Hypertension is very common among older adults. 64 percent of older men and 78 percent of older women have high blood pressure, placing them at heightened risk for heart disease including heart failure, stroke, coronary artery disease and atrial fibrillation, as well as chronic kidney disease and diabetes mellitus. Despite its prevalence, rates of blood pressure control remain substantially lower in the elderly than in younger patients. In fact, over age 80, only one in three men and one in four women have adequate control of their blood pressure.
Faced with an aging patient population and compelling data that confirm the benefits of blood pressure-lowering medications in the elderly (≥80 years), the American College of Cardiology (ACC) and the American Heart Association (AHA) has released the first expert consensus document to help clinicians reduce the risks for developing and effectively manage hypertension in older adults.
"Adequate control of high blood pressure in the elderly can significantly reduce cardiovascular events and mortality, and is much more cost-effective than treating heart problems that result from uncontrolled hypertension," said Wilbert S. Aronow, M.D., clinical professor of medicine at New York Medical College/Westchester Medical Center and one of the chairs of the ACC/AHA writing committee. "The real concern is that a majority of elderly people have suboptimal control of their blood pressure and -- until recently -- many clinicians didn't treat hypertension in octogenarians because they worried that doing so would increase mortality."
Moreover, most hypertension trials had upper age limits or failed to present age-specific results. But in 2008, results from the Hypertension in the Very Elderly Trial (HYVET) -- the largest clinical trial in very elderly patients with hypertension to date -- began to shift this thinking. According to Dr. Aronow, this was the first study to show clear benefits for using anti-hypertensive therapy in people 80 years and older, including a 30 percent reduction in stroke, 23 percent reduction in cardiac death, 64 percent reduction in heart failure and 21 percent reduction in all-cause mortality.
"HYVET was the main impetus for developing this consensus document, which is designed to provide the medical community with systematic recommendations to lower blood pressure in older adults," said. Dr. Aronow. "Treating hypertension in the elderly is particularly challenging because they usually have several health problems and a greater prevalence of cardiovascular risk factors and cardiac events. There also needs to be greater vigilance to avoid treatment-related side effects such as electrolyte disturbances, renal dysfunction, and excessive orthostatic blood pressure decline."
Some of the consensus recommendations addressed in the new ACC/AHA consensus document include:
Experts say the high cost of blood pressure lowering medications also contributes to low rates of blood pressure control in the elderly and should be discussed with patients.
This ACC/AHA expert consensus document was developed in collaboration with the American Academy of Neurology (AAN), the American Geriatrics Society (AGS), the American Society of Hypertension (ASH), the American Society of Nephrology (ASN), the American Society for Preventive Cardiology (ASPC), the Association of Black Cardiologists (ABC), and the European Society of Hypertension (ESH). It will also appear in the May 17, 2011, issue of the Journal of the American College of Cardiology and will be posted ahead of print on the ACC (www.cardiosource.org) and AHA (www.heart.org) web sites.
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