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Older Americans Aren't Being Treated for High Blood Pressure

A systolic reading of 160 or higher is dangerous, study says

TUESDAY, Aug. 31, 2004 (HealthDayNews) -- Too many doctors are ignoring the need to treat older people with elevated systolic blood pressure, the higher number in the ideal 120/80 reading, a new study finds.

Drug treatment should be started when systolic pressure is 160 or higher in elderly people, claims a report in the Sept. 1 issue of the Journal of the American Medical Association.

There's nothing startlingly new in that advice, said study author Dr. Sarwat I. Chaudhry, a research fellow at the Department of Veterans Affairs who is stationed at the West Haven Veterans Affairs Medical Center in Connecticut.

Indeed, it is based on a review of medical studies that show definite benefit from keeping systolic pressure below 160, she said. The problem is that many doctors ignore those findings, clinging instead to an outmoded belief that a systolic pressure of 100 plus a person's age is safe, Chaudhry said.

"But there is very strong evidence from large-scale clinical trials that in the higher range, at least 160, treatment makes a difference for the risk of heart attack, heart failure and that sort of problem," she said.

The situation is trickier for slightly lower levels of systolic pressure, Chaudhry said.

"From 140 to 159, we don't have strong evidence from large-scale trials saying that treating patients with medications has benefits," she said. Still, she added, "people need to know their numbers, need to know what their blood pressure is."

Blood pressure rises and falls during the day; when it is elevated over time, it is called high blood pressure. Systolic pressure is the force of blood in the arteries as the heart beats. Systolic high blood pressure is the most common form of high blood pressure for older Americans, according to the National Heart, Lung, and Blood Institute.

Someone with blood pressure at or near the danger level "needs to talk to a doctor and come up with a treatment plan," Chaudhry said. "This should be a decision process in which patients talk to physicians."

The journal article cited a recent report by the Joint National Committee on Prevention, Evaluation and Treatment of High Blood Pressure, saying that elevated systolic pressure in older people should be the focus of treatment. Despite that recommendation, there's evidence that poor control of systolic pressure is becoming more common, the researchers wrote.

The studies support the use of two classes of drugs, thiazide diuretics and long-acting calcium blockers, as first-line therapy for high systolic pressure, Chaudhry said. Both are available in inexpensive generic versions, she said.

More information

The National Heart, Lung, and Blood Institute offers a guide to lowering high blood pressure.

SOURCES: Sarwat I. Chaudhry, M.D., research fellow, West Haven Veterans Affairs Medical Center, West Haven, Conn.; Sept. 1, 2004, Journal of the American Medical Association
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