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Elevated blood pressure is prevalent and is one of the leading risk factors for mortality. The pathogenesis of hypertension in older adults is different from that in younger adults. Therefore, efficacy and safety in older adults of many existing drugs for hypertension may differ from those in younger adults. The objective of this study was to identify the efficacy and safety of antihypertensive drugs in older adults in the US community-dwelling population. We conducted a retrospective cohort study to investigate the association between antihypertensive drug use and risk of adverse outcomes in older adults in the USA. Data were obtained from the Continuous Medicare Health Outcomes Database and the Medicare Provider Analysis and Review database using a retrospective cohort design. Included were enrollees aged 65 years or older with hypertension who were newly prescribed antihypertensive drugs in 2004 and followed up until 2012. The main outcome was the first occurrence of death from all causes, recurrent stroke, renal disease, or heart failure. Hazard ratios and 95% confidence intervals were estimated using the Cox proportional hazard model. A total of 10 783 patients were included in the current study. During a median follow-up of 4.3 years, 954 adverse events occurred. The overall median survival time was 4.5 years. With the exception of statins, all the antihypertensive drugs were associated with lower risk of adverse outcomes in older adults. The use of statins was associated with higher risk of adverse outcomes compared with non-use (hazard ratio 1.21, 95% confidence interval 1.11 to 1.31). In conclusion, antihypertensive drugs for older adults seem to be associated with a lower risk of adverse events. Statin use was associated with higher risk of adverse outcomes compared with non-use. The findings provide insights to clinicians and patients on the efficacy and safety of antihypertensive drugs in older adults.

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Better educational attainment and numeracy and the lack of comorbid conditions are related to better self-management of hypertension. Better clinical outcomes are associated with better adherence to antihypertensive medication. Self-reported data on daily doses and pill counts should be validated by pill counting. The study of genetic mechanisms, including genetic polymorphisms that are related to blood pressure, is also important. Future research should assess the efficacy of interventions to improve management of hypertension in older adults using genomic technologies. The use of genomic data as a prognostic test should also be explored, as well as the integration of patient-generated data (PGD) to improve the treatment of hypertension.

Recent studies of health literacy among Latinos have tended to focus on literacy alone, while other facets of health literacy, such as numeracy, medication adherence, and health care utilization, are less well understood. We may learn more about the health care experiences of Latinos if we also consider these other aspects of health literacy. The major goals of the study reported in this symposium are to develop a better understanding of the breadth of health literacy, and in turn, learn more about the health care experiences of Latinos and identify how better quality health literacy may affect Latinos’ ability to successfully utilize, understand, and take control of their health care. This study will be conducted with a cohort of Latinos. In addition, we will focus on a segment of the population who may be of special interest to health policy makers, i.e., low-income and undocumented Latinos. We will recruit self-identified Latino adults from a farmworker health clinic in rural California. All participants will be recruited during their regularly scheduled visits to the clinic and completed measures of health literacy and health care utilization. Two authors will have the unannounced opportunity to randomly sample some participants for an in-depth interview. Each of the 200 members of the symposium will be randomly assigned an interview for quality control. Participant interviews will be conducted using a narrative approach. The interviews will be recorded, transcribed, and analyzed using qualitative methods. The analysis will focus on the linguistic and cultural components of health literacy and how these affect the ability of Latino adults to utilize healthcare services.
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