Blood Pressure Treatment in the Elderly: A Study’s Findings

Introduction to Hypertension

High blood pressure, or hypertension, is a significant risk factor for stroke and heart disease. It is prevalent, impacting approximately 25% of adults in Canada and one-third of adults in the United States. Various behavioral changes, such as adopting a healthier diet and increasing physical activity, can help lower blood pressure. Additionally, medications are commonly prescribed when systolic blood pressure exceeds 160 mmHg, with an ideal reading being around 120 mmHg.

Potential Risks of Blood Pressure Treatment in Older Adults

While evidence supports that blood pressure treatment can decrease the risk of mortality and disease in patients with hypertension, most studies have excluded older adults who are often frail or ill. This exclusion raises concerns about the effectiveness of blood pressure treatment in the elderly population. Some smaller studies have even suggested a possible connection between lower blood pressure and increased mortality and cognitive decline among elderly patients.

The Study Conducted in the Netherlands

To investigate this issue, researchers in the Netherlands conducted a study focusing on individuals over 85 years old. Their findings were published in the journal Age and Ageing. The study aimed to include all residents of Leiden turning 85 within a specific two-year timeframe, resulting in 570 participants, nearly 20% of whom were in a hospital or care facility at the time.

Methodology and Initial Findings

At the study’s onset, researchers measured participants’ blood pressure and assessed cognitive function for dementia. They also evaluated grip strength, tested for depression, and collected data on socioeconomic status and smoking habits. The study lasted five years, with annual follow-ups on cognitive function.

Participants and Blood Pressure Treatment

Initially, 44% of participants were on blood pressure medications. Those receiving treatment had a higher prevalence of cardiovascular disease compared to untreated individuals. However, both groups exhibited no differences in cognitive function or other measures, with average systolic blood pressures recorded at 155 mmHg for both groups.

Mortality Rates Among Treated Participants

Over the study’s five years, nearly half of the participants passed away. In the untreated group, blood pressure did not influence mortality rates. Conversely, treated participants with lower blood pressure experienced higher mortality rates than those with higher readings. Remarkably, individuals receiving treatment with blood pressure levels exceeding 170 mmHg had a reduced likelihood of death.

Cognitive Decline and Blood Pressure Treatment

While untreated participants showed no correlation between blood pressure and cognitive decline, treated individuals with lower blood pressure exhibited faster cognitive deterioration. Additionally, those with diminished grip strength at the study’s start experienced accelerated declines in cognitive function.

Conclusions and Implications

The findings suggest that the advantages of maintaining low blood pressure may not extend to the elderly, indicating that treatment could potentially be detrimental. However, as this was an observational study, it does not definitively establish that blood pressure treatment should be avoided in older adults. Future clinical trials would be necessary to provide clearer evidence.

Recommendations for Future Research

While the researchers did not issue specific recommendations, they referenced another recent study that explored the effects of temporarily discontinuing blood pressure medication in older patients, which found no adverse effects. This highlights the need for further research to clarify the relationship between blood pressure treatment and health outcomes in the elderly.

Related Topics of Interest

– Can dementia be prevented with stricter blood pressure control?
– The role of ambulatory blood pressure monitoring in preventing premature deaths.
– The impact of smoking, diabetes, and blood pressure on heart attack risks in women.
– Testing new blood pressure monitoring applications for the iPhone.
– The influence of dietary choices on high blood pressure risk.

References

1. Streit, S., Poortvliet, R. K. E. & Gussekloo, J. “Lower blood pressure during antihypertensive treatment is associated with higher all-cause mortality and accelerated cognitive decline in the oldest-old.” Data from the Leiden 85-plus Study. Age and Ageing 47, 545-550 (2018).
2. Nerenberg, K. A., Zarnke, K. B., Leung, A. A., et al. “Hypertension Canada’s 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children.” Canadian Journal of Cardiology 34, 506-525 (2018).