|Volume 6 Issue 246 Published - 14:00 UTC 08:00 EST 2-Sep-2004 Next Update - 14:00 UTC 08:00 EST 3-Sep-2004||Editor: Susan K. Boyer, RN
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Evidence supports treatment of systolic high blood pressure in older persons
A review of the medical literature suggests that older persons with systolic hypertension (and systolic blood pressure of at least 160 mm Hg) should receive treatment, according to an article in the September 1 issue of JAMA.
Sarwat I. Chaudhry, M.D., of the West Haven Veterans Affairs Medical Center, West Haven, Conn., and colleagues examined the evidence on the clinical management of SH in older persons by reviewing previous studies. The researchers performed a MEDLINE search for relevant reports from 1966-2004 and identified 1,064 studies, of which 36 articles met criteria they established for inclusion in their review.
In analyzing the studies, the researchers found: “There is strong evidence from clinical trials to support the treatment of SH in older persons with SBP of at least 160 mm Hg. Large-scale trials to assess the value of antihypertensive therapy for older patients with SBP of 140 to 159 mm Hg have not been performed, and recommendations to treat these patients are based on observational studies that show a graded relationship of cardiovascular risk with increasing SBP. The studies most strongly support the use of thiazide diuretics and long-acting calcium channel blockers as first-line therapy to treat SH.”
“ … recent work demonstrates the long-term (11-14 years) effectiveness of treating SH in reducing cardiovascular events. Despite this effectiveness, poor control of SH among patients seeking treatment for hypertension is increasing,” the authors write.
“Many questions remain unresolved in the treatment of SH in older persons, leaving patients and clinicians uncertain about how best to balance risks and benefits. In addition, in this age group, decisions about treatment invariably involve tradeoffs of substantial risk,” they write. “Given the scope of the problem and the growing size of the elderly population, there remains an acute need for more study.”
Co-author Dr. Foody is supported by a National Institutes of Health/National Institute on Aging (NIA) Career Development Award and an NIA/Hartford Foundation Fellowship in Geriatrics.
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