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Are Blood Pressure Drugs Safe for Seniors?
Large-scale clinical trials often exclude the elderly, or include too few to draw statistically valid guidance for clinical practice. The effects of high blood pressure treatment in older folks have remained a particularly vexing gap in our knowledge, particularly because this condition becomes more prevalent as we age.
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Blood pressure treatment reduces risk of stroke and heart attack in the middle-aged. In years past, however, experts worried that diseased arteries, more common in senior citizens, might actually require greater pressure to assure blood flow to vital organs. If that’s the case, then treatment of high blood pressure might not help, and could even harm, the elderly. Some observational studies and smaller clinical trials lent credence to this concern, hinting that even if fewer strokes occurred among the elderly taking blood-pressure drugs, these patients still might die more frequently from other causes.
Recently a large trial called HYVET, for Hypertension in the Very Elderly Trial, took on this controversy. British researchers enrolled 3,845 subjects ages 80 and older and divided them into two groups. One group received a combination of blood pressure drugs, while the other took only sugar pills. After four years, the treated patients had 30 percent fewer strokes and a greater than 20 percent reduction in overall and cardiovascular mortality. Strikingly, the treated group also had an incidence of heart failure that was 64 percent lower than those on placebo. Even side effects were less frequent in the treated group compared to the placebo group.
Although this study, published in March in The New England Journal of Medicine, relied on a combination of blood-pressure medications not commonly used in the United States, the results provide an important guide to our practice. Many elderly patients fear a stroke — with the loss of independence, mobility and ability to communicate — even more than a heart attack, while heart failure is the most frequent cause of hospital admissions in the Medicare population. The results of HYVET provide new evidence that treatment of high blood pressure in the elderly can help reduce these burdens.
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EMPLOYEE
I’m
confident
Blood pressure treatment reduces risk of stroke and heart attack in the middle-aged. In years past, however, experts worried that diseased arteries, more common in senior citizens, might actually require greater pressure to assure blood flow to vital organs. If that’s the case, then treatment of high blood pressure might not help, and could even harm, the elderly. Some observational studies and smaller clinical trials lent credence to this concern, hinting that even if fewer strokes occurred among the elderly taking blood-pressure drugs, these patients still might die more frequently from other causes.
Recently a large trial called HYVET, for Hypertension in the Very Elderly Trial, took on this controversy. British researchers enrolled 3,845 subjects ages 80 and older and divided them into two groups. One group received a combination of blood pressure drugs, while the other took only sugar pills. After four years, the treated patients had 30 percent fewer strokes and a greater than 20 percent reduction in overall and cardiovascular mortality. Strikingly, the treated group also had an incidence of heart failure that was 64 percent lower than those on placebo. Even side effects were less frequent in the treated group compared to the placebo group.
Although this study, published in March in The New England Journal of Medicine, relied on a combination of blood-pressure medications not commonly used in the United States, the results provide an important guide to our practice. Many elderly patients fear a stroke — with the loss of independence, mobility and ability to communicate — even more than a heart attack, while heart failure is the most frequent cause of hospital admissions in the Medicare population. The results of HYVET provide new evidence that treatment of high blood pressure in the elderly can help reduce these burdens.Comment -
