Dr. Marvin Moser, Clinical Professor of Medicine at Yale University, recently reviewed in a medical publication the topic of high blood pressure (hypertension) in octogenarians (people in their 80's). In this article, I will summarize some of the very important points that he made.

Hypertension (defined as a blood pressure over 140/90 mm Hg) affects more than two out of three individuals over 75 years of age. However, there has been a tendency not to treat these elevations in blood pressure with blood pressure lowering (anti-hypertensive) medications. This tendency is largely due to a common misconception that a normal systolic pressure is "100 plus your age." Thus, based on this mistaken idea, a systolic blood pressure of 170 in a 70-year-old person would wrongly be considered normal. Furthermore, there is the valid consideration that a too rapid or too great of a reduction of blood pressure may be poorly tolerated in older people. In fact, studies have shown that mild hypertension is often not treated in this age group. For example, only 25 % of patients with systolic pressures as high as 180-185 mm Hg currently are being treated.

To look further at the significance of this situation, Dr. Moser reviewed the results of several large treatment trials. He collected information on more than 700 octogenarians with hypertension who were treated with blood pressure lowering medications. These data were compared to the data in a similar number of octogenarians who were not treated.

Analysis of the data revealed that treatment with blood pressure lowering (anti-hypertensive) medications reduced the risk for strokes and heart failure by 35%. Further, the incidence of other cardiovascular events (for example, heart attacks) was reduced by 20%. In addition, Dr. Moser pointed out that in these large studies, the blood pressure did not consistently reach a goal of less than 140/90. Nevertheless, an average reduction in systolic pressure of only 12-15 mm Hg was enough to achieve these cardiovascular benefits.

When treating the elderly for hypertension, it is also necessary to consider the other medical conditions that they may have. Some of these conditions may make the patients more prone to side effects from the medications. However, modifying the goal of blood pressure reduction, as noted above, can help avoid the side effects. Therefore, it is recommended that these medications be started at low doses and increased slowly to avoid a too rapid or excessive lowering of blood pressure.

Furthermore, it is important to measure the blood pressure in the elderly while they are standing in addition to while they are sitting or lying. You see, older patients may have a tendency to develop postural hypotension (excessively low blood pressure in the standing position). The postural hypotension can cause episodes of lightheadedness or falling. To remedy this situation, the doctor might recommend lower doses of anti-hypertensive medications. The goal would still be to decrease an elevated sitting or lying blood pressure but to a lesser degree to avoid an excessively low standing blood pressure (the postural hypotension).

Finally, it is suggested not to lower the diastolic (lower number) pressure below 55-60 mm Hg. Such a decrease may increase side effects by reducing the circulation of blood to the tissues of the body. All of this information demonstrates that hypertension in the elderly is a significant problem that deserves more attention.

Medical Author: Dwight Makoff, M.D.
Medical Editor: Leslie J. Schoenfield, M.D., Ph.D.

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