Is Hypertension Dangerous For Everyone?
Chronic hypertension is considered to
increase the likelihood of a cardiovascular event, such as stroke or
heart attack, as well as diabetes and some metabolic issues, so managing
high blood pressure has become a routine treatment worldwide,
especially among older adults. A recent study questions this practice
and claims that blood pressure correction may not be universally
beneficial.
Who Is Considered to Have Hypertension?
Before delving into the study itself, let’s define high blood pressure:
According to the most recent American guidelines released by the
American Heart Association and the American College of Cardiology in
2017, any blood pressure with a systolic (higher) reading past 130 is
considered hypertension.
The guidelines differ in Europe, as the European Society of
Cardiology and European Society of Hypertension suggest that
hypertension is a systolic reading over 140.
Crucially, not all European patients over 70 receive a treatment
intended to bring down the systolic blood pressure to 120, and, in
clinical practice, doctors often decide what upper limit is better for
each individual patient.
Is Hypertension Really Bad For Everyone?
As a general tendency, older adults are more likely to suffer from
hypertension, and so any adult past the age of 70 is advised to
continuously monitor their blood pressure and take some form of
medication or a combination thereof to normalize their blood pressure.
A study by the Charité-Universitätsmedizin Berlin in Germany that
researched the mortality rates of 1,628 adults over the age of 70
reached a surprising conclusion. They found that adults over the age 80
may actually be better off not lowering their blood pressure below
140/90. We discuss the study in detail below.
The research was published in the European Heart Journal in 2019, and it
looked at elderly adults (both male and female) with and without any
previous cardiovascular events. They measured and recorded participants’
blood pressure and what medications they took, and 6 years later, they
checked how many of these participants passed away.
Importantly, the average age of the participants was 81 years. Also, the
research controlled for several confounding factors, such as biological
sex, lifestyle choices and body mass index (BMI).
As a result, the generalized findings were
that blood pressure values below 140/90 didn’t decrease risk of
mortality, but increased it by 26%. Now, this refers to the population
that is on average 81 years old, but if we further break down the
results, it is possible to observe an interesting tendency:
The mortality rates decreased (slightly) among the participants with
a normalized BP who were 70-79 years old.
A blood pressure below 140/90 increased the risk of death in the
population that was 80 and older by 40%.
Unfortunately, it remains unclear what role a relatively high blood
pressure may play in assisting older adults and what should be
considered as “normal blood pressure” for this age group. It is clear,
however, that a blanket approach to mass lowering of blood pressure may
not be the correct treatment strategy either.
Thus, the study concludes that patients over the age of 80 benefit from a
more targeted and individualized blood pressure treatment rather than a
steady goal of lowering the blood pressure below 140/90 for everyone.
And though this research definitely made some bold claims, it remains
unclear as to what criteria should be taken into consideration by
practicing doctors to provide said individualized treatment. However,
the researchers are optimistic, and their next goal is to learn to
distinguish between the patients who require antihypertensive
treatments, and those who might not.