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Blood Pressure Control Poorest For The Oldest

But researchers add this group needs aggressive treatment the most

FRIDAY, May 21, 2004 (HealthDayNews) -- Americans 80 years of age or older are in greatest need of getting their blood pressure under control but are least likely to keep it in check.

That dangerous health paradox was reported by researchers on May 21 at the American Society of Hypertension's annual meeting in New York City.

The scientists examined data on more than 2,200 men and 2,900 women taking part in the Framingham Heart Study, which has been providing experts with invaluable health data for 56 years. They found that while risks for hypertension rise with age, the percentage of people whose pressure is successfully kept under control as they get older actually falls.

"The rates of treatment are pretty high, at 70 percent or better, but treatment is not good enough to make sure we reach the goals needed to prevent problems such as stroke, congestive heart failure and heart attack," said study leader Dr. Donald M. Lloyd-Jones, an assistant professor of preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago.

Only 27 percent of study participants aged 60 and younger had high blood pressure, defined as a reading that is greater than 140/90 mm/Hg. That rose to 59 percent in the 60-to-79 age group and more than 70 percent for those aged 80 and older.

Treatment rates increased with age, from 57 percent of those under 60 to 73 percent for people 80 and older. But the rate of successful treatment decreased with age, so that only 32 percent of men and 24 percent of women aged 80 and older had their blood pressure under control.

While most of the people in the study are white, the results almost certainly apply to other ethnic groups, Lloyd-Jones said. "If anything, rates of hypertension are more severe in African-Americans and Hispanics, so we might be underestimating the problem," he added.

Treatment is not as aggressive as it should be because "clinicians are more wary of side effects such as lightheadedness in older people," Lloyd-Jones said. But the need to prevent the crippling consequences of high blood pressure should be paramount, he stressed.

One problem is that "we are still battling the myth that older people must necessarily have high blood pressure," Lloyd-Jones said. "For a long time, people thought it was a normal sign of aging."

Dr. Thomas D. Giles, a professor of medicine at Louisiana State University School of Medicine and president-elect of the American Society of Hypertension, remembered that when he began practicing, the rule for normal blood pressure was "100 plus a person's age. If we tried to get it below that, we were afraid of causing strokes."

People should concentrate on systolic blood pressure, the higher number, Giles said. A reading over 140 is a danger sign for anyone, and even lower readings could require treatment for persons with other risk factors. For example, a reading of 130 can be dangerously high for someone with diabetes, Giles said.

Poor blood-pressure control in older people is often due to an inadequate number of drugs prescribed for them, Lloyd-Jones said. The number of blood pressure medications taken by individual patients was similar in all the age groups, with two-thirds of patients taking one drug and fewer than 10 percent taking three, the study found.

"Clinicians seem to be reluctant to treat elderly patients aggressively," he said.

More information

The details of hypertension are laid out by the American Heart Association, while the National Institute on Aging has specific advice for seniors on controlling their blood pressure.

SOURCES: Donald M. Lloyd-Jones, M.D., assistant professor, preventive medicine, Northwestern University Feinberg School of Medicine, Chicago; Thomas D. Giles, M.D., president, American Society of Hypertension, and professor, medicine, Louisiana State University School of Medicine, New Orleans; May 21, 2004, presentation, American Society of Hypertension annual meeting, New York City
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