroclaw Medical University, Wroclaw, Poland > Family Medicine Department,
Mallen, Christian D.; Keele University, Keele, UK > Primary Care and Health Sciences
Maisonneuve, Hubert; Faculty of Medicine, University of Geneva, Geneva, Switzerland > Primary Care Unit
Merlo, Christoph; Institute of Primary and Community Care Lucerne (IHAM), Lucerne, Switzerland
Mueller, Yolanda; Institute of Family Medicine Lausanne (IUMF), Lausanne, Switzerland
Muth, Christiane; Institute of General Practice Goethe-University, Frankfurt/Main, Germany
Ornelas, Rafael H.; Hospital Israelita Albert Einstein, S~ao Paulo, Brazil
Petek Ster, Marija; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia > Department for Family Medicine
Petrazzuoli, Ferdinando; Lund University, Malmo, Sweden > Department of Clinical Sciences, Centre for Primary Health Care Research,
Rosemann, Thomas; University of Zurich, Zurich, Switzerland > Institute of Primary Care, University Hospital Zurich
Sattler, Martin; SSLMG, Societe Scientifique Luxembourgois en Medicine generale, Luxembourg, Luxembourg
Tatsioni, Athina; University of Ioannina, Ioannina, Greece > Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences,
Thulesius, Hans; Lund University, Malmo, Sweden > Department of Clinical Sciences, Family Medicine
Tkachenko, Victoria; Institute of Family Medicine at Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine > Department of Family Medicine
Torzsa, Peter; Semmelweis University, Budapest, Hungary > Department of Family Medicine
Tsopra, Rosy; St James’s University Hospital, Leeds, UK > Leeds Centre for Respiratory Medicine
Tuz, Canan; Kemaliye Town Hospital, Erzincan University, Erzincan, Turkey
Verschoor, Marjolein; University of Bern, Bern, Switzerland > Institute of Primary Health Care (BIHAM)
Viegas, Rita P. A.; NOVA Medical School, Lisbon, Portugal > Department of Family Medicine
Vinker, Shlomo; Tel Aviv University, Tel Aviv, Israel > Sackler Faculty of Medicine
de Waal, Margot W. M.; Leiden University Medical Center, Leiden, The Netherlands > Department of Public Health and Primary Care
Zeller, Andreas; University of Basel, Basel, Switzerland > Centre for Primary Health Care (uniham-bb),
Rodondi, Nicolas; University of Bern, Bern, Switzerland > Department of General Internal Medicine, Inselspital, Bern University Hospital
Poortvliet, Rosalinde K. E.; Leiden University Medical Center, Leiden, The Netherlands > Department of Public Health and Primary Care
KEY POINTS
- General practitioners (GPs) are in a clinical dilemma when deciding whether (or not) to treat
hypertension in the oldest-old (>80 years of age).
- In this study including 1947 GPs from 29 countries, we found that a high country-specific
cardiovascular disease (CVD) burden (i.e. myocardial infarction and/or stroke) was associated
with a higher GP treatment probability in patients aged >80 years.
- However, the association was modified by country-specific life expectancy at age 60. While
there was a positive association for GPs in countries with a low life expectancy at age 60,
there was no association in countries with a high life expectancy at age 60.
- These findings help explaining some of the large variation seen in the decision as to whether
or not to treat hypertension in the oldest-old.
