A broad review of the use of medications to reduce blood pressure has confirmed that "mild" control of systolic pressure is adequate for adults age 65 or older - in the elderly, there's no clear benefit to more aggressive use of medications to achieve a lower pressure.
Blood pressure is the pressure of the blood in the arteries as it is pumped around the body by the heart. Systolic blood pressure is the top number, (diastolic is the bottom number), which measures the pressure in the arteries when the heart beats (when the heart muscle contracts).
Historically, most medical practitioners tried to achieve control of systolic pressure - the higher of the two blood pressure readings - to 140 or less. Recently changed guidelines now suggest that for adults over 60, keeping the systolic pressure at 150 or less is adequate, and this extensive analysis confirms that.
However, researchers also say in the report that more work needs to be done studying blood pressure in older populations, since most of the research, and the medical guidelines based on them, were done using predominately younger adults.
The review was just published in Drugs & Aging, a professional journal, by scientists from the College of Pharmacy at Oregon State University and Oregon Health & Science University.
"The goal of a systolic pressure at or below 140 has been around a long time, and there's still skepticism among some practitioners about accepting a higher blood pressure," said Leah Goeres, an OSU postdoctoral fellow and lead author on the publication.
"Keeping systolic blood pressure in older adults below 150 is important, it's what we consider a mild level of control," Goeres said. "But for older people that level is also good enough. After an extensive review, there was no significant evidence that more intensive management is necessary."
The issue about how low is low enough, researchers say, is important because blood pressure medications can have unwanted side effects that increase as higher dosages of medications are used. The problem is common - in the United States, about 70 percent of adults age 65 or older have hypertension, and millions of people take medication to control it.
One of the more significant side effects is what's called "orthostatic hypotension," a condition in which a person's blood pressure can suddenly fall when they rise or stand, making them feel light-headed or dizzy, and sometimes leading to dangerous falls. More than 30 percent of people over the age of 80 have this problem.
High blood pressure is a serious health concern, but also one of the most treatable with medication, if such things as diet, exercise, weight management or lifestyle change prove inadequate. Hypertension is often called the "silent killer" because it causes few obvious symptoms, but it weakens blood vessels and has been linked to higher levels of heart attacks, kidney disease and especially stroke.
"There's clearly a value to controlling blood pressure, enough to keep it at 150 or less," said David Lee, an OSU assistant professor of pharmacy practice. "Keeping blood pressure within acceptable levels will lower death rates. But as people get older, there's less clear evidence that stringent control of systolic blood pressure is as important."
The researchers said a goal for the future should be to do more studies specifically with older adult populations and try to identify health situations and conditions that might benefit from different types of management. Such "individualized" treatments, they said, would consider a person's entire health situation instead of treating them based on findings made with large groups.
In this study, the researchers did not find that one approach or another to lowering blood pressure stood out and was clearly better than other alternatives. A variety of medications can be used to treat the condition.
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