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New guidelines fuel debate on when older persons should start taking BP drug

When should the elderly start having blood-pressure medication? The latest guidelines for hypertension management released by two physicians’ group in the Unites States have open up this debate.

The recent guidelines state that in people above the age of 60, treatment should be started only if the systolic pressure or the first number representing the blood pressure when the heart is beating is above 150 mm/Hg. The treatment must be focussed at achieving moderate targets – less than 150 / 90 – in older people, the guideline states.

New guidelines issued on managing blood pressure in adults aged 60 years and above, from ACP and AAFP:

— ACCP Cardiology PRN (@accpcardprn)
January 18, 2017

A healthy blood pressure reading is 120/ 80 mm/Hg.

“Any additional benefit from aggressive BP control is small, with a lower magnitude of benefit and inconsistent results across outcomes,” the article read.

High blood pressure puts people at risk of heart attack and stroke, but the medicines may cause the diastolic or the blood pressure when the heart rests between beats to drop.

City cardiologists agree with the recommendations.

“In the elderly, intervention should be started if the systolic pressure is consistently above 150. Before starting the medicine, however, people must make lifestyle changes and see whether it helps. Consuming less salt, eating fruits and vegetables, exercising regularly and stress management may help in lowering the blood pressure,” said Dr SC Manchanda, senior consultant of cardiology at Sir Ganga Ram hospital.

However, if the lifestyle interventions fail to bring down the BP even after three months, medicines must be given.

“In older persons, there is a condition called isolated systolic high blood pressure. In such condition, the second number remains well below 90. In such cases, we have to be careful with medication because the diastolic pressure might drop further,” said Dr KK Talwar, Chairman of cardiology at Max Super speciality hospital, Saket.

The doctor also said that some medicine may aggravate postural falls. “The blood pressure may drop in some older patients when they stand up suddenly. This may result in falls,” said Dr Talwar.

The blood pressure must be managed to bring it below 140 mm/Hg if the person has co-morbid conditions like diabetes or kidney disease, the doctor said.

Source: HindustanTimes