Despite an increase in the prevalence of hypertension after age 60, elderly patients are not receiving the treatment they need, according to new findings from the National Heart, Lung and Blood Institute’s Framingham Heart Study.
The study was published in full in the July 27Journal of the American Medical Association; you can read the study abstract online at no charge.
The study involved 5,296 participants from 1990 to 1999. Of these, 27 percent of people younger than 60, 63 percent of people 60 to 79 and 74 percent of people 80 and older had high blood pressure.
According to clinical standards established in the seventh report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure, part of NHLBI's National High Blood Pressure Education Program, hypertension in most patients is considered "controlled" when systolic BP is maintained at less than 140 mm Hg and diastolic BP is kept at less than 90 mm Hg. For those with diabetes or chronic kidney disease, control is defined as systolic BP of less than 130 and diastolic BP of less than 80.
While rates for men with controlled hypertension in the current study held fairly constant at between 36 and 38 percent for the three age groups, women’s control rates decreased markedly with age, dropping from 38 percent for women younger than 60 to 28 percent in the 60- to 79-year-old group and resting at 23 percent for women older than 80.
One of the causes of this difficulty achieving adequate control, said the study's authors, may be poor drug class selection or reliance on single-drug therapy. According to the study, 60 percent of patients overall were treated with only one hypertensive medication. Among treated patients 80 and older, only 23 percent of men and 38 percent of women received a diuretic. NHBPEP guidelines recommend at least two medications to bring blood pressure down to the target level.
The study also found relative risks for cardiovascular disease associated with increased BP levels did not decline with advancing age; absolute risks for CVD actually rose among patients in these older age groups.
