{"id":1095,"date":"2016-08-08T10:39:22","date_gmt":"2016-08-08T09:39:22","guid":{"rendered":"http:\/\/blogs.kent.ac.uk\/chss-news\/?p=1095"},"modified":"2016-08-08T10:52:08","modified_gmt":"2016-08-08T09:52:08","slug":"new-blog-from-chris-farmer-blood-pressure-medication-in-older-people-needs-monitoring-and-review","status":"publish","type":"post","link":"https:\/\/blogs.kent.ac.uk\/chss-news\/2016\/08\/08\/new-blog-from-chris-farmer-blood-pressure-medication-in-older-people-needs-monitoring-and-review\/","title":{"rendered":"NEW BLOG from Chris Farmer: Blood pressure medication in older people needs monitoring and review"},"content":{"rendered":"

NEW BLOG from Chris Farmer: Blood pressure medication in older people needs monitoring and review<\/strong><\/p>\n

Older people remain on blood pressure agents despite being hypotensive resulting in increased mortality and hospital admission.<\/strong>Yvonne Morrissey, Michael Bedford, Jean Irving, Chris K. T. Farmer
\nAge and Ageing 2016;<\/em> 0: 1\u20136 doi: 10.1093\/ageing\/afw120
\n<\/em><\/p>\n

‘CHSS Clinical Professor Chris Farmer is a Consultant in Renal Medicine at East Kent Hospitals University NHS Foundation Trust. One of EKHUFT’s most prodigious researchers, Chris’ work has informed national policy in renal medicine<\/em>.<\/p>\n

Blood pressure\u00a0medication\u00a0in older people\u00a0\u2013 the need for monitoring and review\u00a0<\/u><\/strong><\/p>\n

‘High blood pressure (hypertension) may be detected at any age, but it is typically diagnosed\u00a0in mid-life.\u00a0 High blood pressure does not cause symptoms.\u00a0People take blood pressure tablets to reduce the risk of future strokes and heart disease.\u00a0<\/strong>Once\u00a0started, blood pressure medication\u00a0may be continued for many years after.\u00a0 Over time changes in body composition and metabolism occur due to the ageing process. So the antihypertensive drug regime that suited the patient well in their 50\u2019s or 60\u2019s may be too much for them in their 70\u2019s or 80\u2019s.<\/p>\n

With advancing age the patient may contract other medical ailments (co-morbidities) for which more medications are prescribed. By the time the patient reaches old age they may end up on quite a collection of tablets.\u00a0 What is more, the drugs prescribed for co-morbidities may lower blood pressure as a side effect.\u00a0Medications for prostate symptoms for example also lower blood pressure.<\/p>\n

In a recent paper, Professor Mary Tinetti1<\/sup> demonstrated a \u2018trade-off\u2019 in older people with co-existing medical conditions between the benefits of\u00a0blood pressure tablets to reduce the risk of future disease, and increased risks related\u00a0to\u00a0 adverse effects of medication.<\/p>\n

On the one hand the HYVET2<\/sup> study demonstrated that blood pressure tablets reduce the risk of strokes and cardiovascular\u00a0disease\u00a0in older people.\u00a0 On the other hand it is argued the subjects of HYVET differed from the population we as Health Care of Older People physicians see on a clinical basis. For older patients with co-morbidities blood pressure tablets can be associated with falls and serious injuries.<\/p>\n

We are becoming more cognizant of the need to be aware of the \u201cheterogeneity\u201d of the ageing population. We may need to take account of factors such as cognitive functioning, frailty and walking speed when considering antihypertensive treatment. In terms of evaluating outcomes of blood pressure treatment in older people it has been suggested that the effect on patient quality of life should be measured, as well as medical outcomes3<\/sup>.<\/p>\n

In this study we found that a small but significant proportion of a population of primary care patients remain on antihypertensive drugs despite having low blood pressure. The data highlights\u00a0the need for periodic re-evaluation of the older person\u2019s antihypertensive medication regime to achieve the optimal level of blood pressure control for the individual.\u00a0Furthermore, older people\u2019s blood pressure varies throughout the day e.g. it drops on standing up and after meals; so we need to consider the effects of medication over the whole day.<\/p>\n

One implication of this study is perhaps that clinical guidelines and quality standards in relation to blood pressure treatment should recognise the need for a more holistic and patient-centred approach for frail older people with medical complexity’.<\/p>\n

1<\/sup><\/strong>Beckett NS, et al<\/strong>. Treatment of hypertension in patients 80 years of age or older.\u00a0The New England Journal of Medicine<\/em>. 2008. 358(18):1887-1898<\/p>\n

2<\/sup>Tinetti M, Ling\u00a0H, Lee D et al<\/strong>. Antihypertensive Medications and Serious Fall Injuries in a Nationally Representative Sample of Older Adults.\u00a0 JAMA Internal Medicine<\/em>\u00a02014; 174(4):588-595. doi:10.1001\/jamainternmed.2013.14764.<\/p>\n

3<\/sup>Odden A<\/strong> discontinuation trial of antihypertensive treatment.\u00a0 The other side of the story. JAMA Internal Medicine 2015<\/em>; 175(10):1630-1632<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

NEW BLOG from Chris Farmer: Blood pressure medication in older people needs monitoring and review Older people remain on blood pressure agents despite being hypotensive resulting in increased mortality and hospital admission.Yvonne Morrissey, Michael Bedford, Jean Irving, Chris K. T. Farmer Age and Ageing 2016; 0: 1\u20136 doi: 10.1093\/ageing\/afw120 ‘CHSS Clinical Professor Chris Farmer is … <\/p>\n

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