In article <[log in to unmask]>, Dr David J
Plews <[log in to unmask]> writes
>EBM apparently states that treating systolic hypertension of > 160 in the
>elderly (? >65 or 70) significantly reduces the risk of stroke, etc.
>
>Ok, so I have a whole string of mostly women over 80 who no matter what I
>do, I cannot get their systolic below 180/190 without serious side-effects,
>both perceived by the patient ie "I feel awful doctor" and physiological ie
>urea and creat rising through the roof.
>
>So what do I do? Leave them alone, or work my way through the BNF?
>Have I misunderstood the studies?
Reducing elevated blood pressure reduces the risk of stroke. The closer
to normal BP you achieve the great the risk reduction. On the other
hand, it's not worth making someone's life miserable through
unacceptable side effects just to reduce risk, and, in any case,
reduction of systolic from (say) 220 to 180 is worthwhile.
I have found that, after trying all the standard treatments and before
going through the whole BNF, it's often worth trying good old-fashioned
methyldopa, which seems to be well tolerated in some elderly patients
who can tolerate little else and produce a gratifying reduction in blood
pressure.
Toby
--
Dr Toby Lipman
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