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Study Urges Better Blood-Pressure Control
From VA Research Currents Vol. 4, No. 9/Sept. 2004
 A review study led by Sarwat I. Chaudhry, MD, a fellow at the West Haven
VAMC, backs recent recommendations from a national committee that urged
doctors to be more proactive in treating systolic hypertension in older adults. The
study appeared Sept. 1 in the Journal of the American Medical Association.
In systolic hypertension, systolic blood pressure—the higher number in the ideal
120/80 reading—is 140 or above, and diastolic blood pressure is below 90. Adults
with this condition are at increased risk for stroke, heart attack and heart failure.
But according to Chaudhry, many doctors believe that as long as older people’s
systolic pressure is no greater than their age plus 100, no treatment is needed.
Chaudhry and colleagues reviewed 36 clinical trials and other studies from
1966 to 2004 and found strong evidence of reduced heart risk with treatment of
systolic hypertension in cases where systolic blood pressure is 160 or above. In
cases where systolic blood pressure is from 140 to 159, wrote Chaudhry and her
co-authors, treatment decisions should be more sensitive to patient preferences
and tolerance of therapy.
The 2003 report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure stressed that in those aged 60
or older, systolic hypertension is a far more important cardiovascular risk factor
than diastolic hypertension. Despite this recommendation, studies show that poor
control of systolic hypertension is increasing.
The studies analyzed by Chaudry’s team supported the use of diuretics and
calcium channel blockers to treat systolic hypertension.
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