Many Older Adults Are Not Getting Prescribed the Blood Pressure Treatment They Need

Many Older Adults Are Not Getting Prescribed the Blood Pressure Treatment They Need

Blood pressure is a measurement of the force that blood exerts on the artery walls.
Getty Images/Justin Paget

According to a recent Harvard study, more than 7 in 10 older people in the United States who need more severe high blood pressure treatment do not receive it. According to research findings that were released on September 16, 2022, in the American Heart Association journal Hypertension, millions of people are not receiving the proper care, which puts them at an elevated risk of having a heart attack or stroke.

The primary study author, Nicholas Chiu, MD, a clinical fellow at Beth Israel Deaconess Medical Center in Boston, stated in a press statement that “We haven’t been doing well, despite compelling data confirming the strong benefits of effective blood pressure control in older persons.” There is a significant public health gap here that has to be closed

Nearly 50% of American adults suffer from hypertension.

According to MedlinePlus, blood pressure is only a measurement of the force of blood pushing against the walls of the arteries. The highest number in a blood pressure reading, or the systolic blood pressure, represents how much pressure the blood is applying to the artery walls with each contraction. The bottom number in a blood pressure reading, or diastolic blood pressure, represents how much force the blood is applying to the artery walls when the heart is at rest in between contractions.

Long-term high blood pressure can harm your heart, brain, kidneys, eyes, and other organs while also raising your risk of heart attack and stroke. The Centers for Disease Control and Prevention (CDC) estimate that 116 million adults in the United States, or 47% of the population, have high blood pressure, also referred to as hypertension. Hypertension was the main factor in more than 670,000 fatalities in the United States in 2020.

In 2017, the cutoff for high blood pressure was lowered

The American Heart Association (AHA), the American College of Cardiology (ACC), and nine other health organizations released a joint statement in 2017 that lowered the threshold for high blood pressure to 130/80 millimeters of mercury (mmHg) and higher for all adults, regardless of age, from the previous definition of 140/90 and higher.

Researchers examined a decade’s worth of national data, paying particular attention to people who visited their primary care provider and had previously been diagnosed with high blood pressure, in order to learn whether adults over 60 whose readings indicated hypertension received more intensive blood pressure treatment.

Investigators were able to determine which patients received “appropriate antihypertensive intensification,” which is the addition of antihypertensive medication to a patient’s treatment for high blood pressure, using that information.

The American College of Physicians/American Academy of Family Physicians (ACP/AAFP), the European Society of Cardiology, and the ACC/AHA guidelines were utilized to determine blood pressure targets. Additionally, the researchers developed their own all-inclusive measure that complied with the three standards.

According to researchers, during the study period from 2008 to 2018, there were up to 7,404 primary care visits in the sample where treatment intensification was warranted based on office blood pressure measurements. This number can be extrapolated to 293 million visits across the population.

The study’s key findings were as follows:

  • According to the most liberal “all-inclusive” assessment, fewer than three out of ten patients (27.5%) who had hypertension but weren’t already receiving medicine for high blood pressure got their prescriptions filled.
  • By the same standard, only 15.3% of patients who were previously taking medication for hypertension received a second prescription.
  • Over the course of the trial, fewer patients received the proper therapy intensification. Most significantly, under ACP/AAFP objectives, the proportion of patients receiving suitable treatment intensification fell from about 25% in 2008–2009 to roughly 15% in 2015–2018.

People could refrain from receiving the necessary blood pressure treatment because of concerns about side effects and time constraints.

The study’s authors provided a few alternative explanations, even though it wasn’t their intention to figure out why so many people weren’t receiving the prescribed high blood pressure therapy.

According to the senior author, Kenneth Mukamal, MD, an associate professor of medicine at Beth Israel Deaconess Medical Center in Brookline, Massachusetts, both doctors, and patients may be worried about the potential negative effects of the medications.

Additionally, he noted, it’s challenging for primary care doctors to aggressively manage high blood pressure in a usual 15-minute appointment. “Along with trying to control blood pressure, cholesterol, diet, and weight, the paperwork requirements have increased.” Speaking from personal experience, “being a primary care physician is more difficult than ever,” Dr. Mukamal stated.

According to him, future research is required to determine what tactics will encourage medical professionals to treat high blood pressure among older adults more effectively. For instance, he suggested that medical record systems be modified to automatically notify doctors to add a medication when a patient’s blood pressure is higher than what is advised.

Prescription Drugs for High Blood Pressure

To manage blood pressure, many medications are frequently necessary. The following are some of the most often used medication classes, according to MedlinePlus:

Diuretics commonly referred to as “water pills,” aid in the kidneys’ removal of some salt (sodium) from the body. This lowers the volume of fluid in the blood vessels and lowers blood pressure.

Beta-blockers slow down and weaken the heart’s contractions, which helps reduce blood pressure.

Inhibitors of the angiotensin-converting enzyme (ACE) lessen the body’s production of angiotensin II, which aids in blood vessel relaxation and lowers blood pressure.

ARBs (angiotensin II receptor blockers) help to relax the blood vessels and lower blood pressure by reducing the action of angiotensin II in the body.

Calcium channel blockers serve to relax blood vessels by lowering the amount of calcium that enters cells in the blood vessel wall.

Many times, high blood pressure has no overt symptoms.

According to Laxmi Mehta, MD, a professor in the division of cardiovascular medicine and the director of preventive cardiology and women’s cardiovascular health at the Ohio State University Wexner Medical Center in Columbus, hypertension is frequently a silent disease with no obvious symptoms, so many patients are shocked when they are told they have it.

The best approach to determining your blood pressure, according to her, is to get it checked at your doctor’s office.

According to Dr. Mehta, there are risk factors that can lead to high blood pressure, such as a poor diet with a high sodium intake, alcohol, and tobacco use, being overweight or obese, inactivity, sleep apnea or getting little sleep, and high levels of stress. Additionally, there are risk factors that cannot be changed, such as age and family history, she says.

Expert Tips to Maintain Blood Pressure Control

The American Heart Association advises using an automatic cuff-style biceps device at home to monitor blood pressure in people with high blood pressure; wrist and finger monitors are not advised because of their lower reliability. But keep in mind that home monitoring is not a replacement for routine doctor appointments.

Mehta advises maintaining a journal and focusing on the variables you can influence.

In addition to taking any prescribed medications, she advises maintaining a healthy diet, abstaining from smoking, exercising frequently, minimizing stress, and getting enough sleep.

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