ONE SIZE MAY NOT FIT ALL
Article first published online: 5 SEP 2007
The Journal of Clinical Hypertension
Volume 9, Issue 9, page 730, September 2007
How to Cite
(2007), ONE SIZE MAY NOT FIT ALL. The Journal of Clinical Hypertension, 9: 730. doi: 10.1111/j.1524-6175.2007.07335.x
- Issue published online: 5 SEP 2007
- Article first published online: 5 SEP 2007
To the Editor:
I am responding to the article “Hypertension management: results of a new national survey for the Hypertension Education Foundation: Harris Interactive,” which appeared in a recent issue of The Journal of Clinical Hypertension.1 The authors cite information from the National Health Nutrition Examination Survey (NHANES) that defines a patient with hypertension as having a blood pressure reading >140/90 mm Hg or taking hypertensive medication.
One of the questions the Harris survey asked was: Is high blood pressure less of a problem for older adults because higher pressure is necessary to get the blood to the brain and kidneys? This was considered a false statement.
As of July 2003, 12.9 million Americans were aged 75 to 84 years and 4.7 million were aged 85 years and older. The number of the oldest old in our population continues to grow.2
Two recent articles3,4 discuss blood pressure and survival in individuals older than 85 years. Both articles suggest that clinicians should be cautious in the use of blood pressure-lowering medications in this age group.
However, the end point measured in these reports is survival, not the incidence of falls, stroke, or cognitive problems. One of the important physiologic changes in aging is atherosclerosis of the large arteries, which produces systolic hypertension. Lowering blood pressure in this age group may result in falls due to orthostatic hypotension and other problems. An additional issue may be the fall in blood pressure that occurs during sleep. It appears that the guidelines for treating hypertension in patients older than 85 years should be raised and that clinicians, at the least, should be cautious in prescribing antihypertensive medication in this group of the oldest old.—Albert J. Finestone, MD, MSc, Philadelphia, PA
I thank Dr Finestone for his comments. Of course, he is correct about care in decreasing blood pressure too much in people in the very old category (older than 85 years). The available data on treatment of individuals in this age group suggest, however, that strokes and heart failure are reduced if blood pressure is lowered. There are studies underway (Hypertension in the Very Elderly Trial [HYVET]) that should provide more definitive answers. I believe that, based on available information, we can conclude that an elevated blood pressure level at any age is not beneficial or necessary.—Marvin Moser, MD, New Haven, CT
- 265+ in the United States 2005. Washington, DC: US Census Bureau; 2005. Current Population Reports, P23-209., , , et al.