Too much blood pressure medication negatively affects older patients

Old and frail patients are at an increased risk of mortality and memory issues if their blood pressure medication lowers their blood pressure too much, new research from the Netherlands has discovered.

The large-scale study by researchers from the University of Bern and the University of Leiden, the Netherlands, found that blood pressure medication needs amending, which has revitalised the official recommendations for antihypertensive medications.

Lowering blood pressure by the use of medication helps save lives in patients aged 60 and over. At the same time, the population is ageing – people aged 80 and over constitute the fastest-growing age group in our society yet, at the same time, prove the hardest group to research.

Tackling the broad range of patients

The range of patients is broad, ranging from severely handicapped 75-year-olds who live in nursing homes to 95-year-olds who still participate in sports.

However, blood pressure guidelines often ignore this broad spectrum and – as is currently the case in the US – make the generally accepted recommendation that blood pressure levels among all over-60s should be lowered to below 130mmHg.

One of the main recommendations for blood pressure is the lower the better, with a number of studies being able to demonstrate it; however, this, according to PD Sven Streit from the Institute of Primary Health Care (BIHAM) at the University of Bern, excludes “very old and frail people who have multiple illnesses and who are taking multiple types of medication. Thus, even results from the best of studies can only be applied to older people to a certain extent.”

The researchers discovered that antihypertensive medications led to an increased risk of mortality and to quicker cognitive decline among these patients. The study was published in the journal Age and Ageing.

How severely did blood pressure medication affect health?

Following the investigation of 600 people, the research team was able to demonstrate that the lower the blood pressure was reduced using antihypertensive medications, the higher the levels of total mortality and cognitive decline. This was particularly more prevalent in the individuals who were frail.

Streit commented: “Beforehand, the belief was already increasingly taking hold among general practitioners that additional antihypertensive therapy should only be recommended after an individual evaluation of its benefits and risks, especially in the case of frail patients.

“Now, we can prove that their belief was correct – contrary to official recommendations.”