Diagnosis and treatment of isolated systolic hypertension in the elderly: Results of a survey four years post-SHEP

Gautam Ramakrishna, Clyde B. Schechter, Robert A. Phillips

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

There is limited data evaluating the impact on clinical practice of the 1991 SHEP study. To assess present approaches and attitudes to ISH, we surveyed 135 physicians during the spring of 1995. A questionnaire was designed to assess the physician's definition of ISH, views on clinical importance and etiology of ISH, choice of pharmacological intervention (if any), and opinions regarding SHEP's influence on current approaches to the management of ISH. Surveys were distributed to physicians at the weekly Internal Medicine and Cardiology Grand Rounds at The Mt. Sinai Medical Center, New York, NY from February through April 1995. Data were analyzed via Lotus 1-2-3 spreadsheet (Release 3.1 Que Corp.) and responses to opinion statements were factor analyzed on Systat Version 5.0 software. The response rate was 63.7% (87 physician responses). Nearly 50% of the respondents had read the SHEP article and 82.6% had 'heard of the study'. Approximately 60% believed ISH should be defined in accordance with the SHEP guideline (SBP > 160 mm Hg and DBP < 90 mm Hg). Thirty percent of physicians would initiate pharmacological treatment at a SBP ≤ 155 mm Hg for patients aged 65-74 years. Of the 85% of physicians (n = 73) who opted to medicate, the patient's age strongly determined the SBP at which pharmacological treatment would be initiated. Whereas 66% of physicians would use drug therapy for patients aged 65-74 with a SBP ≤ 160 mm Hg, 54% and 45% of physicians would consider the same for patients aged 75-84 and 85+, respectively. Thirty eight percent of physicians chase thiazide diuretics as sole first-line therapy. CCB and ACE inhibitors were chosen by 26.8% and 19.7% of physicians, respectively. When compared to younger physicians (< 60 yrs), older clinicians (≤ 60 yrs) were more likely to agree that the detection of ISH was not important and that treatment of ISH is ineffective. Survey results demonstrate a definite consensus for initiation of pharmacological treatment in elderly patients with ISH. Of note, a significant percentage of physicians would initiate therapy at SBP ≤ 155 mm Hg. This is a level of pressure for which no epidemiological data exists to support treatment. With respect to specific pharmacological treatment of ISH, a clear consensus is still lacking. The increased use of ACE inhibitors and CCB compared with previous studies may have significant impact on the future of treatment costs for the elderly.

Original languageEnglish (US)
Pages (from-to)20-36
Number of pages17
JournalAmerican Journal of Geriatric Cardiology
Volume6
Issue number4
StatePublished - Jul 1997
Externally publishedYes

Fingerprint

Hypertension
Physicians
Pharmacology
Therapeutics
Angiotensin-Converting Enzyme Inhibitors
Surveys and Questionnaires
Teaching Rounds
Sodium Chloride Symporter Inhibitors
Internal Medicine
Cardiology
Health Care Costs
Software
Guidelines
Pressure
Drug Therapy

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Cardiology and Cardiovascular Medicine

Cite this

Diagnosis and treatment of isolated systolic hypertension in the elderly : Results of a survey four years post-SHEP. / Ramakrishna, Gautam; Schechter, Clyde B.; Phillips, Robert A.

In: American Journal of Geriatric Cardiology, Vol. 6, No. 4, 07.1997, p. 20-36.

Research output: Contribution to journalArticle

@article{63bc84d6f69c4540ad503605b86a6c9b,
title = "Diagnosis and treatment of isolated systolic hypertension in the elderly: Results of a survey four years post-SHEP",
abstract = "There is limited data evaluating the impact on clinical practice of the 1991 SHEP study. To assess present approaches and attitudes to ISH, we surveyed 135 physicians during the spring of 1995. A questionnaire was designed to assess the physician's definition of ISH, views on clinical importance and etiology of ISH, choice of pharmacological intervention (if any), and opinions regarding SHEP's influence on current approaches to the management of ISH. Surveys were distributed to physicians at the weekly Internal Medicine and Cardiology Grand Rounds at The Mt. Sinai Medical Center, New York, NY from February through April 1995. Data were analyzed via Lotus 1-2-3 spreadsheet (Release 3.1 Que Corp.) and responses to opinion statements were factor analyzed on Systat Version 5.0 software. The response rate was 63.7{\%} (87 physician responses). Nearly 50{\%} of the respondents had read the SHEP article and 82.6{\%} had 'heard of the study'. Approximately 60{\%} believed ISH should be defined in accordance with the SHEP guideline (SBP > 160 mm Hg and DBP < 90 mm Hg). Thirty percent of physicians would initiate pharmacological treatment at a SBP ≤ 155 mm Hg for patients aged 65-74 years. Of the 85{\%} of physicians (n = 73) who opted to medicate, the patient's age strongly determined the SBP at which pharmacological treatment would be initiated. Whereas 66{\%} of physicians would use drug therapy for patients aged 65-74 with a SBP ≤ 160 mm Hg, 54{\%} and 45{\%} of physicians would consider the same for patients aged 75-84 and 85+, respectively. Thirty eight percent of physicians chase thiazide diuretics as sole first-line therapy. CCB and ACE inhibitors were chosen by 26.8{\%} and 19.7{\%} of physicians, respectively. When compared to younger physicians (< 60 yrs), older clinicians (≤ 60 yrs) were more likely to agree that the detection of ISH was not important and that treatment of ISH is ineffective. Survey results demonstrate a definite consensus for initiation of pharmacological treatment in elderly patients with ISH. Of note, a significant percentage of physicians would initiate therapy at SBP ≤ 155 mm Hg. This is a level of pressure for which no epidemiological data exists to support treatment. With respect to specific pharmacological treatment of ISH, a clear consensus is still lacking. The increased use of ACE inhibitors and CCB compared with previous studies may have significant impact on the future of treatment costs for the elderly.",
author = "Gautam Ramakrishna and Schechter, {Clyde B.} and Phillips, {Robert A.}",
year = "1997",
month = "7",
language = "English (US)",
volume = "6",
pages = "20--36",
journal = "The American journal of geriatric cardiology",
issn = "1076-7460",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Diagnosis and treatment of isolated systolic hypertension in the elderly

T2 - Results of a survey four years post-SHEP

AU - Ramakrishna, Gautam

AU - Schechter, Clyde B.

