Study from London recommends high blood pressure drugs for the elderly
See what you think of this. A London study recommends prescribing high blood pressure drugs for the elderly – whether or not they have high blood pressure. The rationale is that high blood pressure drugs for the elderly may decrease their risk of heart attack and stroke. And prevention is better than cure, right? Or is it?
This study raises lots of questions…
Should doctors dole out high blood pressure drugs for the elderly to reduce their risk of heart attacks and strokes?
Is this even safe? There’s some evidence that taking blood pressure-reducing medications can make you more likely to have a stroke, and/or a fall.
And do we want our aging population increasingly dependent on medications anyway?
These are things we need to be thinking about as a society in the 21st century.
First, here’s an article from The Guardian in 2015 about the proposal to give high blood pressure drugs to the elderly. We then evaluate it, looking at other research into high blood pressure drugs and the elderly, including a 2017 study which suggests that high blood pressure has benefits for some old folks!
Should all older people be on high blood pressure drugs?
All adults over a certain age should be offered drugs which lower blood pressure, according to the authors of a major new study. It found that blood pressure drugs can reduce the risk of heart attacks and strokes in older adults, regardless of what their blood pressure measurement was to begin with.
What do we know already?
Heart attacks and strokes are the leading cause of death in the UK. Among 65-year-olds in England and Wales, about 10 per cent of men and 5 per cent of women will have a heart attack in the next 10 years, and about 5 per cent of men and 4 per cent of women will have a stroke. As you get older, your risk of having a heart attack or stroke increases.
In most people blood pressure starts to climb as they grow older, but it may not be considered high by current guidelines. If your blood pressure becomes too high, it can damage the walls of the blood vessels, increasing the risk of a heart attack or stroke. Treatment for high blood pressure includes changes in lifestyle (diet, exercise, stopping smoking) and medication. What treatment your doctor recommends will depend on how high your blood pressure is, as well as other factors.
At present, blood pressure drugs are used to reduce high blood pressure to a specific target level. But some studies suggest these drugs should instead be prescribed based on the overall risk of cardiovascular disease, regardless of blood pressure. This would mean most older people would be offered these drugs.
Researchers have now explored this issue in the largest-ever review of blood pressure studies.
What does the new study say?
Researchers looked at 147 blood pressure studies, involving more than 464,000 people aged 60 to 69. The studies focused on 5 major types of blood pressure drugs: thiazides, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, and calcium-channel blockers.
The researchers did a meta-analysis, which means they combined the studies’ results to see what conclusions they could draw from the research as a whole. They looked specifically at what happened when drugs lowered systolic or diastolic blood pressure by a given amount. (Systolic pressure is the top number of a blood pressure reading and gives the pressure when the heart pumps the blood out. Diastolic pressure is the bottom number, which is the pressure when the heart is relaxed).
They found that:
- Lowering blood pressure by a given amount reduced the risk of heart attacks by about a quarter and stroke by a third.
- These improvements applied to everyone, regardless of whether their blood pressure had been diagnosed as high before treatment.
- All 5 drugs worked well for reducing the risk of heart attacks and strokes.
- The risk of heart attacks and strokes continued to decrease as blood pressure dropped even lower. This suggests, say the researchers, that doctors should adopt a ‘lower is better’ approach to managing blood pressure, rather than trying to reduce blood pressure to a target level and keep it there.
Tell me more about the study’s findings
The researchers also looked at how combining three drugs at half doses might affect the risk of heart attacks and strokes. To do this, they merged their results with those of 2 other studies.
They found that using 3 drugs at half doses could cut the risk of heart attacks and strokes by twice as much as using 1 drug at a standard dose. This provides support, say the researchers, for offering a ‘polypill’ to anyone with a higher risk of these problems, including most older people.
How reliable are the findings?
These findings are based on a large number of studies, with nearly half a million people in total. This gives substantial weight to the results. However, combining the findings of so many studies can be problematic, as there are differences in how the studies were conducted and what types of patients they included. This leaves room for error and misinterpretation.
The research did not report on the side effects of blood pressure medicines. From other research, we know these can include dizziness, tiredness, sexual problems, and nausea.
Another drawback is that the study doesn’t compare the effects of offering drug treatment to all older adults with the effects of lifestyle advice, such as exercise, reducing salt levels, dietary changes, and stopping smoking.
The study’s conclusions on combining drugs are less reliable, as no studies have actually looked at using 3 blood pressure medicines at half doses. The researchers based their findings on the assumption that combining these drugs would add up to a larger benefit, but we need more studies to know if this is correct.
Where does the study come from?
The study was done by researchers at the Wolfson Institute of Preventive Medicine, at Barts and The London School of Medicine and Dentistry. It was published in the British Medical Journal (BMJ), which is owned by the British Medical Association.
Two of the authors hold patents (granted and pending) on the formulation of a combined pill to reduce four risk factors for heart attack and strokes, including blood pressure.
What does this mean for me?
If you are an older adult, this study suggests you may benefit from taking blood pressure drugs even if your blood pressure isn’t considered high. In future, you might even be offered a ‘polypill’ that combines low doses of different blood pressure drugs to help prevent heart attacks and strokes. However, the guidelines on who and who should not be treated with blood pressure drugs are unlikely to be changed at present.
