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Blood pressure poorly controlled in the elderly, especially women

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Despite numerous clinical studies showing the benefits of lowering blood pressure in older hypertensive persons, data suggest that rates of treatment and control are less than optimal and that risks for cardiovascular disease are substantial, Lloyd-Jones said. Studies from national surveillance data, however, are typically limited to adults younger than age 75, and information regarding current patterns of treatment and control of high blood pressure among those 80 and older is sparse.

Lloyd-Jones and co-researchers Jane C. Evans and Daniel Levy, M.D., from the National Heart, Lung, and Blood Institute analyzed data from almost 5,300 Framingham Study participants (2,300 men and approximately 3,000 women).

Among the oldest hypertensive individuals, only 38 percent of men and 23 percent of women had their blood pressure controlled to recommended levels of less than 140 systolic over less than 90 diastolic.

It appeared that poor control was due in part to lack of use of combination drug therapy and, perhaps, to poor selection of drug classes. Despite abundant evidence suggesting that thiazide diuretics are the most cost-effective drugs for blood pressure reduction, and that they are especially effective in the elderly, the researchers found overall low rates of thiazide use, particularly among men.

Among the oldest hypertensive persons receiving blood pressure-lowering medication, 62 percent were receiving only one antihypertensive medication, and only 23 percent of men and 38 percent of women were receiving a thiazide diuretic.

The researchers observed high prevalence of use of more expensive drugs, such as ACE inhibitors and other drugs, such as alpha-blockers, although data supporting their effectiveness in older hypertensive are limited.

Control of blood pressure is more difficult to achieve when starting at a higher baseline blood pressure, as is often the case with older hypertensive individuals, Lloyd-Jones
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Contact: Elizabeth Crown
e-crown@northwestern.edu
312-503-8928
Northwestern University
26-Jul-2005


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