“We knew that high blood pressure medication was protective in general among older people, however, we focused on whether it is also protective in frail patients with many other medical conditions who are usually excluded from randomized trials,” said Giuseppe Mancia, M.D., lead study author and professor emeritus at the University of Milano-Bicocca in Milan, Italy.
Data was reviewed from close to 1.3 million elderly people with the average age being 76 years old in the Lombardy region of Northern Italy who were taking 3 or more blood pressure medications. The researchers examined the public healthcare database to calculate the percentage of time over 7 years or until death that each individual continued to receive the medications.
To look at the outcome separately among the older populations with various medical conditions the team utilized a scoring system that accounts for 34 different health factors and also has a close relationship with mortality. Data for close to 255,000 individuals who died during the 7 year follow up was compared with age, gender, and health status matched controls who survived and divided them into four groups of health status: very poor, poor, medium, and good.
Almost all medications are free or low cost and dispensed by the public health service, and this corresponds roughly to patients adhering in using medications in Italy. Those with very low adherence to their blood pressure medications was compared to those with high adherence to their blood pressure medications: 44% were less likely to die if they started in good health, and 33% were less likely to die if they started in very poor health; and a similar pattern was seen for cardiovascular deaths.
“Our findings definitely suggest that even in very frail people, antihypertensive treatment reduces the risk of death; however, the benefits may be smaller in this group,” Mancia said.
Regardless of an individual’s initial health status the survival benefits were the greatest in those receiving blood pressure medications to cover more than 75% of the follow up period, compared to those with intermediate coverage of 25-75% of the follow up period or those with low levels of coverage spanning for less than 25% of the follow up period; findings highlight the importance of the consistent use of blood pressure medications.
“Do your best to encourage and support patients to take their medications, because adherence is crucial to getting the benefits. Medications do nothing if people don’t take them,” Mancia said.
All of the data for this study came from Italy where hospitalizations and blood pressure medications are available either for free or at a low cost, thus these findings may not be generalizable to other countries with different healthcare systems. Also prescriptions for the elderly residing in nursing homes or assisted living homes in the country are not included in the national database, meaning the results may only apply to those living in the community.
