Nov 8, 2016 - people in primary care can be described by a 'rule of thirds'. A third of patients are undetected, a third of detected patients are untreated and.
BRITISH GERIATRICS SOCIETY 30(8-60)% (mean, practice range) patients had their BP status undetermined; % had no BP readings recorded and 10% patients had only 1 or 2 elevated readings in last 6 yrs. 35% subjects were normotensive. 35% subjects were hypertensive of which 69(51-100)% were receiving antihypertensive treatment. 44(20-82)% of treated patients were controlled indicating that only 21(6-49)% patients are detected, treated and controlled. These findings suggest that applying a threshold of .£.160/90 mm Hg treatment of hypertension in older people in primary care can be described by a 'rule of thirds'. A third of patients are undetected, a third of detected patients are untreated and slightly more than a third of treated patients are controlled. Although complete detection, treatment and control of hypertension in all older people is not possible, these findings suggest that substantial opportunities for prevention of stroke and myocardial infarction in this age group are possible if strategies to implement improved management of hypertension are successful.
55
G.K.DAVIS, *S.N.H. NAQVI and D.H. ROBERTS Regional Cardiac Unit, Victoria Hospital, Blackpool and *Chorley General Hospital Holter monitoring is frequently requested in elderly patients. We investigated the ability of octogenarians to satisfactorily complete a 24 hour ECG recording and assessed the request indications and diagnostic usefulness in this age group. Method*: The request indications and results of 24 hour Holter monitoring were prospectively analysed in 80 consecutive octogenarians over one year. 67 patients (age 65-75) referred over the same period were controls. 60% of octogenarians and 39% of controls were referred for investigation of syncope/presyncope and 18% vs 30% were referred with palpitations. In 12% the test was used to monitor antiarrythmic treatment. The recorded symptom diary was incomplete in 70% of patients. Arrhythmias [paroxysmal atrial fibrillation (PAF), or non-sustained ventricular tachycardia] were present on 83% of referrals for palpitations but correlated with recorded symptoms in 16%. PAF was present in 44% of octogenarians and in 40% vs 27% of those with syncope/presyncope compared to the control group. Three patients underwent permanent pacemaker implantation for high grade atrioventricular block. Conclusions: The commonest indication for Holter monitoring is syncope/presyncope and it is associated with a significant pacemaker implantation rate. Symptomatic arrhythmia yield is 16% as patients do not complete a diary or in addition are asymptomatic during the recording. PAF is commoner in octogenarians with syncope/presyncope than in younger elderly patients with similar symptoms.
56
DR LEE, A CLUCKIE, VL MASKREY, M BUXTONTHOMAS, CG SWIFT AND SHD JACKSON Clinical Age Research Unit, Dept of Health Care of the Elderly, King's College School of Medicine and Dentistry London In a previous study, we have shown that treating hypertension in elderly patients improves psychomotor performance (Kalra et al 1993, J. Hum. Hypertens. 7, 28590). This may be a consequence of changes in regional cerebral blood flow (rCBF). This study aims to establish whether treating hypertension in elderly patients results in changes in rCBF. Nine known hypertensives were studied. Each had their antihypertensive therapy withdrawn and had a diastolic BP of >95mmHg after a 2 week placebo run-in. Single Photon Emission Computerised Tomography (SPECT) was used to estimate rCBF on placebo and after 3 weeks of nifedipine 20mg twice daily. The regions chosen were frontal, parietal, anterior and posterior temporal, cingulate gyrus, coronal sulcus, occipital, basal ganglia and thalamus Blood Pressure fell on treatment (mean (SD) fall 20/11mmHg (10/6)). Similar falls were seen on ambulatory blood pressure monitoring (mean day systolic pressure fall (SD) 21/14mmHg (13/7)). Despite satisfactory BP falls being achieved, there was no significant change in rCBF in any of the regions studied (whole count pre-treatment 0.76(0.08), post-treatment 0.75(0.18), change in count p>0.05 for all regions). These data suggest that lowering BP in elderly hypertensives does not change rCBF and therefore this cannot be used to explain the improvement seen in psychomotor performance on antihypertensive treatment.
THE ASSESSMENT OF LEFT VENTRICULAR SYSTOLIC FUNCTION BY PORTABLE ECHOCARDIOGRAPHY AT THE DAY HOSPITAL
Downloaded from http://ageing.oxfordjournals.org/ by guest on November 8, 2016
HOLTER MONITORING IN OCTOGENARIANS
DOES REGIONAL CEREBRAL BLOOD FLOW CHANGE ON TREATING HYPERTENSION IN ELDERLY PATIENTS?
P21
57
N. GILLESPIE, M.E.T. McMURDO, U.K. GHOSH, P. HEWITT, C. LIEN, A.D. STRUTHERS and S.D. PRINGLE Departments of Cardiology, Ageing and Health and Clinical Pharmacology, Ninewells Hospital, Dundee DD1 9SY Echocardiography is an essential investigation in the management of patients with suspected left ventricular systolic dysfunction. Many patients, particularly the elderly, are denied access to this investigation in the U.K. This study evaluated the role of a portable echocardiographic service at a day hospital in a cohort of elderly patients. Forty patients (mean age of 76.6 ± 8.6) were studied. Each patient underwent full clinical assessment,
