Blood Pressure Control Poor In Women Over 80

Women older than 80 have poor control of their blood pressure, and sub-optimal treatment may be part of the problem, according to data from a long-running heart study.

The data suggest “major gaps in the implementation of anti-hypertensive therapies recommended by current guidelines,” contended Donald Lloyd-Jones, M.D., of Northwestern University’s Feinberg School of Medicine in the July 27 issue of the Journal of the American Medical Association.

Dr. Lloyd-Jones and colleagues analyzed data on hypertension collected during the 1990s by the Framingham Heart Study, with the goal of understanding how the condition affects those 80 or older.

The researchers analyzed data from 5,296 study participants, who took part in 14,458 medical examinations between Jan. 1, 1990, and Dec. 31, 1999. The participants were divided into three age categories—younger than 60, 60 to 79, and 80 and older.

“It is rare to escape the development of hypertension with aging,” Dr. Lloyd-Jones and colleagues noted.

And indeed, as expected, the prevalence of hypertension and drug treatment among the Framingham study participants increased with advancing age—to 74% and 74.2%, respectively, among the oldest group.

Among all participants with hypertension (including those who were not treated), the rate of control of blood pressure—defined as achieving a systolic pressure of less than 140 mm hg and diastolic pressure of less than 90—was 32.4%.

But this overall control rate fell with age, due “entirely to the substantially lower rates of control” in older women, the researchers say.

The control rate fell from 38% for the youngest group of women, to 28% for the middle group, and to 23% for those over 80. The result was statistically significant at the p<0.001 confidence level.

For men in all three age groups, control rates did not differ significantly.

The poor control found in the study may be partly due to lack of combination therapy with anti-hypertensive drugs; the researchers found that 60% of the treated subjects were using only a single medication, despite evidence that synergistic combinations achieve better results.

Also, among the treated patients older than 80, only 23% of men and 38% of women were using thiazide diuretic agents, “despite a wealth of evidence suggesting that (they) are the most cost effective agents for blood pressure reduction, and that they are particularly efficacious among the elderly,” the researchers said.

Study participants were followed for up to six years to examine the risk of cardiovascular events in the very elderly, broken down by the stage of hypertension.

Such events occurred in 9.5% of those with normal blood pressure, 19.8% of those with pre-hypertension, 20.3% of those with stage 1 hypertension, and 24.7% of those with stage 2 or treated hypertension.

“Short-term risks for cardiovascular disease are substantial,” Dr. Lloyd-Jones and colleagues concluded.

Whether aggressive intervention is a useful strategy in the very elderly has been controversial, the researchers noted, but current data imply that treatment of hypertension can sharply reduce the risk of stroke, major cardiovascular disease, and congestive heart failure.

“The very elderly group is one of the fastest growing in the U.S. population,” Dr. Lloyd-Jones and colleagues noted, calling for “urgent public health measures” to improve treatment and control of hypertension in the very elderly.

Source: Journal of the American Medical Association

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