Many older people may not be getting the intensive treatment they need for their blood pressure

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Less than 30% of older people who need more intensive treatment for high blood pressure actually get it, according to new research. And the problem can get worse.

Nearly half of American adults – about 116 million people – have high blood pressure, also known as hypertension. When not properly controlled, it can lead to serious health problems, including heart attack, stroke, and kidney disease.

“We are not doing well, despite strong evidence demonstrating the significant benefits of good blood pressure control in the elderly,” said Dr. Nicholas Chiu, lead study author and clinical researcher at Beth Israel. Deaconess Medical Center in Boston. “This is a major public health gap that needs to be addressed.”

Common in the elderly, high blood pressure is a leading cause of preventable death and an underestimated contributor to premature disability, according to the most recent American College Hypertension Care Guidelines. of Cardiology and the American Heart Association.

As of 2017, high blood pressure is defined by these organizations as a reading of 130 mmHg and above for systolic blood pressure, the “upper” number of a reading, or 80 and above for the diastolic measurement, or the “lower” number. “. The old definition was 140/90 and above.

For the new study, published Friday in the journal AHA Hypertension, researchers looked at a decade of national data from a sample of adults 60 and older who saw their primary care provider and had previously been diagnosed. of arterial hypertension. The research team focused on patients who underwent “appropriate antihypertensive intensification”, defined as the addition of an antihypertensive drug to their care for high blood pressure.

Based on office blood pressure measurements, treatment intensification was warranted in as many as 7,404 primary care visits captured in data from 2008 to 2018, representing up to 293 million visits nationwide. national.

To determine who had high blood pressure, the researchers used three varying blood pressure targets – those published by the ACC/AHA, the European Society of Cardiology and the American College of Physicians/American Academy of Family Physicians (ACP/ AAFP). The researchers also proposed their own overall measure that meets all three guidelines.

Appropriate intensification of medicine over the study period never exceeded 27.5%. This was by the most liberal measure, the all-inclusive test, for patients who had never taken medication for high blood pressure. By this same measure, only 15.3% of patients already on blood pressure medication had appropriate intensification.

In all three sets of published targets, the percentage of patients receiving appropriate treatment intensification decreased over the study period. More dramatically, within the ACP/AAFP goals, scaling up of appropriate treatment fell from nearly 25% of patients in 2008-2009 to around 15% in 2015-2018.

Chiu called on professional societies to use more uniform blood pressure targets. “That might provide a little more clarity” about what the best treatment strategy might be, he said.

Although the study did not address the reasons for the low numbers, lead author Dr. Kenneth Mukamal offered several theories, including doctors’ concerns that antihypertensive drugs could cause the elderly and elderly to fall. reluctance of patients to add more drugs which could have more side effects.

He also said it can be difficult for primary care providers to treat high blood pressure aggressively during a typical 15-minute visit.

“We’re trying to control not just blood pressure, but also cholesterol, diet and weight, and the documentation loads have also gotten heavier. In my own experience, it’s harder than ever to be a primary care physician,” said Mukamal, an associate professor of medicine at Beth Israel Deaconess Medical Center.

He said future studies are needed to find out what strategies will motivate healthcare professionals to better treat high blood pressure in older adults. One strategy, Mukamal said, could involve “tweaking medical record systems to automatically alert doctors to add medication when a person’s blood pressure is higher than we would like it to be.”

Dr Robert Brook, who was not involved in the new research, called it “an important study (that) highlights the remarkably high rates of treatment inertia in real-world clinical practice.”

“There is a need for innovative strategies,” said Brook, professor and director of cardiovascular disease prevention at Wayne State University in Detroit. “Growing evidence supports reducing or eliminating the mandatory role of physicians in the day-to-day management of uncomplicated hypertension. Algorithm-based care delivered by pharmacists or trained nurses or community health workers have been shown to improve blood pressure control in a variety of trials and pioneering programs.”

Patients also need to be more proactive and know their blood pressure at home and in the clinic, Brook said. “They should work with their provider and encourage them to make any necessary treatment changes to control blood pressure.”

If you have questions or comments about this American Heart Association News story, please email [email protected].

About Antoine L. Cassell

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