The Study of the Week explores an observational analysis of deprescribing blood pressure meds in older adults. But the study falls short--and it could hurt the cause
The root of the problem is the one-size-fits-all blood pressure scale. It's a pile of crap. Using drugs to control blood pressure is also a pile of crap. Except in a dire emergency, drugs should always be the last option, not the first. And if any doctor be a true doctor of health, they would seek not to keep a patient on "forever drugs" but to keep them off of them by using alternative health methods.
I don’t know whether you teach in med school, but if you were teaching what you said here about the increased harm from medicine with age, greater drug-drug interactions and decreased drug clearance, it would be a great boon to students and especially patients because I honestly don’t see that kind of knowledge present.
That said, I know a number of people ranging from middle aged to elderly who were prescribed anti-hypertensives mainly on a perfunctory basis based on their advancing age. They (wisely, IMO) declined and are still all alive and relatively healthy. Given side effects and the fact that it’s not the only way to maintain one’s blood pressure, I’m not sure it’s an optimal preventative.
Couldn't agree more. This is clearly a worthless study but the problem is the mass media will frequently take something like this and dramatize the results in ways that might indeed do more harm than good.
This study is meh. But I wouldn’t say it’s harmful. The authors used reasonable words and did not attempt to imply causation.
However, this paper is extremely “not useful”. It won’t change clinical practice one bit. This is also the sort of thing that gets published in many issues of many journals much of the time. I would criticize the need for such studies in general, without singling out this particular paper. Of course, ridding academia of such studies would make many/most journals non-viable. Though I’m not sure that’s necessarily a bad thing.
It has been many years since I took my statistics course. I seem to recall that non-parametric parameters such as the cognitive function score in this study must be treated with different analytic techniques. It is impossible to have a three-point five score or a 4.2 score, and therefore determining significant changes, presents a problem.
Would like to see studies in a different population than Veterans in a nursing home. They are likely to be more frail than the general elderly population. I think most clinicians recognize that tight control of BP in the frail elderly is fraught with potential problems (orthostasis, falls, etc.). And also their BP often falls on its own due to weight loss, etc. and may be a sign of declining health. At this point, until there is further evidence, it seems reasonable to continue BP meds in active seniors as long as they are not having side effects.
Probably 65 and older. 40 to 65 is middle-age. But I prefer the categories of 65 to 75 being "young old age;" 75 to 85 "medium old age" older than 85 "old old age."
I am depressed(not true) that I am in the age group(not institutionalized, unless, working for a major university is institutionalization) as the study participants, and on some meds that have worked well; I want to know the answer to the question!
Indeed, and that should include knowing what a healthful blood pressure is as that figure has been changed over time whereby what was considered normal in the past is now considered abnormal. Some critical thinking doctors, even on Substack, have called this out as a kind of scam to push hypertension medications.
The root of the problem is the one-size-fits-all blood pressure scale. It's a pile of crap. Using drugs to control blood pressure is also a pile of crap. Except in a dire emergency, drugs should always be the last option, not the first. And if any doctor be a true doctor of health, they would seek not to keep a patient on "forever drugs" but to keep them off of them by using alternative health methods.
I don’t know whether you teach in med school, but if you were teaching what you said here about the increased harm from medicine with age, greater drug-drug interactions and decreased drug clearance, it would be a great boon to students and especially patients because I honestly don’t see that kind of knowledge present.
That said, I know a number of people ranging from middle aged to elderly who were prescribed anti-hypertensives mainly on a perfunctory basis based on their advancing age. They (wisely, IMO) declined and are still all alive and relatively healthy. Given side effects and the fact that it’s not the only way to maintain one’s blood pressure, I’m not sure it’s an optimal preventative.
Couldn't agree more. This is clearly a worthless study but the problem is the mass media will frequently take something like this and dramatize the results in ways that might indeed do more harm than good.
This study is meh. But I wouldn’t say it’s harmful. The authors used reasonable words and did not attempt to imply causation.
However, this paper is extremely “not useful”. It won’t change clinical practice one bit. This is also the sort of thing that gets published in many issues of many journals much of the time. I would criticize the need for such studies in general, without singling out this particular paper. Of course, ridding academia of such studies would make many/most journals non-viable. Though I’m not sure that’s necessarily a bad thing.
It has been many years since I took my statistics course. I seem to recall that non-parametric parameters such as the cognitive function score in this study must be treated with different analytic techniques. It is impossible to have a three-point five score or a 4.2 score, and therefore determining significant changes, presents a problem.
I would appreciate your thoughts on this matter.
Would like to see studies in a different population than Veterans in a nursing home. They are likely to be more frail than the general elderly population. I think most clinicians recognize that tight control of BP in the frail elderly is fraught with potential problems (orthostasis, falls, etc.). And also their BP often falls on its own due to weight loss, etc. and may be a sign of declining health. At this point, until there is further evidence, it seems reasonable to continue BP meds in active seniors as long as they are not having side effects.
What is your definition of elderly?
Probably 65 and older. 40 to 65 is middle-age. But I prefer the categories of 65 to 75 being "young old age;" 75 to 85 "medium old age" older than 85 "old old age."
I am depressed(not true) that I am in the age group(not institutionalized, unless, working for a major university is institutionalization) as the study participants, and on some meds that have worked well; I want to know the answer to the question!
Maintaining a healthful blood pressure, without medication, through diet and exercise is the gold standard for retaining cognitive function.
Indeed, and that should include knowing what a healthful blood pressure is as that figure has been changed over time whereby what was considered normal in the past is now considered abnormal. Some critical thinking doctors, even on Substack, have called this out as a kind of scam to push hypertension medications.