Purpose: To review the relationship between mortality and morbidity and achieved blood pressure, after drug treatment in elderly hypertensive patients.
Contents: Recent studies have suggested that a reduction in systolic blood pressure, with drug treatment, to levels below about 140 mmHg in elderly patients (greater than 60 years) may increase the risk of stroke. However, a J-shaped relationship between both mortality and morbidity and blood pressure has been reported in the untreated controls of the Hypertension in Elderly Patients in primary care (HEP) study. In the European Working Party on High Blood Pressure in the Elderly trial (EWPHE) there was a U-shaped relationship between total mortality and treated systolic pressure, but a similar U-shaped relationship was observed with diastolic pressure in patients on placebo. In addition, patients with the lowest pressure during treatment showed the greatest falls in body weight and haemoglobin concentrations, suggesting that the increased mortality seen with lower blood pressure levels may have been an expression of a deterioration in general health. Moreover, a U-shaped relationship between blood pressure and mortality has been observed in the very old (aged 80 + years).
Conclusions: While it is premature to conclude, on the basis of present evidence, that reducing blood pressure to the lower part of the normal range is harmful in older patients, it appears prudent, nonetheless, not to lower blood pressure excessively with treatment in this age group.