by Dr. S. Russell Vester, MD
22. June 2011 08:00
Many doctors and patients harbor the notion that as people get older they don’t need as careful attention to their blood pressure as they did in their younger years. For unclear reasons the notion had developed that once you are 80 years old you somehow are able to “tolerate” blood pressure on the higher side without undue consequences. Recent studies have shown this to be decidedly untrue.
In 2008 the HYVET (HYpertension in the Very Elderly Trial) data clearly demonstrated the benefits of good blood pressure control in the 80 and over age group. There was a 30% reduction in strokes, 23% reduction in cardiac deaths, a 64% reduction in heart failure and 21% reduction in all-cause mortality. Wow! Wow! Wow!
As a result of this study’s findings and other available information, the American Heart Association and the American College of Cardiology have recently issued their first set of guidelines for management of blood pressures in those more senior. For individuals in the 65 to 79 year age group, blood pressure should be maintained at less than 140/90 mmHg. For age 80 and over a slight increase in the upper number (systolic) to 145 mmHg is acceptable.
One of the biggest problems with blood pressure management in the elderly is simply the cost of medications. A fixed income makes it difficult to afford one or more new pills. One would think that the substantial reductions in stroke and heart failure seen with good blood pressure control would generate large savings in overall health care costs. This stands to reason in my book. Unfortunately this has yet to be proven, so additional financial help for seniors is not on the horizon until some enterprising researcher puts the HYVET data through a thorough cost/benefit analysis.
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