Combination BP meds raise risk of mortality in elderly

Researchers raised concerns about the safety of prescribing combination antihypertensive medications in elderly patients with low blood pressure, in a new JAMA Internal Medicinestudy.

Published in the April 7 issue of the journal, the article was authored by Wilbert S. Aronow, MD, with the cardiology division at Westchester Medical Center/New York Medical College in Valhalla, N.Y.

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While clinical evidence supports the beneficial effects of lowering blood pressure (BP) levels in community-living, robust, hypertensive individuals aged older than 80 years, observational studies in frail elderly patients have shown no or even an inverse relationship between BP and morbidity and mortality, according to Dr Aronow.

To that end, Dr Aronow conducted a longitudinal study with elderly residents of nursing homes, analyzing the interaction between low systolic blood pressure (SBP) and the presence of combination antihypertensive treatment on two-year, all-cause mortality. A total of 1,127 women and men aged 80 years and older living in nursing homes in France and Italy were monitored for 2 years. Patients with a SBP less than 130 mm Hg who were receiving combination antihypertensive treatment were compared with all other participants.

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A significant interaction was found between low SBP and treatment with 2 or more BP-lowering agents, resulting in a higher risk of mortality in patients with low SBP who were receiving multiple BP medicines compared with the other participants.

“The findings of this study raise a cautionary note regarding the safety of using combination antihypertensive therapy in frail elderly patients with low SBP (greater than 130 mm Hg),” Aronow wrote. “Dedicated, controlled interventional studies are warranted to assess the corresponding benefit to risk ratio in this growing population.”

The article did not list which antihypertensive medications the patients were taking.

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