Strong evidence to treat systolic hypertension in the over-60s
There is strong evidence of the benefits of treating systolic hypertension in patients aged 60 years and over, according to a review which identified over 1,000 studies and selected 36 for inclusion.
The authors define systolic hypertension (SH) as 160mm Hg or more. They
say that, in older patients, SH is a much more important risk factor
for cardiovascular disease than diastolic hypertension. Poor control
of SH is increasing, they add.
There is firm evidence from clinical trials to support the treatment
of this condition, the review finds. The studies support the use of thiazide
diuretics and long-acting calcium channel blockers as first line therapy.
The evidence available to support treatment of patients to the level
of 140mmHg or those with baseline systolic blood pressure of 140–159mmHg
is less strong. Thus decisions on therapy for these patients should be
more sensitive to
patient preference and tolerance of therapy, the
authors suggest.
“Many questions remain unresolved in the treatment of SH in older
persons, leaving patients and clinicians uncertain about how best to
balance risks
and benefits. In addition, in this age group, decisions about treatment
invariably involve trade-offs of substantial risk,” say the US
researchers (JAMA 2004;292:1074-80). |
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