A study released in last week's Journal of the American Medical Association (JAMA) makes several important criticisms of medical care for elderly Americans with hypertension (high blood pressure).
Despite the fact that safe, effective, and well-established treatments exist for hypertension, the JAMA study reports abysmally low rates of blood pressure control among Americans, especially older women. The researchers offer two explanations for this: the relative lack of use of combination therapy (those who were on medication were more likely to take only one drug) and preferential prescription of particular drugs by physicians. The researchers found that expensive drugs such as ACE inhibitors and alpha-blockers were prescribed more often than thiazide diuretics. The thiazides, however, are more cost-effective and a greater body of research exists on their efficacy in the elderly population, raising questions as to why the other medications are more readily prescribed. These community-level findings confirm trends that have been reported in national surveys.
The JAMA study also underscores the fact that women have much lower rates of blood pressure control than men; around 37% of the male patients in each age group had successfully controlled blood pressure, compared with only 23% of women in the highest age bracket. Whether this discrepancy is due to poor prescription practices, because women are discouraged from seeking treatment by the prevailing myth that CVD is a "man's disease," or because of some other factor is unknown. As the American population ages, the burden of hypertension is expected to increase. Clearly, then, remedying these poor rates of blood pressure control should be a top public health priority.
Unlike so many overhyped health risks, the dangers of high blood pressure and related cardiovascular disease have been well established, as have the efficacy of the available medications. The JAMA study presents credible evidence of something public health officials have suspected for a long time; hypertension is not being as effectively controlled as it ought to be, especially among women, resulting in needless suffering and death from strokes and heart disease.
Now that a weakness in the health delivery system has been pointed out, appropriate interventions can be planned. Perhaps we will soon see this study -- for once, a real health scare deserving attention -- on the evening news.
For more information on hypertension treatment and prevention, see http://www.ash-us.org/
Source: Lloyd-Jones, D et al. "Hypertension in adults across the age spectrum." Journal of the American Medical Association, vol. 294: July 27, 2005.
Mara Burney is a research associate at the American Council on Science and Health (ACSH.org, HealthFactsAndFears.com).