Lowering pressure significantly reduces risk of stroke and heart failure for those over 80, study finds

Despite some doctors' reluctance to do so, a new study finds that treating high blood pressure in patients aged 80 years 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 doctors 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 in the US, 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 by the New England Journal of Medicine, to coincide with a presentation at the American College of Cardiology's April annual meeting, in Chicago.

In the 'Hypertension in the Very Elderly Trial', an international team of researchers assigned 3845 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 15mmHg lower than patients receiving a placebo. And their diastolic pressure was 6.1mmHg 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% lower and the rate of death from stroke was reduced by 39%, compared with people receiving a placebo.

In addition, there was a 23% drop in the rate of death from cardiovascular disease, and a 64% 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% 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 emphasised that the treatment given to the patients in the study cannot be generalised 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.

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Originally posted May 2008.

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