High Blood Pressure Treatment for the Elderly May Be Overaggressive

Evidence-based data suggest that people who are over 80 years old are being treated too aggressively for high blood pressure, warns a new editorial.

According to James M Wright, M.D., Ph.D., coordinating editor of the Cochrane Hypertension Review Group (Vancouver, BC, Canada), data from an updated review of hypertension in the elderly, published in the October 2009 issue of the Cochrane Review, demonstrates that antihypertensive treatment has significantly reduced the proportion of people who had a fatal or nonfatal stroke or MI (compared with placebo). In practical terms, however, the reduction in total cardiovascular events was in fact predominantly the result of a reduction in fatal and nonfatal stroke, but without any concomitant reduction in total mortality. According to Dr. Wright, this could suggest that antihypertensive treatment is increasing other fatal events, and that the magnitude of that harm is similar to the benefit.

The updated Cochrane review included data from two new trials that looked specifically at the effect of antihypertensive drugs in people over the age of 80. Interestingly, the only trial that found a significant reduction in mortality was the most conservative in terms of number of drugs and dose of drugs allowed, involving three easy steps, with a target blood pressure of 150/80 mmHg. Dr. Wright points out that in reality, only half of the people on this regimen would actually achieve a target blood pressure of 150/80 mmHg, which is below current recommendations in the United Kingdom (UK) that suggest that 70% of all patients should meet treatment targets. The guest editorial was published on December 28, 2009, in BMJ Clinical Evidence.

"The proper treatment of elevated blood pressure in those over 80 is clearly important for clinicians, as this is a growing population with a high prevalence of hypertension; but the results of a recently updated Cochrane review, of which I was a coauthor, suggest that our present approach may be excessively aggressive,” explained Dr. Wright. "Clinicians should change what they are presently doing and move towards a more conservative approach for people aged over 80.”

The UK National Institute for Clinical Excellence (NICE; London; United Kingdom) guidelines state that people over 80 should receive the same treatment as people of any other age, using an increasing combination of ACE inhibitors, calcium channel blockers, and diuretics, as well as potentially adding drugs from other classes, to reach a target blood pressure of 140/90 mmHg.

Related Links:
Cochrane Hypertension Review Group
UK National Institute for Clinical Excellence