The National Institute for Health and Care Research (NIHR) (2022) has discussed the importance of people of any age, with even slightly raised blood pressure, to have timely access to antihypertensive medication. Recent research found that the medication can reduce risk of myocardial infarction and stroke in any age up to 85 years, with the trend continuing above this age, although it can be difficult to ascertain outcomes due to the limited sample in this age category.
The NIHR (2022) reports that one in three adults in the UK has hypertension, with many being completely unaware of their condition due to invisibility of high blood pressure as a symptom. The ideal blood pressure should be between 90/60 and 120/80 mmHg. The systolic blood pressure rep-resents the pressure at which the blood is pushed around the body by the heart, and the diastolic is representative of the resistance to blood flow in the vessels (NIHR, 2022). This measurement is so important that even 5 mmHg makes a big difference.
The Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC, 2021a) reported from their large-scale study of 358 707 people aged between 21 and 105 years that a 5 mmHg reduction of systolic blood pressure reduced the risk of major cardiovascular events by 10%, regardless of any pre-existing cardiovascular disease, and this applied even to normal or the upper range of normal blood pressure values. The researchers found that a fixed degree of pharmacologically maintained blood pressure-lowering is effective for both primary and secondary prevention of major cardiovascular disease—even at levels that would not usually be considered as requiring any kind of antihypertensive treatment.
For every 5 mmHg reduction in systolic blood pressure, cardiovascular events were found to have been reduced by 18% of anyone over the age of 55, by 9% in age groups between 55 and 84, and by 1% in those aged 85 and older (BPLTTC, 2021a). On critique, however, it is the older population that suffers more from these types of events, and therefore, despite the reduction of risk being so significant in the younger age group, they are at lesser at risk. This means that the reduction in events still equates to fewer events due to the proportion of people aged under 55 suffering from cardiovascular problems.
The 1% reduction appears low but translates into a higher number of cardiovascular events prevented in an age group that is suffered by many. This is important, as there is often disagreement about treatment being given to people with hypertension over the age of 70. In the US, it is currently not recommended to offer antihypertensives to over 70's and targets differ per age group in Europe (NIHR, 2022). The research by the group on both the effectiveness of antihy-pertensive medication and the effectiveness in different age ranges of antihypertensive medication, therefore, points to the use of antihypertensives being important no matter the person's age.
BPLTTC (2021b) published their results shortly after publication of their initial study (BPLTTC, 2021a). The meta-analysis found that blood pressure reduction is effective across a wide range of ages and that there was no evidence to suggest that relative risk reductions for prevention of major cardiovascular events vary according to the baseline systolic or diastolic blood pressures, which currently vary according to target blood pressure per age range in European recommendations. The group found no evidence to say that treatment could increase mortality in any age group.
However, the group did state that more research would be needed in the oldest age range of over 85's, as the sample was too small and cardiovascular events in this smaller sample were too few to draw proper conclusions. The team commented that the increase in systolic blood pressure usually has been deemed essential as the body ages, to maintain coronary and cerebral perfusion. However, in remote rural areas, this blood pressure does not increase with age, suggesting that it is not a natural or essential process. Consequently, it should not be regarded as something to avoid treating, as the research has shown that a reduction in the smallest amount of blood pressure and the use of antihypertensive medication for normal, high normal or high blood pressure across any age group, is effective at avoiding major cardiovascular events.