September 22, 2005

Blood pressure poorly controlled in elderly

By Elizabeth Crown

Controlling high blood pressure in individuals age 80 years and older has become a major national health problem, according to a study published in JAMA.

The study found that almost three fourths of those 80 years and older have hypertension — blood pressure greater than 140 systolic over greater than 90 diastolic. Fewer than 10 percent have “normal” blood pressure levels — less than 120 systolic over less than 80 diastolic.

The research, which was based on data from the National Heart, Blood, and Lung Institute’s long-standing Framingham Heart Study, also found that older hypertensive women are especially at risk for having poorly controlled hypertension.

Risks for cardiovascular disease also are substantial in this population, indicating the need for greater efforts at safe, effective risk reduction among the oldest hypertensive persons. Among men and women study participants with the highest levels of blood pressure at age 80 or older, 25 percent had a major cardiovascular event (heart attack, stroke or hospitalization for heart failure) within six years’ follow-up.

“Greater public health and clinical efforts are needed for patients and physicians to improve awareness of the risks of hypertension, to understand the benefits and potential risks of treatment and to identify safe and effective strategies for blood pressure and overall cardiovascular disease risk reduction in the oldest hypertensive individuals,” said Donald Lloyd-Jones, M.D., assistant professor of preventive medicine, who was lead author on the article.

The very elderly are among the fastest growing segments of the U.S. population and they have the highest prevalence of hypertension. It is rare to escape the development of hypertension with aging: Even for individuals free of hypertension at age 65, the remaining lifetime risk of developing hypertension is approximately 90 percent, Lloyd-Jones said.

Despite numerous clinical studies showing the benefits of lowering blood pressure in older hypertensive persons, data suggest that rates of treatment and control are less than optimal and that risks for cardiovascular disease are substantial, according to Lloyd-Jones.