By AMERICAN HEART ASSOCIATION NEWS
ANAHEIM, California — The risk of heart attacks, heart failure, strokes and death can be reduced in adults 65 and older if they’re treated for blood pressure the same way younger people are – to a systolic blood pressure of less than 130 – according to new guidelines from scientists and medical experts.
Most adults with measurements of 130 for the top number (systolic) or 80 for the bottom number (diastolic) are now considered to have high blood pressure, under guidelines released Monday by the American Heart Association, American College of Cardiology and nine other health organizations. The treatment standard had previously been 140 for people younger than 65 — and 150 for people that age and older.
The question of treating blood pressure in older people is complicated by the fact that blood pressure commonly increases with age, so more people at higher ages have the condition. In the past few years, several groups have debated whether lower targets for blood pressure control were effective or even safe for seniors.
Some doctors worried lower pressure levels could increase the number of falls in older populations. A guideline from the American College of Physicians and the American Academy of Family Physicians suggested patients older than 60 be treated only to a level below 150/90.
But Jeff Williamson, M.D., chief of Geriatric Medicine and Gerontology at Wake Forest University, said a raft of recent studies have shown the benefits of achieving much lower targets for adults who are able to get around on their own and aren’t in a nursing home.
“We know a lot of people in their 70s and 80s are healthier than those in their 60s, and those guidelines put them at risk for complications that would lead to their disability,” said Williamson, who was on the 21-person writing committee for the new guidelines. “You shouldn’t base your therapeutic decisions on age. It should be based on where your patient is [medically]. We shouldn’t deny them evidence-based care just because of their age.”
A clinical trial sponsored by the National Institutes of Health, called the Systolic Blood Pressure Intervention Trial (SPRINT), studied people 50 and older who had high blood pressure and at least one other risk factor for heart disease.
The study found that using medicines to reduce systolic blood pressure, the top number in a reading, to near 120 reduced the combined rate of having a heart attack, acute coronary syndrome, heart failure, stroke or death from cardiovascular disease by nearly one-third. It reduced deaths from any cause by nearly a one-quarter compared to reducing blood pressure to less than 140.
In an analysis that reported the results of the SPRINT trial for people 75 and older, researchers determined that lowering blood pressure to a target of 120, compared with 140, also led to significantly lower rates of death and “cardiovascular events” the same as it did for younger people. Because more people at advanced age experience these complications, fewer need to be treated to avoid these adverse effects from high blood pressure.
Because of its “high prevalence in seniors,” hypertension is a leading cause of preventable death, according to the new guidelines. “But, perhaps more importantly, hypertension is under-recognized as a major contributor to conditions leading to premature disability and institutionalization.”
The guidelines acknowledge that treating high blood pressure in older people is “challenging” because seniors have other existing health issues and take other medication that could interfere with blood pressure treatment.