Should High Blood Pressure In Seniors Be Treated Differently?
December 24, 2009
People over 80 years are being treated too aggressively for high blood pressure, warns Dr. James Wright, Coordinating Editor of the Cochrane Hypertension Review Group, in an editorial in BMJ Clinical Evidence this week, citing the latest evidence suggests that less aggressive drug therapy may be more effective at reducing mortality in this age group. Dr. Wright suggests clinicians change what they are presently doing and move towards a more conservative approach for people aged over 80. Despite limited evidence about high blood pressure, or hypertension, treatment in the over 80s, UK and US guidelines recommend that people over 80 should receive the same treatment as people of any other age. This means using combinations of drugs to reach a target blood pressure of 140/90 mmHg. However, a recently updated Cochrane review suggests that the present approach may be "excessively aggressive." The review includes data from two new trials that looked specifically at the effect of high blood pressure drugs in people over the age of 80. 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, with a treatment regime involving three easy steps, with a target blood pressure of 150/80 mmHg. Using this approach would require little adjustment of drug doses and would markedly simplify and reduce the cost of managing these patients, says Wright. However, he does point out that only 50% of the people on this regimen would achieve the target blood pressure, which below recommendations set out for UK GPs in the Quality and Outcomes Framework (QOF), suggesting that 70% of all patients should meet treatment targets. Trials are now needed to compare this conservative approach with the more aggressive treatment strategies in common use today, he writes. In the meantime, he suggests that clinicians change what they are doing and move toward a more conservative approach for people aged over 80.
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