Wednesday, May 13, 2015

Keeping blood pressure among the elderly at a high enough level

Alan Cassels talks about the dangers of keeping blood pressure low among the elderly.
People who talk about prescribing in the elderly call it an 'evidence-free zone.' ... [B]lood pressure makes a very poignant example of the kind of care the elderly can often be subject to.... The problem is that trying to get blood pressure that low for someone who is 80 is almost totally irrational. Why? Because the physiology of old people is different and most blood pressure studies have specifically excluded people aged 80 and over. Those few studies that have focused on the elderly find something terribly surprising: the patients in the trials who had lower blood pressure had a higher risk of death.
This gets my goat. Because some doctors treat the elderly like they're middle aged and drown them in antihypertensives to keep their bp within the range appropriate for half century old individuals. Hence adverse effects can kick in. As in dizziness and light headedness in my mom's case. Seemingly unable to think out of the box, these doctors (hopefully in the minority) treat their now septua- and octogenarian patients as if they were still in their 50s. And worse, patients have been indoctrinated into believing there is an unquestionable Goldilocks zone for bp which is true for everyone and for all ages. And so they happily go along with their physicians' recommendations.

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