AU - Phillips, Robert A.

PY - 1997/7

Y1 - 1997/7

N2 - There is limited data evaluating the impact on clinical practice of the 1991 SHEP study. To assess present approaches and attitudes to ISH, we surveyed 135 physicians during the spring of 1995. A questionnaire was designed to assess the physician's definition of ISH, views on clinical importance and etiology of ISH, choice of pharmacological intervention (if any), and opinions regarding SHEP's influence on current approaches to the management of ISH. Surveys were distributed to physicians at the weekly Internal Medicine and Cardiology Grand Rounds at The Mt. Sinai Medical Center, New York, NY from February through April 1995. Data were analyzed via Lotus 1-2-3 spreadsheet (Release 3.1 Que Corp.) and responses to opinion statements were factor analyzed on Systat Version 5.0 software. The response rate was 63.7% (87 physician responses). Nearly 50% of the respondents had read the SHEP article and 82.6% had 'heard of the study'. Approximately 60% believed ISH should be defined in accordance with the SHEP guideline (SBP > 160 mm Hg and DBP < 90 mm Hg). Thirty percent of physicians would initiate pharmacological treatment at a SBP ≤ 155 mm Hg for patients aged 65-74 years. Of the 85% of physicians (n = 73) who opted to medicate, the patient's age strongly determined the SBP at which pharmacological treatment would be initiated. Whereas 66% of physicians would use drug therapy for patients aged 65-74 with a SBP ≤ 160 mm Hg, 54% and 45% of physicians would consider the same for patients aged 75-84 and 85+, respectively. Thirty eight percent of physicians chase thiazide diuretics as sole first-line therapy. CCB and ACE inhibitors were chosen by 26.8% and 19.7% of physicians, respectively. When compared to younger physicians (< 60 yrs), older clinicians (≤ 60 yrs) were more likely to agree that the detection of ISH was not important and that treatment of ISH is ineffective. Survey results demonstrate a definite consensus for initiation of pharmacological treatment in elderly patients with ISH. Of note, a significant percentage of physicians would initiate therapy at SBP ≤ 155 mm Hg. This is a level of pressure for which no epidemiological data exists to support treatment. With respect to specific pharmacological treatment of ISH, a clear consensus is still lacking. The increased use of ACE inhibitors and CCB compared with previous studies may have significant impact on the future of treatment costs for the elderly.

AB - There is limited data evaluating the impact on clinical practice of the 1991 SHEP study. To assess present approaches and attitudes to ISH, we surveyed 135 physicians during the spring of 1995. A questionnaire was designed to assess the physician's definition of ISH, views on clinical importance and etiology of ISH, choice of pharmacological intervention (if any), and opinions regarding SHEP's influence on current approaches to the management of ISH. Surveys were distributed to physicians at the weekly Internal Medicine and Cardiology Grand Rounds at The Mt. Sinai Medical Center, New York, NY from February through April 1995. Data were analyzed via Lotus 1-2-3 spreadsheet (Release 3.1 Que Corp.) and responses to opinion statements were factor analyzed on Systat Version 5.0 software. The response rate was 63.7% (87 physician responses). Nearly 50% of the respondents had read the SHEP article and 82.6% had 'heard of the study'. Approximately 60% believed ISH should be defined in accordance with the SHEP guideline (SBP > 160 mm Hg and DBP < 90 mm Hg). Thirty percent of physicians would initiate pharmacological treatment at a SBP ≤ 155 mm Hg for patients aged 65-74 years. Of the 85% of physicians (n = 73) who opted to medicate, the patient's age strongly determined the SBP at which pharmacological treatment would be initiated. Whereas 66% of physicians would use drug therapy for patients aged 65-74 with a SBP ≤ 160 mm Hg, 54% and 45% of physicians would consider the same for patients aged 75-84 and 85+, respectively. Thirty eight percent of physicians chase thiazide diuretics as sole first-line therapy. CCB and ACE inhibitors were chosen by 26.8% and 19.7% of physicians, respectively. When compared to younger physicians (< 60 yrs), older clinicians (≤ 60 yrs) were more likely to agree that the detection of ISH was not important and that treatment of ISH is ineffective. Survey results demonstrate a definite consensus for initiation of pharmacological treatment in elderly patients with ISH. Of note, a significant percentage of physicians would initiate therapy at SBP ≤ 155 mm Hg. This is a level of pressure for which no epidemiological data exists to support treatment. With respect to specific pharmacological treatment of ISH, a clear consensus is still lacking. The increased use of ACE inhibitors and CCB compared with previous studies may have significant impact on the future of treatment costs for the elderly.

UR - http://www.scopus.com/inward/record.url?scp=0030739462&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030739462&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:0030739462

VL - 6

SP - 20

EP - 36

JO - The American journal of geriatric cardiology

JF - The American journal of geriatric cardiology

SN - 1076-7460

IS - 4

ER -