Treating systolic high blood pressure in older persons is beneficial

Treatment to lower systolic high blood pressure in older persons is associated with substantial reduction of stroke and other cardiovascular diseases, Yale researchers report in the September 1 issue of Journal of the American Medical Association.

The Yale team critically reviewed medical literature on systolic blood pressure (SBP) in older persons between 1966 and 2004. They found strong clinical evidence to support the treatment of persons with systolic blood pressure of at least 160 mm Hg.

“Physicians and patients should pursue treatment of hypertension for SBP in this range,” said first author Sarwat I. Chaudhry, M.D., postdoctoral fellow in Internal Medicine at Yale School of Medicine and postdoctoral research fellow at the West Haven VA Connecticut Healthcare System. “Systolic hypertension in this range is not a consequence of normal aging. The old adage ’systolic blood pressure equals age plus 100’ is outdated and should be abandoned.”

Chaudhry and co-authors JoAnne Micale Foody, M.D. and Harlan M. Krumholz, M.D., concluded that large-scale trials to assess the value of therapy for older patients with SBP 140-159 mm Hg have not been performed. “Recommendations to treat these patients are based on observational studies that show a graded relationship of cardiovascular risk with increasing SBP, but evidence to prove a benefit of treatment of hypertension in these patients is largely lacking,” Chaudhry said. “Therefore, treatment decisions in this group should be more sensitive to patient preferences and tolerance of therapy.”

The decision whether to lower blood pressure in older patients is often challenging. Chaudhry said although the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) states that a blood pressure of greater than or equal to 140/90 mm Hg warrants pharmacological therapy irrespective of age, no clinical trial evidence is available to demonstrate that reducing a blood pressure of 140-159 mm Hg in older persons improves morbidity or mortality.

“Hypertension treatment decisions, particularly in older persons, must often rely on extrapolations, and fall into a gray area where optimal choice for an individual patient may be unclear and people might choose differently,” said Foody. “In these instances, patients must understand the probable outcomes of options; consider the personal value they place on benefits versus risks; and share decision making with their practitioners.”