New Guidelines: Treat High Blood Pressure in Over-80s

April 25, 2011 - New guidelines stress more aggressive treatment of high blood pressure in very elderly patients.

It's long been clear that people ages 65 to 79 benefit greatly from treatments that lower blood pressure. But now an expert panel convened by the American College of Cardiology (ACC) and the American Heart Association (AHA) endorses treatment for patients over age 80.

Because blood-pressure-lowering drugs can have dangerous side effects in very elderly patients, doctors have been wary of aggressively treating high blood pressure in people over age 80.

The result: Only one in three men and only one in four women over age 80 have their blood pressure under control.

Yet a groundbreaking 2008 study of 3,845 over-80 patients found that over two years, lowering blood pressure in over-80 patients with a water pill (and, if needed, a blood pressure drug called an ACE inhibitor):

• Cut all-cause deaths by 21%
• Cut strokes by 30%
• Cut stroke deaths by 39%
• Cut heart deaths by 23%
• Cut heart failure by 64%

"The real concern is that a majority of elderly people have suboptimal control of their blood pressure and -- until recently -- many clinicians didn't treat hypertension in octogenarians because they worried that doing so would increase mortality," guideline writing co-chair Wilbert S. Aronow, MD, says in a news release.

Those findings prompted the ACC and AHA to convene an expert panel. Their 78-page report, published today in the Journal of the American College of Cardiology, notes that doctors must consider individual factors for each of their elderly patients.

Nevertheless, the panel makes these general recommendations for people over age 80:

• A target systolic blood pressure (the first or top number in a two-number blood-pressure reading) should be 140 to 145 if the patient tolerates the side effects of treatment.
• Patients should not have a systolic blood pressure below 130 or a diastolic blood pressure (the second or bottom number) below 65.
• For very elderly patients whose high blood pressure doesn't come down with initial treatment, the combination of a type of blood pressure drug known as a RAAS blocker, a calcium antagonist, and a water pill is often effective.
• Very elderly patients may benefit from lifestyle changes that lower blood pressure: losing weight, reducing salt in the diet, drinking less alcohol, and taking up the DASH diet.