Elderly with hypertension less likely to get lifestyle modification advice from doctors

Nov 5 2007

People older than 60 with high blood pressure are less likely than other groups of patients to receive advice from their doctors about lifestyle modifications that can help lower their blood pressure, a study by UNC researchers concludes.

In addition, hypertension (high blood pressure) patients who are not taking antihypertensive medication and patients who are not overweight or obese are less likely to receive lifestyle modification advice than groups such as hypertension patients aged 18 to 39, those who are overweight or obese and those taking antihypertensive medication, said Anthony J. Viera, M.D., M.P.H., the study's lead author.

“Our study found that most people who have been diagnosed with high blood pressure say they remember receiving at least some advice from their doctors about lifestyle modifications – such as eating healthier, exercising more and reducing both salt and alcohol intake – that can help lower their blood pressure,” Viera said.

“However, the most important finding of the study is who is not getting that advice,” Viera said. “Lifestyle modification advice should always be the doctor's first step in treating a patient with high blood pressure, and this advice should not be abandoned at any point, in any group of hypertension patients.”

The study is published in the November 2007 issue of The Journal of Clinical Hypertension. Viera, an assistant professor in the Department of Family Medicine, was the principal investigator. His UNC co-authors are Abhijit V. Kshirsagar, M.D., M.P.H., and Alan L. Hinderliter, M.D.

For their study, Viera and colleagues analyzed data collected by the Centers for Disease Control and Prevention in a national survey of 28,457 adults with high blood pressure. They found that 90.3 percent of those surveyed reported receiving some type of lifestyle modification advice from their doctors. Of these, 74.6 percent reported receiving exercise advice, 69.3 percent were told to reduce salt intake, 61.9 percent were told to change their eating habits and 43.5 percent said they were advised to reduce alcohol intake.

But disparities emerged when the researchers examined the survey results for particular types of advice received by particular groups of patients. For example, 53.7 percent of those aged 60 or older reported receiving eating habit advice, compared to 71.2 percent of those aged 40-59 and 64.9 percent of those aged 18-39. Similarly, 35.1 percent of those 60 or older reported receiving advice to reduce alcohol intake, compared to 48.9 percent of those aged 40-59 and 43.4 percent of those aged 18-39.

“It is possible that health care providers may put aside or even abandon the notion of giving LSM advice to older patients, perhaps feeling that their hypertension mandates the use of medication,” the researchers wrote. “Even for individuals on medication, however, LSM should remain an important part of hypertension management; it can help reduce the need for higher doses of medication or multiple antihypertensive agents.”

When the survey responses were sorted according to body weight, 45.5 percent of those who were underweight or at a healthy weight reported receiving eating habit advice, compared to 59.5 percent of those who were overweight and 75 percent of those were were obese. When the results were sorted according to medication use, 63.2 percent those who were taking antihypertensive medication reported receiving eating habit advice, compared to 56.9 percent of those not taking medication.

A greater disparity emerged in the medication group when exercise advice was examined. Of those taking medication, 82.6 percent reported receiving exercise advice, compared to 65.9 of those not taking medication.