How do we treat, or not treat, high blood pressure in the oldest old? A practice study in Swedish geriatricians.

ABSTRACT

No clear guidelines exist for the treatment of hypertension in the oldest old (age 80+). While on the one hand the benefits of antihypertensive treatment in stroke prevention are greatest in very old people, on the other hand the adverse effects of treatment are more frequent in these frail, elderly patients. What is optimum blood pressure (BP) in healthy old patients, and in old patients with stroke or dementia? This study aimed to describe physicians opinions regarding BP treatment in geriatric patients. Of 462 Swedish geriatricians sent a postal questionnaire, 350 responded. In answer to the question what stage they would initiate treatment in a healthy, 82-year-old female patient, more than half responded that they would start treatment at higher BP levels (systolic BP >180 mmHg or diastolic BP >100 mmHg) than is recommended for younger elderly. Opinion varied on ideal BP in the case of a recent minor stroke, or dementia. Findings from epidemiological studies concerning the relations between BP and stroke and dementia are discussed. We conclude that further research is needed in this area.