I.

Myths About Hypertension

1. Hypertension is an "asymptomatic" disease.
It is well-recognized that the majority of people with hypertension in the United States have stage 1 or 2 (mild or moderate) hypertension, and as a result might experience few or no symptoms during the early years of their hypertension. Remember, however, that hypertension does progressive damage to blood vessels, and the first symptom of untreated or inadequately-treated hypertension might be a disabling stroke or possibly a fatal heart attack. Congestive heart failure also is a common result of inadequately-treated hypertension. Be aware that the five-year mortality of individuals experiencing a first episode of congestive heart failure is 50 percent. Yet, for many hypertensive individuals, these major cardiovascular events are preventable with aggressive, optimal treatment and long-term control. It is also of particular interest that several recent clinical studies assessing quality of life measures have shown that treated and controlled hypertensive patients actually experience a better quality of life than those individuals in control groups. These studies suggest that there are in fact, subtle symptoms in untreated or uncontrolled hypertensive people that can actually be improved by aggressive treatment and control of blood pressure.

2. A "normal" systolic blood pressure equals 100 plus your age.

Until a decade ago, this statement was a commonly quoted assumption regarding the natural history of blood pressure with aging. It suggested that a systolic blood pressure of 170 was normal in a 70-year-old individual. Today, we know this to be absolutely false. We now have sufficient clinical evidence for older Americans with both systolic and diastolic hypertension, and particularly in isolated systolic hypertension (ISH), that verify the benefits of aggressive treatment of blood pressure in older Americans. There is very firm data supporting treatment of systolic blood pressure down to 150 mm Hg in older hypertensive people. Therefore, this marker is an appropriate initial goal in most older patients with ISH. For many, a blood pressure below 140/90 mm Hg represents an appropriate treatment goal today.

3. The systolic blood pressure does not matter if the diastolic blood pressure is below 90 mm Hg.
For many years, hypertension was classified on the basis of diastolic blood pressure, and the systolic blood pressure was not even considered. Recommendations for the treatment of hypertension were also based on diastolic blood pressure readings with no attention paid to the systolic reading. Fortunately, these misconceptions were corrected with studies during the past decade that addressed systolic blood pressure. We now know that the systolic blood pressure is actually a better predictor of cardiovascular risk (stroke, heart attack, congestive heart failure) than is the diastolic blood pressure.

4. Older patients will not take their antihypertensive medicines.

It has long been assumed that older hypertensive individuals are not optimally compliant with medicines prescribed for high blood pressure. It had been assumed that health beliefs or decreases in cognitive function with aging would necessarily result in a decrease in compliance with medicine regimens. To the contrary, studies in the elderly hypertensive patient population have revealed that the older subgroup over age 65 are not only more compliant with medicines prescribed in carefully controlled clinical trials, but they also achieve the target blood pressure goals in those studies in a higher percentage of cases. It is believed that the key is adequate education of the hypertensive patient, regardless of age. Health providers must offer adequate education regarding hypertension together with the importance and benefits of taking regular medicine.

5. Older patients seldom reach target blood pressure with treatment.

It has long been a myth that older patients have blood pressures that respond less well to antihypertensive treatment. Further, it has long been assumed that, when treated, it is difficult to achieve recommended target blood pressure goals. On the contrary, recent clinical trials in the elderly have also put this myth to rest with evidence that clearly demonstrates that older populations are not only more compliant, but also achieve target blood pressure goals in a higher percentage than younger people. Obviously, we must change the attitudes of both patients and providers to recognize the importance and potential benefits of aggressive treatment of high blood pressure in older Americans.