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Women of Primary Concern
Blood Pressure Control for Elderly Should Have
Higher Priority
May 19, 2004 - Blood pressure control of people 80
years and older, especially women, must be made a national priority,
says a Northwestern University researcher at the American Society of
Hypertension’s Nineteenth Annual Scientific Meeting.
“The current rates of blood pressure control in the
elderly are unacceptably low,” says Donald M. Lloyd-Jones, MD, of
Northwestern’s Feinberg School of Medicine, Chicago. “The elderly are
the fastest growing segment of the US population and they have the
highest prevalence of hypertension. Yet, clinicians seem to be reluctant
to treat older patients aggressively, perhaps because of perceived lower
benefits or possible increased risk of side effects.”
Dr. Lloyd-Jones and colleagues from the National
Heart, Lung, and Blood Institute’s Framingham Heart Study pooled 14,087
examinations of participants in the Framingham Heart Study from
1990-1999.
The Framingham Heart Study, started in 1948 in
Framingham, MA, is the longest-running prospective epidemiological study
of heart disease. Researchers are now enrolling the grandchildren of the
study's original participants.
There were 2,234 individual men and 2,958 women in
the current study. Participants were stratified by age – less than 60,
60-79 and 80 and older.
“As expected, the prevalence of hypertension
increased markedly with advancing age,” Dr. Lloyd-Jones said. In the
less than 60 age group, 26.9% had high blood pressure; in the 60-79
group, 58.9% had high blood pressure and 70.9% had high blood pressure
in the 80 and older group.
“The overall prevalence of treatment was 65.8%,” he
said. “Treatment rates increased substantially from the younger to old
age group (57.2% to 71.6%) with no further increase in the 80 and
greater ‘old-old’ group (72.9%),” he explained. “However, the number of
antihypertensive medications used was similar across all age groups,
with two-thirds of treated hypertensives using only one medication, 25%
using two and fewer than 10% using three medications.”
Dr. Lloyd-Jones noted that the use of thiazide
diuretics increased steadily with advancing age, but remained
suboptimal. In the age 80 and older group, only 21.8% of men and 32.2%
of women with hypertension were using thiazide diuretics for therapy,
“despite the fact that thiazides have been shown to be extremely
effective in older hypertensive patients.”
Dr. Lloyd-Jones said among hypertensive individuals
in the 1990s, the overall prevalence of blood pressure control (less
than 140 mm Hg systolic and 90 mm Hg diastolic) was 33.7%. Control rates
declined with advancing age, with a more dramatic decline in women.
Among those 80 and older with hypertension, only 32% of men and 24% of
women had their blood pressure under control.
The investigators also showed that the risks
associated with hypertension for the development of cardiovascular
disease, major coronary events and congestive heart failure were
substantially higher in the oldest age group compared with younger
people with high blood pressure.
“There are several major public health implications
to be drawn from the study,” Dr. Lloyd-Jones concluded. “The elderly
have the highest prevalence of hypertension and the risks associated
with hypertension increase with advancing age.
“Treatment principles should be the same for all
age groups,” he said. “Lower initial doses of medications may be needed
to avoid side effects in older patients, but standard doses and multiple
drugs may be required to reach appropriate blood pressure targets.
“That means physicians should start low, and add
more medications as necessary to help their patients reach their blood
pressure goals,” Dr. Lloyd-Jones said. “Poor control is due in part to
an inadequate number of medications and, perhaps, to poor selection of
drug classes.”
The American Society of Hypertension (ASH) is the
largest US organization devoted exclusively to hypertension and related
cardiovascular diseases. ASH is committed to alerting physicians, allied
health professionals and the public about new medical options, facts,
research findings and treatment choices designed to reduce the risk of
cardiovascular disease.
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