Study: Is Hypertension Over-Treated?

In older adults, mild control of systolic pressure is good enough, an Oregon research team has found. Writing in Drugs & Aging, Leah Goeres and colleagues at the College of Pharmacy at Oregon State University and Oregon Health & Science University said that for adults age 60 and over, a reading of 150 for systolic blood pressure (SPB) is adequate—upsetting the conventional wisdom that these patients should get enough medications or other treatments to bring SPB down to 140.

About 70% of adults age 65 or older have hypertension, and millions take medication for the condition, the authors noted.

“Keeping systolic blood pressure in older adults below 150 is important, it’s what we consider a mild level of control,” Goeres said in an article on the university’s website. “But for older people that level is also good enough."

After an extensive review of studies published on MEDLINE and ClinicalTrials.gov, the team found 31 studies that tracked blood pressure targets and had endpoints of cardiovascular morbidity, mortality, and any harm done by antihypertensive medications.

“Keeping blood pressure within acceptable levels will lower death rates,” said co-author David Lee, “But as people get older, there’s less clear evidence that stringent control of SBP is as important.”

They found that “these studies consistently demonstrated reduced cardiovascular morbidity and mortality compared with no treatment.” But they also found that strict control that reduced SBP to below 140 was not consistently better than mild control, reducing SBP to below 150.

The team also found that these studies showed that mild SBP control benefit patients who were older than 65 as well.

But the researchers were unable to report on whether any of the antihypertensive medication regimes caused harm to patients.

Those could include orthostatic hypotension, the light-headedness on standing that can cause falls, a condition experienced by about a third of people age 80 and over.

“Reporting of harms stratified by age is lacking,” they wrote in the article.