Letters

Influence of patient's age on GPs' definition of hypertension

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6992.1471a (Published 03 June 1995) Cite this as: BMJ 1995;310:1471

Patients aged over 80 may not benefit from antihypertensive treatment

  1. Tim Coleman
  1. Honorary clinical research fellow Faculty of Medicine, University of Leicester, Leicester General Hospital, Leicester LE5 4PW

    EDITOR,—J E C Dickerson and M J Brown explore the influence of patients' ages on general practitioners' reported management of hypertension but include all patients aged >/=65 in one category.1 While it has been shown that treatment of hypertension is beneficial in people aged 65-80, there is no good evidence that it is warranted in those aged over 80.2 Asking what are the lowest blood pressures at which general practitioners would both define and treat hypertension in this heterogeneous age group is therefore ambiguous, and the responses are difficult to interpret.

    If, however, we accept the data at their face value it is useful to look for reasons why general practitioners' reported practices are at variance with the recommended guidelines. The increase in the threshold blood pressure at which general practitioners report starting treatment with age could be explained by the fact that general practitioners care for all over 65 year olds, while healthier subgroups have been studied in trials. In the Medical Research Council's trial, for instance, the participants were fit enough to attend for screening (68% responded to an invitation).3 Even in this ambulant group 565 patients with hypertension (11% of those identified) were excluded from randomisation because of pre-existing disease and 575 patients (13%) were withdrawn from their allocated treatment groups because of side effects. Patients not enrolled into trials of antihypertensive drugs will therefore be more likely to suffer from other health problems and may be less likely to tolerate antihypertensive agents.

    General practitioners' experiences in caring for this portion of the elderly, hypertensive population may have contributed towards their reported management of hypertension. This may explain why general practitioners seem reluctant to consider starting antihypertensive drugs in the over 65s, reserving this intervention for patients with the highest blood pressures and the greatest chances of morbidity.

    References

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