Older Patients Need Better Guidelines for Optimal Treatment of High Blood Pressure

Abstract

Effective drug-based treatment of hypertension is now a mainstay of adult preventive medicine. The first clinical trials demonstrated the benefit of lowering diastolic pressure in middle-aged participants.1 Extension of drug treatment to older populations with high systolic pressures has likewise been clearly shown to prevent cardiovascular disease and is universally accepted for medical practice.2 The high prevalence of predominant or isolated systolic hypertension in older groups, coupled with the evidence from trials, has then led to guidelines that exhort the need to treat and control hypertension based on goal blood pressures far lower than had been accepted in the past.3 These efforts have been successful, as recent surveys from the United States and England report higher control rates for older groups compared with previous assessments. In part, these trends may be attributable either to more older patients receiving any drug treatment or to more aggressive deployment of drug classes and higher doses. On the other hand, where treatment of hypertension is already widely available, as in the US Veterans’ Affairs system, control rates for hypertension now are higher in middle-aged groups compared with older ones.4 In assessing the effect of age on control of hypertension, it is crucial that all of the relevant factors be included: adherence to medication; use of appropriate medications, ie, drug classes and dosing; and explanation of dropout or refusal rates (adverse effects, cost, and health beliefs). Present practice databases may contain relevant information for some of these factors so that exploration of their content may …