A new study published in Hypertension found that taking blood pressure medication as prescribed helped even the frailest elderly patients live longer, whereas the healthiest patients saw an even more significant increase in survival.

Investigators analyzed data on nearly 1.3 million people aged 65 years and older in the Lombardy region of Italy. With an average age of 76, patients had 3 or more blood pressure medication prescriptions between 2011 and 2012. The researchers examined the public health care database to calculate the percentage of time over the next 7 years, or until death, that each person continued to receive their medications.

Finally, the researchers analyzed approximately 255,000 patients who died during the 7-year follow-up period, comparing age-, gender-, and health status-matched controls who survived. They divided the patients into 4 groups according to health status: good, medium, poor, or very poor.

“We knew that high blood pressure medication was protective in general among older people,” said lead study author Giuseppe Mancia, MD, in a statement. “However, we focused on whether it is also protective in frail patients with many other medical conditions who are usually excluded from randomized trials.”

They found that the probability of death over the 7-year period was 16% for patients rated in good health, and the probability increased progressively to 64% for patients rated in very poor health. Compared with those with very low adherence to their medications, patients with high adherence were 44% less likely to die if they began the study in good health and 33% less likely to die if they started in very poor health.

The investigators noted a similar pattern in cardiovascular deaths. The greatest survival benefit was seen among those who started in good health and the most modest survival benefit was in those who began the study in very poor health.

“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 the patient’s initial health status, the greatest survival benefits were seen in those who received blood pressure medication to cover more than 75% of the follow-up period, compared with those who had intermediate or low levels of coverage. In a press release, the authors said this finding underscores the importance of consistent medication adherence.

“Do you best to encourage and support patients to take their medications, because adherence is crucial to getting the benefits,” Mancia concluded. “Medications do nothing if people don’t take them.”

REFERENCE
Blood pressure medications help even the frailest elderly people live longer [news release]. American Heart Association; June 8, 2020. https://newsroom.heart.org/news/blood-pressure-medications-help-even-the-frailest-elderly-people-live-longer?preview=e9d3. Accessed August 19, 2020.