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Irish Study Reveals Persistent Gaps in Hypertension Diagnosis and Treatment Among Older Adults

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New Research Reveals Gaps in Hypertension Management in Ireland

62% of people aged 50 and over with high blood pressure—approximately 445,000 individuals—are not being optimally managed, according to new findings from The Irish Longitudinal Study on Ageing (TILDA) at Trinity College Dublin.

The study, published in Open Heart, spanned 12 years and involved over 8,000 participants, offering a comprehensive national overview of hypertension care. The findings indicate that many individuals with high blood pressure are not being diagnosed or treated according to European Guidelines.

Key Findings

Unmet needs in hypertension care have persisted over time. At the most recent data collection, the majority of older adults with high blood pressure were not appropriately managed. This includes those with undiagnosed hypertension, those diagnosed but untreated, or those on treatment whose blood pressure remains above recommended targets.

When applying the stricter <130/80 mmHg blood pressure target from the 2024 European Society of Cardiology (ESC) guidelines, the percentage of older adults not optimally managed rises to 77%.

Prevalence and Awareness

  • Prevalence: Hypertension rates consistently increased from 63% to 71% over the 12-year study period.
  • Diagnosis Awareness: Only 56% of those with hypertension were aware of their condition, highlighting significant under-diagnosis.

Treatment and Control

  • Treatment Rates: 71% of individuals with hypertension were taking medication, but treatment intensity was often suboptimal.
  • Only 14% were prescribed guideline-recommended dual therapy.
  • 57% received guideline-recommended monotherapy.
  • Control Rates: Among treated individuals:
    • 33% achieved the <130/80 mmHg target.
    • 54% achieved the <140/90 mmHg target.

Elevated Blood Pressure

40% of the population had elevated blood pressure (SBP 120–139mmHg or DBP 70-89mmHg), with 71% of this group showing evidence of high cardiovascular risk.

Specific Populations

The study observed that certain groups showed better outcomes:

People aged 85 years and older, and those with moderate to severe frailty, were less likely to have undiagnosed hypertension and more likely to be on guideline-recommended medications, achieving blood pressure control rates similar to the wider population.

Individuals with chronic kidney disease (CKD) were also more likely to receive guideline-recommended treatment and achieve blood pressure control to a target of <140/90mmHg, suggesting targeted care is effective in high-risk groups.

Implications and Recommendations

Dr. Caoimhe McGarvey, lead author, emphasized that high blood pressure is a common and treatable condition, but if left untreated, it can lead to heart disease, kidney disease, stroke, and dementia. She highlighted the significant unmet need in Ireland's hypertension management and the potential for improving health outcomes by addressing it.

Professor Rose Anne Kenny, Principal Investigator of TILDA, advised:

Individuals aged 40 years or over should have their blood pressure checked regularly.

The research aligns with Health Service Executive (HSE) and Department of Health priorities, advocating for early detection and effective management of chronic conditions to support healthy ageing and reduce avoidable illness.