Blood Pressure Control Lacking in People Over 80
Nearly one in three Americans has ]]>high blood pressure]]> , or hypertension. Your risk of developing high blood pressure increases as you get older. Uncontrolled high blood pressure may eventually lead to cardiovascular disease, including ]]>stroke]]> , ]]>heart attack]]> , and ]]>heart failure]]> .
Fortunately, high blood pressure can be treated. When diet and exercise alone cannot lower blood pressure to desired levels, physicians may prescribe one or more blood pressure-lowering medications. These medications, including thiazide diuretics, beta-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors, can be extremely effective in controlling high blood pressure.
Despite the available treatments, rates of blood pressure treatment and control are still relatively low among people with high blood pressure. A new study in the July 27, 2005 issue of the Journal of the American Medical Association examined the rates of high blood pressure, as well as its treatment and control, in people ages 80 and older. The researchers found that most of these people had high blood pressure that was often left untreated or uncontrolled.
About the Study
This study summarized the results of 14,458 physical examinations undergone by 5,296 participants of the Framingham Heart Study. The participants were free from known cardiovascular disease at the time of examination. During the examinations, physicians measured the participants’ blood pressure. Blood pressure status was categorized using the following criteria:
|Blood pressure category||Systolic blood pressure, or “top number” (mmHg)||Diastolic blood pressure, or “bottom number” (mmHg)|
|Normal||Less than 120||Less than 80|
|Stage 1 hypertension||140-159||90-99|
|Stage 2 hypertension||160 or higher||100 or higher|
People taking high blood pressure medications were considered to have stage 2 hypertension.
For up to six years, the researchers tracked whether the participants developed cardiovascular disease.
The participants were divided into three age categories: younger than 60 years (youngest), 60-79 years (older), and 80 years or older (oldest). The researchers compared the rates of high blood pressure, its treatment, its control (defined as treated blood pressure less than 140/90 mm Hg), and the development of cardiovascular disease among the different age groups.
The oldest participants were significantly more likely than the other age groups to have high blood pressure. Specifically, the oldest participants had a 74% prevalence of hypertension, compared with 27% and 63% in the youngest and older groups, respectively. There was only a 7% prevalence of normal blood pressure in the oldest group, compared with 39% in the youngest group and 14% in the older group.
Overall, 69% of the participants with high blood pressure were being treated. Those ages 60 and older were significantly more likely than younger participants to be receiving blood pressure treatment. However, the prevalence of blood pressure control declined with age, due to markedly low rates of control in older women.
Blood pressure control was low in participants being treated with blood pressure medications (47% control in treated participants overall). In these participants, rates of control significantly declined with age in both men and women.
As blood pressure increased, the risk of having cardiovascular disease increased more markedly in the oldest participants. In these participants, major cardiovascular events (e.g., heart attack, stroke) occurred in 10% of those with normal blood pressure, in 20% with prehypertension or stage 1 hypertension, and in 25% with stage 2 hypertension.
How Does This Affect You?
These results suggest that while people ages 80 and older are most likely to have high blood pressure, their rates of blood pressure treatment and control are unacceptably low. And the strong link between high blood pressure and cardiovascular disease in this group suggests they have the most to gain from high blood pressure treatment.
Why is high blood pressure in people ages 80 and older so under-treated? The authors of this study suggest that physicians may be reluctant to prescribe aggressive blood pressure treatments to their older patients because some feel the risks of treatment (such as lightheadedness and subsequent falls) may outweigh the benefits in this population. However, this study supports previous research by suggesting that treating high blood pressure in older people has substantial benefits.
It is important to monitor and control your blood pressure throughout your lifetime. No matter what your age, eating a low-sodium, low-fat diet and exercising regularly can help keep your blood pressure under control. When this isn’t enough, your physician may decide to prescribe you blood pressure medications.
American Heart Association
National Heart, Lung, and Blood Institute
High blood pressure. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=2114 . Accessed July 26, 2005.
Lloyd-Jones DM, Evans JC, Levy D. Hypertension in adults across the age spectrum: current outcomes and control in the community. JAMA . 2005;294:466-472.
Last reviewed July 28, 2005 by ]]>Richard Glickman-Simon, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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