High blood pressure not well controlled among older men and women

07/22/05

Nearly three-quarters of men and women age 80 and older have high blood pressure, but their conditions are frequently not kept under control, according to new data from the National Heart, Lung, and Blood Institute's (NHLBI) long-standing Framingham Heart Study. In this age group, only 38 percent of men and 23 percent of women had blood pressures that met targets set forth in the National High Blood Pressure Education Program's (NHBPEP) clinical guidelines.

Full study results will be published in the July 27, 2005, edition of the Journal of the American Medical Association.

This study shows that while the rate of high blood pressure increased with age, numbers of people receiving treatment for the condition did not. Seventy-four percent of people age 80 and older had high blood pressure, compared with 63 percent of those age 60 to 79 and 27 percent of those under the age of 60. However, less than two thirds of hypertensive patients in the two older age groups received treatment.

High blood pressure, also called hypertension, is a major risk factor for the development of heart disease and a leading cause of many life-threatening conditions such as stroke, heart attack, and kidney failure.

"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 Daniel Levy, M.D., director of the Framingham Heart Study and a study co-author. "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."

Investigators from the Framingham Heart Study, a landmark epidemiological study that began in 1948, analyzed data from its original cohort of participants, enrolled in 1948-1952, and their offspring, enrolled 1971-1973. In all, this study included 5,296 participants contributing 14,458 total examinations over the period studied. High blood pressure was defined as a systolic blood pressure of greater or equal to 140 mm Hg or diastolic blood pressure greater than or equal to 90 mm Hg, or taking medication for reducing blood pressure. Normal blood pressure is less than 120 mm Hg systolic and less than 80 mm Hg diastolic.

According to the authors, the data suggest that the poor control rates may be due in part to poor selection of drug classes or from the use of a single drug for therapy. Among all ages studied, 60 percent of patients were treated with only one antihypertensive medication, and only 23 percent of men and 38 percent of women over age 80 were being treated with a diuretic.

Guidelines issued by NHLBI's NHBPEP state that most high blood pressure patients will require two or more medications to get blood pressure down to target levels, and that a diuretic should be one of the medications used. Diuretics have been shown to be more beneficial in lowering blood pressure and protecting against adverse complications of hypertension.

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