J Gerontol A Biol Sci Med Sci. 2003 Jul;58(7):653-8.

Embracing complexity: A consideration of hypertension in the very old.

Source

Department of Internal Medicine, School of Medicine, and Sealy Center on Aging, The University of Texas Medical Branch, Galveston 77555-0460, USA. jsgoodwin@utmb.edu

Abstract

The consequences of hypertension and its treatment differ in very old men and women compared to younger populations. In populations aged 85 years and older, higher levels of systolic and diastolic blood pressures are associated with increased survival, and this relationship is not eliminated by controlling for comorbidity, blood pressure treatment, and other relevant factors. In addition, in 3 of the 4 published randomized controlled trials of treatment of hypertension that included subjects aged 80 years or older, the investigators reported loss of efficacy of treatment in preventing the primary end points in subjects aged 80 and older. In a meta-analysis of those trials, total mortality was actually 14% higher (p =.05) in the treatment group for subjects aged 80 years and older. These data suggest 2 conclusions. First, we should reexamine that dictum that nontreatment of hypertension in those aged 80 years and older is de facto evidence of "ageism." Second, we are unlikely to come to any set of coherent "rules" regarding treatment of hypertension (and several other conditions) in the very old until we routinely stratify all older subjects enrolled in interventional or observational trials by indicators of physiologic vigor.

Comment in

Commentary on "Embracing complexity: A consideration of hypertension in the very old". [J Gerontol A Biol Sci Med Sci. 2003]
Commentary on "Embracing complexity: A consideration of hypertension in the very old".Aronow WS. J Gerontol A Biol Sci Med Sci. 2003 Jul; 58(7):659-60; discussion 669-70.
Commentary on "Embracing complexity: A consideration of hypertension in the very old". [J Gerontol A Biol Sci Med Sci. 2003]
Commentary on "Embracing complexity: A consideration of hypertension in the very old".Hajjar RR. J Gerontol A Biol Sci Med Sci. 2003 Jul; 58(7):661-2; discussion 669-70.
Help! Grandma's stroking: Balancing morbidity and mortality in the treatment of hypertension among the very old. [J Gerontol A Biol Sci Med Sci. 2003]
Help! Grandma's stroking: Balancing morbidity and mortality in the treatment of hypertension among the very old.Denson S. J Gerontol A Biol Sci Med Sci. 2003 Jul; 58(7):660-1; discussion 669-70.
Aging well and aging poorly: primary and secondary low blood pressure. [J Gerontol A Biol Sci Med Sci. 2003]
Aging well and aging poorly: primary and secondary low blood pressure.Harris TB. J Gerontol A Biol Sci Med Sci. 2003 Jul; 58(7):662-4; discussion 669-70.
Commentary on Goodwin's "Embracing complexity: a consideration of hypertension in the very old". [J Gerontol A Biol Sci Med Sci. 2003]
Commentary on Goodwin's "Embracing complexity: a consideration of hypertension in the very old".Hajjar I. J Gerontol A Biol Sci Med Sci. 2003 Dec; 58(12):M1146-8.
Commentary on "Embracing complexity: A consideration of hypertension in the very old". [J Gerontol A Biol Sci Med Sci. 2003]
Commentary on "Embracing complexity: A consideration of hypertension in the very old".Michel JP, Grab B, Perrenoud JJ. J Gerontol A Biol Sci Med Sci. 2003 Jul; 58(7):665-6; discussion 669-70.
Commentary on "Embracing complexity: A consideration of hypertension in the very old". [J Gerontol A Biol Sci Med Sci. 2003]
Commentary on "Embracing complexity: A consideration of hypertension in the very old".Newman AB. J Gerontol A Biol Sci Med Sci. 2003 Jul; 58(7):666-7; discussion 669-70.
The struggle to relate epidemiology to real people. [J Gerontol A Biol Sci Med Sci. 2003]
The struggle to relate epidemiology to real people.Thomas DR. J Gerontol A Biol Sci Med Sci. 2003 Jul; 58(7):667-8; discussion 669-70.
Commentary on "Embracing complexity: A consideration of hypertension in the very old". [J Gerontol A Biol Sci Med Sci. 2003]
Commentary on "Embracing complexity: A consideration of hypertension in the very old".Lowenthal DT. J Gerontol A Biol Sci Med Sci. 2003 Jul; 58(7):664-5; discussion 669-70.

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