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GPs are urged to exemption report the frail elderly for hypertension and to keep an eye on BP monitoring

Chasing aggressive blood pressure targets in the elderly is causing increasing numbers of patients to suffer from falls and blackouts, according to new research. The number of referrals for hypotension has leapt since the advent of the new contract as GP chase quality and outcomes points.

At least half of elderly people with episodes of low blood pressure were suffering from the adverse effects of hypertension drugs, says research leader Dr Julia Newton.

Dr Newton, senior lecturer in geriatrics and general medicine at the University of Newcastle, criticised the contract, saying: 'You have to weigh up the risks and benefits; you can't practise medicine by ticking boxes.'

She added that 10 per cent of patients who developed hypotension problems would end up breaking a bone.

The Primary Care Cardiovascular Society said aggressive chasing of targets was inappropriate in elderly patients and advised GPs to use exception reporting where necessary (see box).

'I think it's unfortunate the new contract doesn't have age limits,' said Dr Terry McCormack, the society's deputy-chair and a GP in Whitby, Yorkshire. 'The targets should not be applicable in these patients so it's right to exception report them if you can't get a balance.'

Researchers assessed 385 patients with an average age of 74, who were referred to the falls and syncope service at Royal Victoria Infirmary in Newcastle.

A total of 127 patients had problems with hypotension, of whom 48 per cent experienced improvements in symptoms when their medication was stopped or reduced.

Diuretics and a-blockers were significantly more likely to cause problems than ACE inhibitors, according to the study, presented at the British Geriatric Society conference last week.

The authors called for trials on the most appropriate medication in the elderly.

Dr Newton added: 'Our study highlights the need for more information.'

By Emma Wilkinson

Treating hypertension in the elderly

Advice from the Primary Care Cardiovascular Society

In over-80s take a sitting and standing BP

If standing systolic BP is more than 20mmHg lower than sitting BP, reduce medication

Alternatively, judge patients' control against the standing BP measurement

If a balance cannot be achieved, exception report the patient for reaching maximum tolerated dose

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