From: greenla@umichZ.edu (Lee Green MD MPH)
Newsgroups: sci.med.cardiology
Subject: Re: BP in the elderly...
Date: Fri, 28 Nov 1997 20:43:33 -0500

In article <347A6FE2.5F8A@idt.net>, John Guzobad <guz@idt.net> wrote:

> Hello all,
>
> I found this morsel in a medical text:
>
> "Although bringing blood pressure down to 120/85
> may be appropriate in a young hypertensive patient,
> a more reasonable goal for an elderly hypertensive
> patient might be 150/95..."
>
> Presumably, this is taking into account any HTP meds
> being taken.  As such, that reading seems a bit high
> to me (esp. the diastolic) -- any comments?

That is a good illustration of the hazards of textbooks.  They are an
unfortunate mix of data-based statements and clinical speculation, and
it's often impossible to tell the various kinds of statements apart.
(Notable exceptions exist, such as Scientific American Medicine.)

The textbook is wrong.  For the full data-based details, see the
just-released Sixth Report of the Joint National Commission on
Hypertension (JNC VI) from NIH.  It's on their website,
http://www.nhlbi.nih.gov/nhlbi/nhlbi.htm, as an Adobe Acrobat document, or
in dead tree edition from the NIH as publication # 98-4080, or in the
upcoming issue of Archives of Internal Medicine.  (This is a shameless
plug; I'm a coauthor.)

For the short form, the SHEP (Systolic Hypertension in the Elderly) study
demonstrated quite clearly that elders do *not* do better with relaxed
criteria for hypertension treatment.  Indeed, the young hypertensive is
more likely to do so.  The absolute risk reduction for hypertension
treatment, in terms of avoiding heart failure, stroke, and heart attack,
is greater for elders than for the young.  It's a serious disservice to an
elder to slack off on treatment goals.

--
Lee Green MD MPH          Disclaimer: My postings are my doing, not
Family Practice           a service of nor in any way the
University of Michigan    responsibility of the University of
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