What should I do now?
You don’t need to do anything as a result of this study. But if you are concerned about your risk of having a heart attack or stroke, be sure to talk to your doctor. You can have a risk assessment to estimate your chances of heart attack or stroke. This will look at a range of risk factors such as your exercise levels, weight, and family history, as well as your blood pressure. All adults over 40 should have a risk assessment, and adults of all ages with a strong family history of early heart disease or stroke should have one.
Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665.
On the surface you’d think: ‘Hey, that’s a good idea. Give mild high blood pressure drugs to the elderly and save lives!’
Read a little closer and its starts to appear more sinister.
The main question of course is:
Q: Who’s publishing the results?
A: The Wolfson Institute of Preventive Medicine. As the article states, two of the authors hold patents (granted and pending) on the formulation of a combined pill to reduce four risk factors for heart attack and strokes, including blood pressure.
In other words, this study is anything but objective. If accepted by the medical community the authors may become multimillionaires overnight.
This article is indicative of how the entire medical industry shifted its central role of caring and healing sick people to becoming a giant dispenser machine for the pharmaceutical industry.
Don’t expect the Wolfson Institute of Preventive Medicine to champion exercises and diets to live healthy and long. There’s no money in that!
Side effects of high blood pressure drugs for the elderly – and everyone else
Another thing that the authors of the study ignore is the potential side effects of taking hypertension medications. These side effects (as noted in the Guardian article quoted above) are well-known and can be very unpleasant. I’ve written more about this here: High blood pressure medication side effects
One side-effect that can be more common and particularly serious among the elderly is falling. Researchers at Yale School of Medicine in the US studied almost 5,000 people over 70 with high blood pressure for three years.
They found that those who were taking blood pressure-lowering medications were more likely to have falls than those who weren’t on such medications. (This is discussed in more detail in our article: High Blood Pressure and the Elderly )
So is shoving everyone over a certain age onto prescription medications really a good idea?
High blood pressure drugs can actually increase the risk of stroke
UPDATE 2017: A study conducted in Alabama, USA, found that some high blood pressure medications can actually increase your risk of a stroke rather than decrease it. Specifically, putting people on combinations of blood pressure-reducing medications can radically increase stroke risk. Which seems to go directly against the suggestions of the study described above.
Now, to be fair, this Alabama study does show that prescribing high blood pressure meds to people before their hypertension goes through the roof can be effective.
Their point is that once blood pressure has become very high, then putting people on medications to lower it isn’t necessarily safe. In fact, compared to people with healthy blood pressure, folk with high blood pressure who were on three or more medications for it were over twice as likely to have a stroke!
In the words of the lead researcher, Dr. George Howard,
You’re in as much trouble by the time you are on three medications that achieve excellent control as you are when you have hypertension and it is untreated, which is amazing. We want to raise the issue that, despite great advances in a pharmaceutical approach, relying solely on this approach is going to come at a dear price of people’s lives.
He goes on to say that the best solution is to prevent high blood pressure from getting rampantly out of control in the first place. And recommends the proven non-drug approaches including being physically active regularly, keeping your weight healthy, and eating a healthy diet.
His conclusion? Prevention is better than cure. And neither has to involve risky medications. At least some doctors are talking sense :):
Possible benefits of high blood pressure for the elderly !
UPDATE 2017: Another interesting study suggests that developing high blood pressure late in life can have some benefits. Researchers at the University of California found that developing high blood pressure after the age of 80 or so may help protect people from dementia.
The researchers followed 559 people aged 90 and older for nearly three years. None of them had dementia at the start of the study although some developed it during the course of the study. The researchers found was that those who’d developed high blood pressure in their 80s were 42% less likely to develop dementia in their 90s. This is compared to those whose blood pressure remained normal. Those who developed high blood pressure in their 90s were 63% less likely to develop dementia than those with normal blood pressure.
Can high blood pressure reduce your risk of dementia?
These are quite compelling figures! However, at this stage, the figures demonstrate just an association between very late-onset high blood pressure and lower risk of dementia. It’s not yet clear if there’s any actual causal link. In other words, it’s not known if it’s the high blood pressure itself which is staving off dementia.
Nonetheless, these are intriguing findings. Scientists are now trying to figure out how high blood pressure affects the brain in the elderly. It may be that higher blood pressure ensures the brain gets enough oxygen to function well. In the words of Professor Corrada,
“It’s a matter of creating enough pressure to get blood to oxygenate the brain adequately. [And] there is evidence that high blood pressure may also reduce frailty and disability.”
Now, to be clear, the study’s lead researcher, Professor Maria Corrada, reminds us that developing high blood pressure in middle age can increase the risk of stroke and heart attack and dementia. It’s only high blood pressure arising very late in life which may be beneficial to the brain. But it does throw further doubt on the wisdom of prescribing high blood pressure drugs for the elderly indiscriminately.
You can read a lot more about the ins and outs of treating high blood pressure in the elderly in our new article here: High Blood Pressure and the Elderly
Post by Simon. Updated by Alison.
Blood pressure drugs for the elderly: Some references and further information