Increased Mortality, Memory Problems in Elderly When BP Lowered Excessively

For your doctors to consider when trying to figure out your best blood pressure post stroke.

These earlier articles might be instructive, you do expect your doctor to be famialar with them?

Effects of Blood Pressure in the Early Phase of Ischemic Stroke and Stroke Subtype on Poststroke Cognitive Impairment

Blood Pressure in Acute Stroke To Treat or Not to Treat: That Is Still the Question

 

Effects of Blood Pressure in the Early Phase of Ischemic Stroke and Stroke Subtype on Poststroke Cognitive Impairment

 

Systolic Blood Pressure Control and Mortality After Stroke in Hypertensive Patients July 2015

 

BP Lowering in Acute Stroke Flops for Improving Outcomes February 2015

 

After stroke, compared with Systolic Blood Pressure in the high range, low to normal SBP is associated with poorer mortality outcomes. May 2015

 

Systolic Blood Pressure and Mortality After Stroke May 2015

 

Blood pressure-lowering treatment with candesartan had no beneficial effect on activities of daily living and level of care at 6 months June 2015

Blood pressure reduction in acute ischemic stroke according to time to treatment: a subgroup analysis of the China Antihypertensive Trial in Acute Ischemic Stroke trial May 2017

Intensive blood pressure lowering in patients with acute intracerebral haemorrhage: Clinical outcomes and haemorrhage expansion. Systematic review and meta-analysis of randomised trials February 2017 

 

 

 

 The latest here:

Increased Mortality, Memory Problems in Elderly When BP Lowered Excessively

BERN, Switzerland -- June 29, 2018 -- Old and frail patients have an increased mortality risk and increased memory problems when their blood pressure is lowered too much through medication, according to a study published in the journal Age and Ageing.

Lowering blood pressure by using medication helps many people and saves lives, particularly among patients aged 60 and over. The range of patients is broad: from severely handicapped 75-year-olds who live in nursing homes to 95-year-olds who still participate in sports. However, blood pressure guidelines often ignore this broad spectrum and -- as is currently the case in the United States -- make the generally-accepted recommendation that blood pressure levels among all over-60s should be lowered to below 130mmHg.

“The lower the better” is one recommendation which applies for many people, including the elderly, as randomised studies were able to demonstrate. However, there can be a catch here, according to Sven Streit, MD, Institute of Primary Health Care (BIHAM), University of Bern, Switzerland. “Such studies exclude very old and frail people who have multiple illnesses and who are taking multiple types of medication. Thus, even results from the best of studies can only be applied to older people to a certain extent.”

However, general practitioners deal with the whole spectrum of very old people, ie a spectrum which includes those excluded from clinical studies. The group of patients under investigation included all inhabitants of Leiden, the Netherlands aged 85. This also accounted for patients suffering from dementia, living in nursing homes, or who are otherwise frail. The researchers discovered that antihypertensive medications led to an increased risk of mortality and to quicker cognitive decline among these patients.

In the study, 249 (44%) of 570 participants were prescribed antihypertensive therapy. All-cause mortality was higher in participants with lower blood pressure prescribed antihypertensive medication. Participants taking antihypertensive medication showed an association between accelerated cognitive decline and lower blood pressure; decline in cognition was more rapid in those with lower hand grip strength. In participants not prescribed antihypertensive medication, no significant associations were seen between blood pressure and either mortality or cognitive decline.

With this study, the researchers confirmed that which had already been speculated in previous observational studies. However, this is the first study whose results can be applied across the entire population. “Beforehand, the belief was already increasingly taking hold among general practitioners that additional antihypertensive therapy should only be recommended after an individual evaluation of its benefits and risks, especially in the case of frail patients,” says Dr. Streit. “Now, we can prove that their belief was correct – contrary to official recommendations.”

Reference: https://doi.org/10.1093/ageing/afy072

SOURCE: University of Bern