Blood pressure medication helps even the frailest seniors live longer

Taking blood pressure medication as prescribed helps seniors aged 65 and over people live longer. And the healthiest older people had the biggest survival boost, according to a large study in northern Italy published in Hypertension, an American Heart Association journal.

“We knew that high blood pressure medication was protective in general among older people, however, we focused on whether it is also protective in frail patients with many other medical conditions who are usually excluded from randomised trials,” said Giuseppe Mancia, lead study author and professor emeritus at the University of Milano-Bicocca.

Researchers reviewed data on almost 1.3 million people aged 65 and older (average age 76) in the Lombardy region of northern Italy who had three or more high blood pressure medication prescriptions in 2011–2012. Examining the public healthcare database, researchers calculated the percentage of time over the next seven years (or until death) that each person continued to receive medication. Almost all medication is free or low cost and dispensed by the public health service, so this corresponds roughly to people’s adherence in using the medication in Italy.

To look separately at outcomes among older people with various medical conditions, researchers used a score that monitors 34 different health factors.

Researchers compared roughly 255,000 people who died during the seven-year follow-up with age, gender, and health status-matched controls who survived and divided them into four groups of health status: good, medium, poor or very poor.

The probability of death over seven years was 16 per cent for people rated in good health at the beginning of the study. Mortality probability increased progressively to 64 per cent for those rated in very poor health.

Compared with people with very low adherence to blood pressure medication (dispensed pills covered less than 25 per cent of the time period), people with high adherence to blood pressure medication (more than 75 per cent of the time period covered) were 44 per cent less likely to die if they started in good health; and 33 per cent less likely to die if they started in very poor health.

A similar pattern was seen with cardiovascular deaths. The greatest survival benefit was seen among the people who started in good health, and the most modest survival benefit was in those who started in very poor health.

“Our findings definitely suggest that even in very frail people, anti-hypertensive treatment reduces the risk of death; however, the benefits may be smaller in this group,” Professor Mancia said.

No matter what a person’s initial health status, survival benefits were greatest in those who received blood pressure medication to cover more than 75 per cent of the follow-up period, compared with those with intermediate (25–75 per cent) or low levels (less than 25 per cent) of coverage, highlighting the importance of consistent use of blood pressure medications.

“Do your best to encourage and support patients to take their medications, because adherence is crucial to getting the benefits. Medications do nothing if people don’t take them,” Prof. Mancia said.

Prescription medications given to elderly people living in nursing homes or assisted-living homes in Italy are not included in the national database, so the study’s results may only apply to elderly people living in the community. In addition, all data for this analysis are from Italy, where hospitalisations and blood pressure medications are available free or at low cost. The study’s findings, therefore, may not be generalisable to countries with a different healthcare system.

Do you or someone close to you take blood pressure medication? Do you find the research surprising? Do you think that this type of medication is accessible enough to the average Australian?

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Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.

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