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Date: Fri, 20 Sep 1996 01:06:22 +0100 To: [log in to unmask] From: [log in to unmask] (Gerard Freriks) Subject: Re: Hypertension in the Elderly Reply-to: [log in to unmask] At 18:07 on 19/9/96, IAN QUIGLEY wrote: > "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?" > > David > As I' m sure you are the aware the SHEP study demonstrated a benefit for these > patients. However > what is the benefit of a theoretical decrease in the risk of stroke >compared to > a real drop in quality of life > caused by side effects. In some of these patients i just accept a high blood > pressure. You could always > ask the patient her view. Trouble is while the 30 somethings like to dictate > their healthcare needs the eighty somethings are more likely to want to be > dictated to. > BTW I usually find Ca antagonists helpful in this age group. > Ian I WILL COMPLICATE THINGS: 1- Lowering the bloodpressure will increase the risk associated with it. Recently I read, but forgot the references, an article where was demonstrated the effect of lowering the pressure to "normal" but increasing the rate of other problems. 2- I recall having read articles whre C-antagonists were effective at lowering the pressure but inceasing the chances of death! The whole issue of treatment of elevated bloodpressure is not resolved. To many pharmaceutical firms, "experts" have vested interests to sustain the notions that elevated bloodpressure is a risk.And we GP's feel very important because we perform an important medical intervention, and a simple one at that. And that lowering it will be beneficial. Only treatment with diuretics and beta-blockers have been proven to be "effective" at lowering the number of CVA's but not cardiac problems. All the rest is wishfull thinking. Hypophetising. And at best: making people without complaints patients, treating them with a small chance of lowering the risk, and dying later in more dear circumstances on account of something else. Gerard Freriks,huisarts, MD C. Sterrenburgstr 54 3151JG Hoek van Holland the Netherlands (31) 174-384296/ Fax: -386249 ARS LONGA, VITA BREVIS Cool it chaps - given the choice of a LONGA ARS and a LONGER VITA i know what i opt for. If there's anything based on evidence then lowering BP by any drug has benefits even though the final proof of the degree of reduction in morb and mort has only been shown for b-blockers and thiazides. But the evidence for the over 80s is actually a bit more sparse. Nevertheless, my oldies opt for the benefit. Most patients can be 'controlled' but targets must obviously be modified with some individuals. When control is difficult, check: for compliance for drug interactions for secondary hypertension for white coat hypertension ................and you've done your best! Malcolm Aylett Northumberland for funny peak-trough effects %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%