Do older adults benefit from blood pressure treatment?

Q. I've been taking blood pressure pills for 20 years, but I just turned 75. Do I still benefit from taking them?

A. There is no doubt about the benefit of treating high blood pressure in people younger than 75. But some doctors have wondered if, in people older than 75, the benefits might be less and the chance of bad reactions to medicines might be greater. So, you're asking a question that we doctors have asked ourselves.

A study published online Aug. 26, 2021, by The Lancet is the best one I've seen on this question. It indicates that the value of blood pressure treatment continues in people over 75 years old. Scientists pooled the results of 51 randomized clinical trials involving 358,707 people, who ranged in age from 21 to 105 years old. Nearly 59,000 people were ages 75 or older. With so many people in the analysis, the results are more likely to be valid.

Randomized trials are the best type of study for judging the benefits and the risks of treatment. Such trials randomly assign some people to take a real blood pressure pill and others to take a placebo (inactive pill). Since the people in the two groups are very similar except for the kind of pill they are taking, any differences in their subsequent health are likely to be explained by whether they took the real medicine or the placebo. So, because of the large number of people in the analysis, and the fact they were all in randomized trials, we can trust the results of the analysis.

The study mainly looked at cardiovascular diseases such as strokes, heart attacks, and other heart problems caused by clogged arteries. For people younger than 75, the study confirmed that people taking blood pressure medicines had 10% to 20% fewer cardiovascular disease problems. For people 75 to 84, there still was a 10% reduction. For people older than 85, the results were mixed, but there still appeared to be a benefit from blood pressure treatment.

While this analysis did not specifically look at side effects from treatment, other large studies have. The bottom line is that side effects from blood pressure treatments are not greater in people over 75 than in younger people. Rarely, an older person develops unpleasant symptoms if treatment lowers blood pressure below 130/85 millimeters of mercury (mm Hg), requiring a lower dose of medicine.

So, this analysis confirms that treatment to lower blood pressure protects against heart attacks, strokes, and other major cardiovascular disease problems — in the average person below age 75, the person in the 75-to-84 age group, and possibly the person older than 85. The goal of treatment is a blood pressure of around 120/70 mm Hg. Fortunately, today there are many effective medicines for high blood pressure.

Image: © peepo/Getty Images