Experts Offer New Guidance for Blood Pressure Control in Elderly

MONDAY April 25, 2011 -- Elderly Americans are at high risk for high blood pressure and related health problems and death, but lifestyle changes and proper use of medicines can reduce these risks, says a clinical guidance statement released Monday by the American Heart Association and the American College of Cardiology.

High blood pressure, or hypertension, affects 78 percent of older women and 64 percent of older men in the United States, increasing their risk for heart disease, kidney disease and diabetes. Among those 80 and older, only one-third of men and one-quarter of women have adequate control of their blood pressure.

Controlling blood pressure in elderly patients is much more cost-effective than treating heart problems that result from uncontrolled hypertension, but many doctors don't treat hypertension in these patients because they worry that doing so will increase the risk of death, explained American College of Cardiology/American Heart Association (ACC/AHA) writing committee co-chair Dr. Wilbert S. Aronow, clinical professor of medicine at New York Medical College/Westchester Medical Center.

"Treating hypertension in the elderly is particularly challenging because they usually have several health problems and a greater prevalence of cardiovascular risk factors and cardiac events," Aronow said in an ACC/AHA news release. "There also needs to be greater vigilance to avoid treatment-related side effects such as electrolyte disturbances, renal dysfunction and excessive orthostatic blood pressure decline."

The clinical guidance statement is meant to help doctors safely and effectively manage hypertension in elderly patients. The decision to develop the statement was prompted by results released in 2008 from the Hypertension in the Very Elderly Trial. This large trial found that high blood pressure treatment in people 80 and older led to 30 percent fewer strokes, 23 percent fewer cardiac deaths, 64 percent fewer cases of heart failure, and a 21 percent drop in death from all causes.

Among the recommendations in the clinical guidance statement:

  • Routine monitoring of blood pressure, including taking blood pressure readings while a patient is standing.
  • The appropriate therapeutic targets are blood pressure levels of less than 140/90 mm Hg in people aged 65 to 79, and a systolic blood pressure (the top number in a blood pressure reading) between 140 and 145 mm Hg in people 80 and older if tolerated.
  • Use of medications, when appropriate, based on efficacy, tolerability, the presence of other health problems, and cost.
  • When beginning treatment with antihypertensive drugs, doctors should generally begin with the lowest dose and gradually increase the dose as tolerated by the patient.
  • Patients should be encouraged to make lifestyle changes to prevent and treat high blood pressure. These changes include regular physical activity, restricted salt intake, weight control, quitting smoking, and limiting alcohol intake.

The statement authors also noted that the high cost of antihypertensive drugs is a factor in low rates of blood pressure control among the elderly, and doctors should discuss this issue with patients.

The statement, which appears on the ACC and AHA websites, will be published in the May 17 issue of the Journal of the American College of Cardiology.

More information

The U.S. National Institute on Aging has more about high blood pressure.

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Posted: April 2011


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