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The hypertensive patient. Not just a number
1Department of Preventive Medicine, UTCHS College of Medicine, Memphis, TN 38105.
Insights
Treating hypertension in older adults reduces cardiovascular events. However, current strategies require treating many to benefit a few, necessitating better risk-based targeting for effective primary prevention.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Public Health
Background:
- Hypertension treatment in elderly patients (over 65) reduces cardiovascular morbidity and mortality.
- Studies like EWP-HBP and SHTEP demonstrate significant event reduction but highlight the need for improved targeting.
Purpose of the Study:
- To evaluate the effectiveness of hypertension treatment in reducing cardiovascular events in the elderly.
- To identify the need for enhanced strategies in primary prevention for this demographic.
Main Methods:
- Analysis of data from large-scale clinical trials on hypertension in the elderly.
- Assessment of cardiovascular event rates in treated versus untreated groups.
Main Results:
- Significant reductions in cardiovascular morbidity and mortality were observed in treated elderly hypertensive patients.
- Event prevention rates varied between studies (29/1,000 person-years in EWP-HBP, 55/1,000 person-years in SHTEP).
Conclusions:
- While beneficial, current hypertension treatment in the elderly necessitates treating a large population for a modest number of benefits.
- Development of targeted treatment strategies based on comprehensive risk assessment is crucial for optimizing primary prevention in older adults.
Abstract:
Treatment of both systolic-diastolic and isolated systolic hypertension in patients over age 65 has been shown to decrease subsequent cardiovascular morbidity and mortality. In the European Working Party on High Blood Pressure in the Elderly study, the number of morbid and mortal cardiovascular events prevented in the treatment group was 29/1,000 person-years, whereas in the Systolic Hypertension in the Elderly Program, the number was 55/1,000 person-years. This magnitude of reduction is substantial, but in the case of primary prevention in the elderly, a large number of patients must be treated to benefit relatively few. Better strategies of targeting treatment based on risk over and above that of high blood pressure are needed. Certainly, patients with more than one cardiovascular risk factor or evidence of end-organ damage should be treated more aggressively.