Adherence to guideline-recommended care of late-onset hypertension in females versus males: A population-based cohort study.

Autor: Bugeja A; Division of Nephrology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.; Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada., Girard C; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.; ICES uOttawa, Ontario, Canada., Sood MM; Division of Nephrology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.; Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada., Kendall CE; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.; ICES uOttawa, Ontario, Canada.; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada., Sweet A; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada., Singla R; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada., Motazedian P; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.; University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Vinson AJ; Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.; Kidney Research Institute, Nova Scotia, Canada., Ruzicka M; Division of Nephrology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.; Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada., Hundemer GL; Division of Nephrology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.; Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.; ICES uOttawa, Ontario, Canada., Knoll G; Division of Nephrology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.; Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada., McIsaac DI; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada.; Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.; ICES uOttawa, Ontario, Canada.; Departments of Anesthesiology & Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.
Jazyk: angličtina
Zdroj: Journal of internal medicine [J Intern Med] 2024 Sep; Vol. 296 (3), pp. 280-290. Date of Electronic Publication: 2024 Jul 08.
DOI: 10.1111/joim.13821
Abstrakt: Background: Sex-based disparities in cardiovascular outcomes may be improved with appropriate hypertension management.
Objective: To compare the evidence-based evaluation and management of females with late-onset hypertension compared to males in the contemporary era.
Methods: Design: Retrospective population-based cohort study.
Setting: Ontario, Canada.
Participants: Residents aged ≥66 years with newly diagnosed hypertension between January 1, 2010, and December 31, 2017.
Exposure: Sex (female vs. male).
Outcomes and Measures: We used Poisson and logistic regression to estimate adjusted sex-attributable differences in the performance of guideline-recommended lab investigations. We estimated adjusted differences in time to the prescription of, and type of, first antihypertensive medication prescribed between females and males, using Cox regression.
Results: Among 111,410 adults (mean age 73 years, 53% female, median follow-up 6.8 years), females underwent a similar number of guideline-recommended investigations (adjusted incidence rate ratio, 0.997 [95% confidence interval [CI] 0.99-1.002]) compared to males. Females were also as likely to complete all investigations (0.70% females, 0.77% males; adjusted odds ratio, 0.96 [95% CI 0.83-1.11]). Females were slightly less likely to be prescribed medication (adjusted hazard ratio [aHR] 0.98 [95% CI 0.96-0.99]) or, among those prescribed, less likely to be prescribed first-line medication (aHR, 0.995 [95% CI 0.994-0.997]).
Conclusions: Compared to males, females with late-onset hypertension were equally likely to complete initial investigations with comparable prescription rates. These findings suggest that there may be no clinically meaningful sex-based differences in the initial management of late-onset hypertension to explain sex-based disparities in cardiovascular outcomes.
(© 2024 The Author(s). Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)
Databáze: MEDLINE
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