Experts Offer New Guidance for Blood Pressure Control in
MONDAY, April 25 (HealthDay News) -- 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
"As we age, high blood pressure is often part of the process," noted one expert, Dr. Suzanne Steinbaum, a preventive cardiologist at Lenox Hill Hospital in New York City. "In fact, 78 percent of women and 64 percent of men over the age of 65 have high blood pressure, which can potentially lead to devastating illnesses like heart attacks, strokes, heart failure, and atrial fibrillation," she said.
According to the AHA, among those 80 and older, only one-third
of men and one-quarter of women have adequate control of their
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
- 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 also be encouraged to make lifestyle changes to
prevent and treat high blood pressure.
Steinbaum agreed with the last point, especially.
"Lifestyle management could be helpful in managing high blood pressure, with exercise, drinking in moderation, not smoking, and maintaining a low-salt diet," she said.
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
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.
The U.S. National Institute on Aging has more about
high blood pressure.
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