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The J-shaped curve in elderly hypertensives
J P Cox1, E O'Brien, K O'Malley
1Blood Pressure Unit, Beaumont Hospital, Dublin, Ireland.
Summary
Lowering blood pressure too much in elderly hypertensive patients may increase mortality risk. Careful blood pressure management is crucial for older adults to avoid potential harm from excessive treatment.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Clinical Pharmacology
Background:
- Recent studies suggest that lowering systolic blood pressure below 140 mmHg in elderly patients may elevate stroke risk.
- A J-shaped relationship between mortality/morbidity and blood pressure was observed in untreated hypertensive patients.
- U-shaped relationships between blood pressure and mortality/morbidity have been noted in both treated and untreated elderly populations.
Purpose of the Study:
- To examine the association between achieved blood pressure levels and mortality/morbidity in elderly patients with hypertension undergoing drug treatment.
- To synthesize evidence regarding the safety and efficacy of blood pressure targets in older adults.
Main Methods:
- Review of existing studies and clinical trial data, including the Hypertension in Elderly Patients in primary care (HEP) study and the European Working Party on High Blood Pressure in the Elderly (EWPHE) trial.
- Analysis of mortality and morbidity data in relation to treated and untreated blood pressure levels in elderly populations.
- Examination of potential confounding factors, such as changes in body weight and hemoglobin levels.
Main Results:
- Evidence suggests a U-shaped relationship between total mortality and treated systolic blood pressure in the elderly.
- Lower achieved blood pressure levels in treated patients were associated with greater falls in body weight and hemoglobin, potentially indicating general health deterioration.
- Observations in the very old (80+ years) also indicate a U-shaped relationship between blood pressure and mortality.
Conclusions:
- Current evidence does not definitively prove harm from lowering blood pressure to the lower normal range in older patients.
- It is advisable to avoid excessively lowering blood pressure with treatment in elderly hypertensive individuals.
- Further research is needed to establish optimal blood pressure targets for this demographic.