Hypertension Undertreated in Elderly

Yet they're at highest risk of heart attack and stroke, study says

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WEDNESDAY, July 27, 2005 (HealthDayNews) -- Many older people with high blood pressure aren't receiving the recommended care for their condition, a new study finds.

Researchers examined the current patterns of treatment for blood pressure, also known as hypertension, in people aged 80 and older. They wanted to find out how well blood pressure is being controlled in this group and determine the risk of high blood pressure among the elderly.

"The reason why that is important is that there are very few data in this age group, and this is the fastest growing population group in the U.S.," said lead researcher Dr. Donald M. Lloyd-Jones, an assistant professor of preventive medicine at Northwestern University's Feinberg School of Medicine.

"We found that three-quarters of people aged 80 and over have hypertension. About 70 percent are on only one blood pressure medication; therefore, the rates of controlling their hypertension are very low," Lloyd-Jones said.

In their study, Lloyd-Jones and his team collected data on nearly 5,300 participants enrolled in the National Heart, Lung, and Blood Institute's Framingham Heart Study.

While hypertension and drug treatment increased with age, control rates were sharply lower in older people, especially women, the researchers found. Among people younger than 60 years, 38 percent of men and women had their blood pressure under control. For those 60 to 79, control rates were 36 percent for men and 28 percent for women. But among those 80 and older, blood pressure control rates were 38 percent for men and just 23 percent for women, according to the study.

Moreover, those 80 and older had a high rate of "major cardiovascular events," such as heart attack or stroke. During six years of follow-up, 9.5 percent of those with normal blood pressure, 19.8 percent of those with pre-hypertension, 20.3 percent of those with stage 1 hypertension and 24.7 percent of those with stage 2 hypertension had a heart attack, stroke or heart failure, the study found.

The study results appear in the July 27 issue of the Journal of the American Medical Association.

Medications to control high blood pressure include diuretics and beta-blockers, among others.

Lloyd-Jones believes there are many reasons why older people aren't having their blood pressure controlled. "In general, elderly people are taking a lot of pills already," he said. "There are concerns about polypharmacy [use of many drugs], additional costs.

"In addition, there is reluctance among many clinicians to treat older people for higher blood pressure because they don't understand how high the risk is for cardiovascular events," Lloyd-Jones said. "There are concerns about side effects of medication as well."

Lloyd-Jones believes that older patients should discuss with their doctor how best to control their blood pressure to lower their risk of heart attack and stroke. "The era where systolic blood pressure (the top reading on a blood pressure test) should be 100 plus your age is over. We really need to redouble our efforts to control systolic blood pressure, because that is what is conferring so much of the risk."

Ideally, systolic blood pressure should be below 140 and preferably at 120, Lloyd-Jones said.

Dr. Harlan M. Krumholz, a professor of internal medicine cardiology and professor of epidemiology and public health at the Yale University School of Medicine, agrees with Lloyd-Jones. "This study reinforces the conventional wisdom that increasing blood pressure is associated with increasing risk," he said.

There is strong evidence from clinical trials that older patients could lower their risk of stroke and heart disease if they got their blood pressure under control, Krumholz said.

He believes that even patients with pre-hypertension and modest hypertension can benefit from lowering their blood pressure. "This is an area where there are few trials," he said. "I think that it's a hunch that these people would be better off. The elderly is a group that can benefit from preventive strategies because their underlying risk is so high."

But many doctors don't offer hypertension treatment to the elderly, Krumholz said. "Acts of omission have been tolerated in older patients," he noted. "It's almost like, 'let nature take its course.' I think a lot of this non-treatment is about doctors making inferences that old people are not good candidates to be treated."

More information

The American Heart Association can tell you more about high blood pressure and how to treat it.

SOURCES: Donald M. Lloyd-Jones, M.D., Sc.M., assistant professor, preventive medicine, Feinberg School of Medicine, Northwestern University, Chicago; Harlan M Krumholz, M.D., professor, internal medicine cardiology, and professor, epidemiology and public health, Yale University School of Medicine, New Haven, Conn.; July 27, 2005, Journal of the American Medical Association

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