Many Elderly Skip High Blood Pressure Drugs While Battling Other Ailments

High Blood Pressure

Like the squeaky wheel getting the grease, elderly patients with high blood pressure who also suffer from asthma or depression tend to treat those symptomatic ailments while high blood pressure, the "silent killer," goes untreated, according to a study reported in Hypertension: Journal of the American Heart Association.

Researchers found that illnesses unrelated to heart disease, depression, asthma, gastrointestinal disorders and osteoarthritis, appear to deter the use of high blood pressure drug therapy among seniors. High blood pressure is known as the silent killer because it has no symptoms.

"We theorized that patients tend to the ailments that are most bothersome, but awareness needs to be raised to the fact that high blood pressure is as important to treat as more symptomatic conditions," said Philip Wang, M.D., lead author of the study and an assistant professor of psychiatry, medicine and health-care policy at the Harvard Medical School in Boston.

"We found that elderly high blood pressure patients with other illnesses were generally half as likely to take their medication for high blood pressure," he said. "This is a little surprising when you consider the magnitude and consistency of the effectiveness of high blood pressure medication."

These results are particularly alarming because only 60 percent of high blood pressure patients are treated and only 34 percent are adequately controlled, Wang said.

Researchers examined data on 51,517 patients age 65 and older enrolled in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program, the largest state prescription benefits program for the elderly in the United States. PACE participants paid $6 per prescription.

Researchers compared blood pressure medication adherence of elderly high blood pressure patients with and without other conditions. A patient's tendency to take high blood pressure medication was:

• 57 percent less likely with asthma/chronic obstructive pulmonary disease;

• 50 percent less likely with depression;

• 41 percent less likely with gastro-intestinal disorders; and

• 37 percent less likely with osteoarthritis.

Reduced use of high blood pressure drugs also was associated with older age, female gender, white race, hospitalizations, nursing home care, the presence of other more severe diseases, the absence of some cardiovascular indications and the use of fewer other medications.

"Identifying reasons for this underutilization is a critical first step in developing interventions to improve use of this highly effective therapy," Wang said.

Wang said that his study confirms earlier findings that had identified mood disorders and chronic airway diseases' association with under use of health care in general and treatments for cardiovascular conditions in particular.

In an accompanying editorial, Jan A. Staessen of the University of Leuven in Herestaraat, Belgium, said the study should be heralded as groundbreaking.

"Wang's study shows the overwhelming benefits of early versus delayed blood pressure control," said Staessen. He also suggested that self-measurement of blood pressure might increase adherence to high blood pressure drug treatments.

The study was funded in part by grants from the National Institute on Aging and the National Institute of Mental Health.

___________

Statements and conclusions of study authors that are published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability. DALLAS, June 28