New Suggestions for Managing High Blood Pressure in Senior Citizens

The American College of Cardiology and the American Heart Association have issued the first suggestions specifically for the treatment of high blood pressure in patients 65 and older. In the past, most research studies excluded patients 65 or older so it was difficult to extrapolate suggestions for treating younger patients to older patients.  The Hypertension in the Very Elderly (HYVET) trial changed that. It showed that when we lower the blood pressure in patients 80 years and older there is a decrease in deaths from stroke, a decrease in heart failure deaths and, decrease in death from all causes.

The consensus panel made the following suggestions:

1.  The general targeted blood pressure is less than 140/90

2.  Patients with coronary artery disease, diabetes and chronic kidney disease should aim for a BP less than 130/80 mm Hg.

3.  Lifestyle changes should be encouraged to manage milder forms of hypertension. This includes increasing exercise, reducing salt intake, controlling weight, stopping smoking and limiting alcohol to 2 drinks or less per day.  If this doesn’t work then medication treatment is indicated

The group supported the use of the “step care medication choice program” with the introduction of a thiazide diuretic as the first step in blood pressure medication usage.  They then went on to describe the appropriate usage of two medications at once, the use of beta blockers in cardiac patients and the use of calcium channel blockers.

They also supported screening patients’ urine for the presence of protein which would indicate that kidney problems need evaluation.  The group further suggested that the diagnosis of high blood pressure be made based on at least 3 blood pressure readings performed at two or more office visits.

The suggestions were not the more formal evidence based guidelines we have become accustomed to. They were a compromise agreement of a panel of experts from two organizations.  They encouraged further studies of these suggestions in the elderly so that they can accumulate the data they need to make future, firm, evidence-based guidelines.

For the average patient, nothing should change dramatically. As physicians, we will need to identify patients with elevated blood pressure and convince many of the elderly that there are significant benefits to taking medication to control their hypertension. This has been exceptionally difficult in the healthy elderly who develop hypertension in their mid to late 70’s and do not want to deal with the cost or side effect profile of taking “another pill.” Improving their lifestyle will always be the first option to control the elevated blood pressure.  However, the use of medications was strongly supported to control the pressure in those who need additional treatment.

Honey May Be Effective at Killing Bacteria and Thwarting Antibiotic Resistance

I have on many occasions advised my patient’s ill with an upper respiratory infection and a cough to try some tea and honey. The recommendation is based on family suggestions bridging generations plus practical experience in noting its therapeutic effect when I have a cold and cough.  Of course in today’s world of randomized double blinded objective research studies it is nice to have some evidence to back the recommendation up.

Pri-Med released a summary of a study done at the University of Wales Institute Cardiff which shows the benefits of Manuka honey.  The honey is made from the nectar collected by bees from the Manuka tree in New Zealand. This honey apparently can hamper the ability of pathogenic streptococci and pseudomonas from attaching to tissue. This is an essential step in the initiation of acute infections.

Lead author Rose Cooper additionally pointed out that Manuka honey was effective at making Methicillin Resistant Staph Aureus “more susceptible to the antibiotic Oxacillin.” Methicillin resistant staph aureus is resistant to drugs like Methicillin and Oxacillin. They do not improve or cure the infection. If you add honey, the infections are now showing a response to Oxacillin .

This is very clearly early data with more studies needed. It will not prevent me from continuing to extol the virtues of tea and honey, as well as chicken soup, as part of the treatment of a viral or bacterial upper respiratory infection.