Features December 2007 Issue

Low Blood Pressure Vital at Any Age

Even those over 80 can benefit from controlling hypertension, new evidence suggests.

Preliminary results from the Hypertension in the Very Elderly Trial (HYVET) suggest that trial participants, who were in their 80s, had a lower risk of dying when they were treated with antihypertensive medications.

"High blood pressure medication has been known to reduce the rate of stroke, but the HYVET study suggests that both incidence of stroke and survival rate were improved. These data, although not yet published, confirm our belief that high blood pressure should be treated regardless of age," says Gary Francis, MD, head of the Section of Clinical Cardiology at Cleveland Clinic and editor-in-chief of Heart Advisor.

Why blood pressure control is critical

Hypertension is a well-known major risk factor for the development of heart failure and stroke. Additionally, poorly controlled blood pressure can lead to kidney dysfunction and retinopathy (damage to blood vessels in the eye that can result in blindness).

Medication precautions

Elderly patients metabolize medications differently than younger patients, and as a result, they more frequently experience side effects, which may include dry cough, edema, constipation, and changes in metabolic functions, such as a decrease in insulin sensitivity and/or glucose intolerance.

A common side effect of blood pressure medications is "orthostatic hypotension," which causes dizziness or lightheadedness when someone changes posture quickly. This is of particular concern in the elderly population, since they are more prone to falls. "Patients who take high blood pressure medications should change postures gradually to avoid low blood pressure upon standing. For example, when people wake up in the middle of the night to go to the bathroom, they should sit on the edge of the bed for a few seconds to allow their blood pressure to equilibrate to the upright position," says Dr. Francis.

To reduce the risk of side effects, elderly patients are often treated with lower initial doses of medications, and dosage may be increased more slowly over time. Dr. Francis advises, "Patients should be aware of and discuss potential drug interactions and side effects with their doctor when prescribed medications to treat high blood pressure."

Lifestyle strategies

Blood pressure often improves with weight loss, exercise, and reduction in salt intake. However, Dr. Francis points out that many patients cannot lose weight and fail to maintain a low-sodium diet, thus creating the need for prescription medications.

"Unfortunately, even today, most patients with high blood pressure are either undertreated or not treated at all, in most cases because they lack any symptoms," says Dr. Francis. Whether treatment of hypertension includes medications, lifestyle changes, or both, keeping blood pressure under control is a crucial strategy for maintaining good health at any age.