Those who are most at risk from high blood pressure have the most to gain from treatment - yet they are being neglected. Doctors are often reluctant to treat people with high blood pressure when they have other risk factors, like high cholesterol or diabetes. Maybe they believe little can be done when matters have reached the 'multiple risk factor' stage, or they may worry about lowering blood pressure in a patient whose health is poor. Whatever the reason, it means that of 18.5 older Americans with high blood pressure, 15 million are not adequately diagnosed or treated.
This is totally against the patient's interest according to new research from Wake Forest University. They have used a risk assessment tool developed by the American Heart Association to classify the risk of future heart attack, stroke and heart failure in nearly 5,000 adults over 60 in the Systolic Hypertension in the Elderly Programme. They already found that treating systolic (top figure) hypertension reduces adverse events like heart attacks. This new study divides patients into four groups, depending on their cardiovascular risk.
Treating those in the high risk group is four times more effective than for the low risk group. But the high risk group comprises exactly those people who are not being treated. It's a wake-up call for doctors - they should re-think their approach to older patients with high blood pressure and other risk factors.