Few Seniors Have Normal Blood Pressure, Study Finds

Less than 10 percent of those 80 and older have normal blood-pressure levels, according to a new study that finds managing high blood pressure in the very old has become a major chronic health issue.

The research, published Wednesday in The Journal of the American Medical Association, was based on data from the National Heart, Blood and Lung Institute’s long-running Framingham Heart Study. The results indicate that advances in treating high blood pressure may not be reaching many of the very old, particularly women.

"Many more men and women are now living healthy and active lives into their 80s and 90s. As clinicians, we should not loosen our management of high blood pressure just because a patient has had the good fortune to reach an older age," said Dr. Daniel Levy, director of the Framingham Heart Study and a co-author of the report.

"For these patients, managing high blood pressure may make the difference between living many more healthy years, or spending those years recovering from a debilitating stroke or heart attack."

High blood pressure, or hypertension, is a major risk factor for developing heart disease and a leading cause of life-threatening conditions including stroke, heart attack and kidney failure.

The study found that almost three-quarters of those 80 and older have hypertension, defined as a reading of equal to or greater than 140 systolic (beating heart) over a diastolic (resting heart) reading of equal to or greater than 90. Fewer than 10 percent had normal levels of less than 120 over less than 80.

The researchers, led by Dr. Donald Lloyd-Jones, an assistant professor of preventive medicine at Northwestern University in Chicago, looked at data from the original group of Framingham patients who enrolled between 1948 and 1952 and from their offspring, who entered the study between 1971 and 1973. In all, blood-pressure readings and other health data were included for 5,292 people, including about 3,000 women.

Among men and women age 80 and older in the study with the highest levels of blood pressure, 25 percent had a heart attack, stroke or were hospitalized for heart failure within six years.

Lloyd-Jones noted that it is rare to escape hypertension as we age. Even for a person with normal blood pressure at age 65, the remaining lifetime risk of developing high blood pressure is nearly 90 percent. Most of the time, the high readings come on the high (beating heart) number rather than the resting-heart number.

Although current guidelines suggest that most high-blood-pressure patients need to take at least two medications, including diuretics (water pills), to get their pressure down to target levels, that wasn’t happening in the oldest patients.

Sixty-two percent of the oldest hypertensive patients were getting just one drug, and only 23 percent of men and 38 percent of women were taking a diuretic.

Instead, the researchers found "a high prevalence of use of more expensive agents such as ACE inhibitors and other classes of drugs, such as alpha blockers, although data supporting their effectiveness in older hypertensive patients is limited," according to the study.

The researchers noted that doctors may be reluctant to treat older patients as aggressively for high blood pressure due to a perception that the benefits are limited or because they’re concerned that side effects of drugs may prove worse than the condition itself for a frail elderly person’s quality of life.

"There is no question that benefits of antihypertensive therapy is enhanced in the elderly, but so are the side effects," said Dr. Franz Messerli, director of the hypertension program at St. Luke’s-Roosevelt Hospital in New York City and a leading expert on the condition who was not involved in the research.

"Diuretics, although in general underused, may cause dehydration leading to weakness, orthostatic symptoms (sudden plunges in blood pressure) and even syncopy (blackouts) in susceptible patients."

Messerli said it’s a bad idea for doctors to try to lower blood pressure in all elderly people without regard to their overall condition."The ‘sledgehammer’ approach _ that everybody’s blood pressure should be hammered down to below 140 _ is inappropriate in octogenarians," he said.

On the Net: http://www.jama.com

www.nhlbi.nih.gov/guidelines/hypertension/index.htm

BREAKOUT MATERIAL

High blood pressure is defined as readings equal to or greater than 140 (when the heart is beating) over greater than or equal to 90 (when the heart is resting).

Hypertension is a fact of aging for most people. Even if you don’t have high blood pressure at age 65, the odds are 9 in 10 that you’ll develop it later. Among people 80 and older, only about 8 percent of men and 6 percent of women have blood-pressure readings in the normal range, according to a new study.

The study found that while 38 percent of people 60 and younger with hypertension have the condition controlled; among people 80 and older, that rate falls to 38 percent for men and 23 percent for women.

(Contact Lee Bowman at BowmanL(at)SHNS.com. Distributed by Scripps Howard News Service, http://www.shns.com)

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