Blood pressure drug could cut risks for elderly, say UK docs
By Salma Khalik, Health Correspondent
TAKING a drug to lower blood pressure could dramatically cut the risk of heart attack and stroke in older people, even those who do not need the medicine, says a team of British specialists.
After reviewing 150 studies of about half a million people, the specialists found that those who took a standard dose of any blood pressure lowering drug cut their risks of heart attacks by about a quarter, and strokes by about a third. The doctors from the Barts and The London School of Medicine at Queen Mary University of London said: 'Our results indicate the importance of lowering blood pressure in everyone over a certain age, rather than measuring it in everyone and treating it in some.'
But experts here disagreed with their findings and suggestions, published last month in the British Medical Journal.
Dr Tan Huay Cheem of the National University Heart Centre was aghast at the idea of giving drugs to all older people, healthy or not.
'One should not use age alone as a factor in deciding on therapy, especially when the drugs come with attendant adverse effects and cost,' he said.
The value of an analysis of so many studies done over four decades is questionable, according to Dr Jimmy Lim, a cardiologist in private practice.
'The conclusions drawn are never as sure as a well-conducted randomised controlled study,' he said, referring to studies that compare the effect of a drug on patients who are given it and patients who are not.
Dr Tan said blood pressure drugs are highly effective in cutting the risk of heart attacks and strokes in patients at risk. But how well they work for individual patients depends on their level of risk. His colleague, Associate Professor Poh Kian Keong, said it was important to first define the level of blood pressure at which risk goes up for heart problems and strokes. Prof Poh said it would help to know how effective the drugs are for patients with different levels of blood pressure.
Both Dr Lim and Prof Poh, however, feel that more people need to be on such drugs, since national studies show that more than half the adult population have higher than ideal blood pressure levels.
It would be better to get such people onto medication, rather than freely distribute it to people over a certain age.
Another reason for not giving the drug to all and sundry, said Prof Poh, is that it could lead to too low a blood pressure in some people.
However, Associate Professor Terrance Chua of the National Heart Centre found the suggestion that all older people be medicated for blood pressure 'an interesting idea', adding that it supports findings from other studies.
The British authors had argued that most people's blood pressure rises as they age, and that this 'is one of the main reasons for strokes and heart attacks being so common'. However, they were not able to pinpoint the age from which such drugs should be taken, since the trials they looked at were generally for people in their 60s.
The doctors also found that people with a diastolic blood pressure of 90, when given three drugs at half the standard dose, had their risk of coronary heart disease cut by 46 per cent and stroke by 62 per cent - or double the protection of taking one drug at the standard dose. As a result, they said: 'Guidelines on the use of blood pressure-lowering drugs can be simplified so that drugs are offered to people with all levels of blood pressure.'
Dr Low Lip Ping, a veteran cardiologist in private practice, noted that the studies were of people with relatively high blood pressure, and so should not be extrapolated to all older people.
