Older people may benefit from tighter blood pressure control. A recent study, called the Systolic Blood Pressure Intervention Trial (SPRINT) found that more aggressive treatment of hypertension in people aged 75 or older resulted in significantly fewer deaths from any medical cause. During the follow-up period of three years, there were fewer fatal and nonfatal heart attacks and strokes when doctors aimed to keep the systolic blood pressure (upper reading) of older patients below a target of 120 mm Hg compared with a more usual target of 140 mmHg.
Current blood pressure targets for older people
The usual aim of treatment for people aged 80 and over is to achieve a blood pressure of below 145/80mmHg. Some doctors prefer not to reduce systolic blood pressure to less than 160mmHg in case going too low (hypotension) results in dizziness, faints, confusion, falls and bone fractures.
In the SPRINT study, however, the benefits of intensive blood pressure control were consistent whether or not people in this older age group (of which the average age was 80) were frail or less mobile. Small increases were seen in the number of episodes of feeling faint but these appeared to be more than offset by the large benefits of treatment.
There is a note of caution, however, since older persons with a systolic blood pressure of less than 110 mmHg on standing were excluded from this study. This means the risk of faints and falls may well have been underestimated.
As three out of four people over the age of 75 have hypertension, this latest finding, has important implications for treating older people. The downside is that achieving a systolic blood pressure of below 120mmHg means having to take more medication. On average, the benefits that resulted from intensive therapy required treatment with one additional antihypertensive drug, and more frequent visits to monitor the response and adjust the dose.
The researchers, writing in the Journal of the American Medical Association, suggest a stepwise approach to treating hypertension in older people.
- First, doctors should aim to achieve a systolic blood pressure of less than 140 mm Hg.
- If this is well tolerated, they can either increase the dose or add in another drug to achieve a systolic blood pressure of less than 130 mm Hg.
- After that, the decision about whether or not to go lower is less clear.
The choice of which blood pressure medication to use will depend on doctor and patient preference, as the benefits of treatment are due to the lowering of blood pressure rather than which drug is used.
Which antihypertensive drug is best for older people?
The usual first-line medication choices are diuretics, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor antagonists. Beta blockers may be used in patients with coronary heart disease, abnormal heart rhythms such as atrial fibrillation or congestive heart failure. Combination drug preparations are also useful to avoid having to take multiple drugs.
If your blood pressure is not well controlled, it is important to consult your doctor – whatever your age – or you have an increased risk of experiencing a complication such as a heart attack, stroke, congestive heart failure, kidney failure and of developing an aortic aneurysm.
If your blood pressure is raised, self-monitoring is key to maintaining good control.
Click here for advice on choosing a blood pressure monitor to use at home.
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