Aggressive Treatment Recommended for At-Risk Older Adults with Hypertension

October 15, 2001

The very group of patients that doctors are often reluctant to treat for high blood pressure - older adults with multiple risk factors for cardiovascular disease - have the most to gain from aggressive treatment, reported researchers from Wake Forest University Baptist Medical Center and colleagues in this week''s issue of Circulation.

Treating these high-risk older adults was four times more effective at preventing heart attacks, strokes and heart failure than treating those with lower levels of risk, reported the researchers.

"This is a real breakthrough in geriatric medicine because high blood pressure is one of the most prevalent and least adequately treated cardiovascular conditions in older people," said Marco Pahor, M.D., professor of geriatrics at Wake Forest. "It is estimated that 18.5 million Americans age 65 years or older have hypertension, of which 15 million are inadequately diagnosed or treated."

Doctors may have several reasons for not aggressively treating hypertension in older adults who have multiple risk factors for cardiovascular disease, including smoking, diabetes and high cholesterol, said Pahor. They may be concerned about possible drug interactions, believe there is little that can be done to alter the natural progression of blood vessel disease, or worry that lowering blood pressure could be more risky than beneficial.

"Most of the time, doctors think treating systolic hypertension is useless in older patients if they have additional risk factors," said Luigi Ferrucci, M.D., Ph.D., the study''s lead researcher from the National Institute for Research and Care for the Elderly (INRCA) in Florence, Italy. "We have demonstrated very clearly that this is not true. The patients who often aren''t treated are exactly the ones who should be treated."

The researchers used a risk assessment tool developed by the American Heart Association to classify the risk of future heart attacks, stroke and heart failure in 4,453 adults over age 60 who participated in the Systolic Hypertension in the Elderly Program (SHEP), a study concluded in 1991. Participants had systolic blood pressure readings - the top number of a blood pressure reading - of at least 160 mmHg. They were treated with diuretics or beta blockers to bring pressure within normal levels.

A major finding of the SHEP study was that treating isolated systolic hypertension in people over age 60 is effective at lowering the risk of future strokes, heart attacks, congestive heart failure and all cardiovascular events combined. For the current study, researchers re-analyzed the SHEP data to compare the benefits of treating people at varying levels of risk.

Participants were divided into four groups based on risk. The researchers found that treating participants with the highest risk for future heart attacks, stroke and heart failure was four times more effective than treating the low-risk group.

"This finding indicates that we shouldn''t be hesitant to treat people just because they have several risk factors. In fact, it shows just the opposite, that we get the most benefit from treating just this group," said Jack Guralnik, M.D., Ph.D., chief of the epidemiology and demography section at the National Institute on Aging.

The study, which was funded by the National Institute on Aging and the National Heart Lung and Blood Institute, was a collaboration between Wake Forest University Baptist Medical Center and the Azienda Ospedaliera Careggi and INRCA in Florence, Italy. Wake Forest is a Claude D. Pepper Older Americans Independence Center and conducts research on preventing disability and maintaining the independence of older adults with chronic diseases.


Media Contacts: Wake Forest: Karen Richardson, (336) 716-4453, National Institute on Aging: Doug Dollemore, (301) 496-1752,

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