High Blood Pressure May Protect Some Frail Elderly: Study

Medication needs might vary for patients who can't walk a certain speed or distance, experts say

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Monday, July 16, 2012

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MONDAY, July 16 (HealthDay News) -- Frail, elderly people with high blood pressure may live longer than their peers with lower blood pressure, new research suggests.

In the study of 2,340 seniors, low blood pressure protected those who were healthier and more robust, but the same could not be said for their frail counterparts. In general, high blood pressure, or hypertension, is a major risk factor for heart attack and stroke.

Researchers used data from two yearly U.S. National Health and Nutrition Examination Surveys. The new findings were published online July 16 in the Archives of Internal Medicine.

Frailty and fragility was assessed via walking-speed tests. Study participants were asked to walk for about 20 feet at their normal pace. Those who walked less than 2.6 feet per second were "slower walkers." Their faster-walking counterparts had lower rates of diabetes, heart disease and other health problems. A third group included participants who were unable to complete the walking test.

In this third group, those frail seniors with higher blood pressure levels were 62 percent less likely to die during the study period when compared to their counterparts with lower blood pressure levels.

"Older frail adults might benefit from slightly higher blood pressure," said study author Michelle Odden, a public health epidemiologist at Oregon State University, in Corvallis, Ore. "As the blood vessels get more stiff with age, it may be necessary to have more pressure to keep blood pumping to the central organs, like the brain and heart."

It's too early to make any treatment recommendations, Odden said. "Our study does support lower blood pressure in healthy elderly people," she said.

Each patient is different, she noted. "If you have seen one older adult, you have seen one older adult," she said. "This really sums up the wide variety of health status we see in older adults."

The study linked data from the nationwide health surveys in 1999-2000 and 2001-2002 to U.S. National Death Index data through December 2006. During the study, 589 people died. Faster walkers with high blood pressure were 35 percent more likely to die, compared to those fast walkers with normal blood pressure levels, the study showed. There was no link seen between high blood pressure and death among slow walkers.

According to the American Heart Association, normal blood pressure is a systolic pressure of less than 120 and a diastolic pressure of less than 80. Systolic pressure (the upper number in a blood pressure reading) refers to pressure in the arteries when the heart beats. Diastolic pressure (the lower number) measures pressure in the arteries between heart beats.

One expert said the new results would have a direct impact on clinical practice.

Among older people with chronic conditions "hypertension is amongst the most common, and choosing one, two or three drugs to reduce blood pressure is an all-too-common dilemma," said Dr. Bradley Flansbaum, director of Hospital Medicine at Lenox Hill Hospital in New York City. "These pills all have costs and side effects," he said. "Now, by walking our patients and determining those folks that can exceed 2 mph or greater -- 30 minutes per mile -- doctors can select who will benefit from these classes of drugs."

He added that blood pressure treatments that could help a relatively healthy 80-year-old might not benefit a frailer patient. "Those who cannot achieve a similar [walking] speed signal a burden of illness and debilitation that does not warrant therapy, which if used, might even be harmful."
Another expert agreed.

When it comes to blood pressure, "'one size fits all' doesn't really hold," said Dr. Howard Weintraub, clinical director of the Center for the Prevention of Cardiovascular Disease at NYU Langone Medical Center in New York City. "For elderly, frail individuals, our primary focus should not necessarily be getting their blood pressure down."

Some of the medications used to treat high blood pressure, including diuretics and beta blockers, may confer more risk than benefit in this group, he said.

"We need to focus on hypertension, but give a little slack," he said, adding that not every patient will benefit from efforts to lower their blood pressure. However, he said, "If the systolic pressure is 180, I am not leaving it alone. I would also treat someone who also has diabetes and has high cholesterol or other risk factors." A systolic blood pressure of higher than 180 is considered a hypertensive crisis, according to the American Heart Association.

SOURCES: Michelle Odden, Ph.D., public health epidemiologist, Oregon State University, Corvallis, Ore.; Howard S. Weintraub, clinical director, Center for the Prevention of Cardiovascular Disease, NYU Langone Medical Center, New York City; Bradley Flansbaum, D.O., director, Hospital Medicine, Lenox Hill Hospital, New York City; July 16, 2012, Archives of Internal Medicine, online

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