Immediate and late benefits of treating very elderly people with hypertension: results from active treatment extension to Hypertension in the Very Elderly randomised controlled trial

Dear Editor,

We congratulate Dr. Beckett et al. for a high quality randomized controlled trial (RCT) on HYVET, which has given a new direction for management of hypertension in the elderly and very elderly patients. That said, we would like to point out the occasional instances of the condition 'Pseudo-hypertension' in the elderly, where the blood pressure may just be normal, but may still lead to unwarranted treatment to bring down and maintain the blood pressures at satisfactory levels. Arteriosclerosis can result in pseudo-hypertension. Both the systolic and diastolic pressures are affected.

Very high blood pressure with no significant target organ impairment should raise the suspicion of pseudo-hypertension in an elderly. Treatment efforts may result in adverse effects and such symptoms like dizziness, confusion, and decreased urine output, etc. A simple bedside procedure which goes by the name of 'Osler's maneuver'. In this, if the radial artery can still be palpated despite the blood pressure cuff being inflated over the arm, it denotes a positive Osler's sign, which is a likely pointer towards pseudo-hypertension.

In today's time, when automatic blood pressure instruments are freely available, and are in rampant use as well for home blood pressure monitoring, we possibly need to be a bit more cautious so as to prevent unnecessary treatment or over-treatment. Gold standard remains the measurement of intra-arterial pressure, which shall provide the definitive diagnosis.

Best regards.

Dr. Ajay Kumar Singh Parihar

Dr. Shruti Chauhan

Dr. Rajesh Chauhan