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Calls for GPs to use drugs for hypertension in older people

By Nigel Praities

GPs must not neglect hypertension in older people as treatment can significantly reduce the risk of mortality and stroke, say UK researchers.

In evidence that goes against calls for age caps on blood pressure targets, the HYVET study in nearly 4,000 hypertensive patients over 80 years found standard hypertensive treatment reduced the risk of fatal stroke drop by nearly 40%.

Heart failure was reduced by 64% and all cause mortality over a fifth in patients receiving the diuretic indapamide – with the ACE inhibitor perindopril added if patients did not reach the target of 150/80 mmHg – compared with placebo.

NICE guidelines currently urge caution in the use of blood pressure lowering medications in the over 80s, advising GPs take account of any comorbidity and the existing burden of drug use.

But Dr Nigel Beckett, the lead investigator and a research fellow at Imperial College, London said his study had ‘squashed' the idea that that there was a delicate balance of risk and benefit in the over 80s and showed guidelines need to change.

‘We have shown that hypertensive treatment is effective in the over 80s and we hope they will be reflected in future guidance from NICE and others,' he said.

Berkshire GP Dr George Kassianos said: ‘We must not neglect the over-80s. There is a belief in primary care that we do not need to treat these patients, but we do.'

But other experts were more cautious about the results. Professor Neil Poulter, president of the British Hypertension Society, said this data was a welcome addition to the evidence base in older people, but GPs should still consider other factors and before adding blood pressure treatments.

‘If you are a fit 80 year old then the one thing you don't want is a stroke. So this trial is great news and a good public health message. But GPs know better than anyone that you have to take the whole patient into account,' he said.

Dr Rubin Minhas, a GP in Gillingham, Kent, and cardiology lead for Medway PCT, agreed: ‘Older patients often have more than one condition and polypharmacy is quite common. Physicians and patients have to balance up new medication with the overall pill burden.'

The results of the HYVET study were published online by the New England Journal of Medicine.

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