Elderly Can Benefit From High Blood Pressure Treatment

By Steven Reinberg
Despite some doctors' reluctance to do so, a new study finds that treating high blood pressure in patients 80 age and older can reduce the rate of stroke, heart failure and death from cardiovascular disease.
The degree to which elderly patients receive treatment for a variety of conditions, including high blood pressure, is controversial, with some physicians believing that aggressive treatment may do more harm than good.
"This elderly population is growing dramatically and we lack much information about how best to care for these patients," said Dr. Harlan M. Krumholz, a professor of medicine at Yale University School of Medicine, who was not involved in the study.
Many doctors often think these patients are too old to treat, Krumholz said. "We get nihilistic by saying, 'Someone's 80 years old, what are you going to do at this point?' " he said. "The older you are, the less aggressively we treat you."
The study results were released Monday by the New England Journal of Medicine, to coincide with a presentation at the American College of Cardiology's annual meeting, in Chicago.
In the Hypertension in the Very Elderly Trial, an international team of researchers assigned 3,845 people 80 and older with high blood pressure to be treated with either a diuretic to lower their blood pressure or to receive a placebo.
After two years of therapy, the systolic blood pressure among patients taking the diuretic was 15 mmHg lower than patients receiving a placebo. And their diastolic pressure was 6.1 mmHg lower than the placebo patients, the researchers found. Systolic and diastolic pressures are the top and bottom numbers in a reading, respectively.
Most important, the rate of stroke among patients receiving the blood pressure medication was 30 percent lower and the rate of death from stroke was reduced by 39 percent, compared with people receiving a placebo.
In addition, there was a 23 percent drop in the rate of death from cardiovascular disease, and a 64 percent reduction in the rate of heart failure among patients receiving a diuretic, compared with those receiving a placebo. There were also fewer adverse events among people on the blood pressure medication, and a 21 percent drop in the rate of death from all causes, according to the study.
"In the elderly, acts of omission are tolerated much more than acts of commission," Krumholz said. "Somehow we are much more comfortable with neglecting something and saying, 'This is just nature taking its course,' than saying, 'We may have an opportunity to make a difference here,' " he said.
Studies like this reassure doctors that treating the elderly can be beneficial, he added.
Krumholz emphasized that the treatment given to the patients in the study cannot be generalized to include other medication regimens. "It may be true that certain medication regimens are better than others. If we want to use other regimens than we must study them," he said.
Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, agreed that the new study should encourage doctors to treat elderly patients with high blood pressure more aggressively.
"This study convincingly demonstrates that the benefits of treating high blood pressure in patients age 80 and above greatly outweighs the risks," he said.