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Far too many people 80 and older have high blood pressure, get poor treatment and needlessly suffer such deadly consequences as heart attacks and strokes, a study reports today.
The research involved 2,317 men and 2,979 women in the Framingham Heart Study, an analysis of heart disease in residents of a Massachusetts community. The study began 54 years ago.
Nearly two-thirds of the participants 80 and older had high blood pressure, yet just 38% of men and 23% of women were treated sufficiently to push their blood pressure to a target level of 140/90 or below.
"Older patients are not being treated, and when they are treated are not being treated aggressively enough," says Framingham study director Daniel Levy, a co-author of the report in today's Journal of the American Medical Association.
Blood pressure creeps up with age for many reasons, including hormonal changes, hardening of the arteries and aging kidneys that don't clear fluid from the blood as efficiently as they once did. Many doctors have long believed that increased blood pressure was necessary to sustain aging organs.
"The conventional wisdom was 'Leave Grandpa alone,'" says Edward Roccella of the National Heart, Lung, and Blood Institute, which sponsored the study.
The study showed how risky that is. Nearly 25% of older study participants with severe high blood pressure had strokes, heart attacks or other serious cardiovascular problems.
"Rather than spending the last 10 years of your life rehabilitating a stroke, you can prevent it," he says. "This has implications for lowering health care costs. And having a healthy grandma or grandpa around is a real neat thing in many households."
Treatment guidelines advise using more than one drug to boost potency and minimize side effects. Doctors also can combine a diuretic that siphons fluid out of the blood with one or more drugs that relax arteries and lighten the heart's workload.
Despite the guidelines, almost two-thirds of the older patients were being given just one drug.
"If there's anything we've learned in the past decade, it's that it is going to require two medications for the vast majority of people with hypertension to get to goal," says lead researcher Donald Lloyd-Jones of the Northwestern University School of Medicine.
One medicine that should be considered, Lloyd-Jones says, is an inexpensive, generic thaizide diuretic.
Despite their low cost and demonstrated effectiveness, thiazides were prescribed to just 23% of men and 38% of women in the study.
The diuretic "has gotten something of a bad reputation," Lloyd-Jones says. "It may accelerate the onset of diabetes, and, if not used carefully, precipitate a gout attack in someone who has gout. But compared with having a stroke, those are manageable side effects."
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