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Should elderly blood pressure therapy be limited?

Wednesday December 23rd, 2009

By Jane Collingwood
Elderly people are often over-treated for high blood pressure, an expert claims today.

Dr James Wright of the Cochrane Hypertension Review Group in Vancouver, Canada, believes that a less aggressive approach may be best.

On the British Medical Journal Clinical Evidence website, he challenges UK guidelines that recommend people over 80 should receive the same treatment as younger patients.

The guidelines, from the National Institute for Health and Clinical Excellence (NICE), involve a combination of ACE inhibitors, calcium channel blockers, and diuretics, as well as potentially drugs from other classes, to reach a target blood pressure of 140/90 mmHg. But "the results of a recently updated Cochrane review suggest that our present approach may be excessively aggressive."

Dr Wright says blood pressure drugs can reduce fatal stroke but may raise death from other causes. Only trials that took a conservative approach to treatment - in terms of number of drugs and dose of drugs allowed - led to a significant reduction in death rates.

The regime that Dr Wright recommends was used in the Hypertension in the Very Elderly Trial (HYVET).

It comprises initial treatment with the lowest dose of a thiazide or thiazide-like diuretic, then half the recommended starting dose of an ACE inhibitor, building up to double the dose of the ACE inhibitor.

"Using this approach would require little adjustment of drug doses and would markedly simplify and reduce the cost of managing these patients," he writes.

The proportion of patients achieving optimum blood pressure levels would not meet Quality and Outcomes Framework targets, but Dr Wright urges clinicians to use this conservative approach. "I have done so with my patients," he concludes.

But British experts warned that the elderly still need treatment for high blood pressure.

Ellen Mason, a senior cardiac nurse with the British Heart Foundation, called for more studies of the best treatment for elderly people.

She said: "It is important that high blood pressure is treated in people of all ages as it causes an increased risk of stroke and is a risk factor for heart disease."

* A second study today warns that Britain is facing a massive increase in its elderly population.

The British Medical Journal says the numbers will increase by a third by 2020.

Wright, J. M. Treating hypertension in the over 80s: putting the evidence into context.BMJ Clinical Evidence December 2009

Tags: Geriatric Health | Heart Health | North America | Pharmaceuticals | UK News

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