Advise hypertensive elderly on lifestyle modifications

Lifestyle modification is an indispensable part of the management of patients with hypertension, and this is just important in elderly patients, reported at the University of North Carolina, Chapel Hill. Based on results of a new study, older hypertensive patients (aged >60 years) are less likely to receive such advice from their doctors than their younger counterparts.

Their major finding were, that compared with younger people with high blood pressure, people older than 60 were less likely to receive advice from their doctors about lifestyle modification.

He and his colleagues analyzed data from 28,457 patients with high blood pressure (BP); of these, 76% were overweight or obese, 80% were taking anti-hypertensive agents, and 20% also had diabetes.

Although 90% had received at least 1 of the 4 types of lifestyle advice, there were significant differences in who received what type of advice.

As might be expected, people who were overweight or obese were more likely to get the advice than people of healthy weight. However, dietary advice is more than weight-loss advice. Even people of healthy weight who adopt certain kinds of diets rich in fruits and vegetables can have benefits on their blood pressure.

Physicians are more likely to advice about eating habits to certain hypertensive patients than others:

• Only 54% of hypertensive older adults ≥ 60 years received dietary advice compared with 72% of those aged 40 to 59 years and 65% of those aged 18 to 39 years.

• Although 63% of patients who were taking antihypertensive medications received advice about eating habits, 57% of those with elevated BP who were not taking medication did not receive such advice.

• Whereas 75% of obese hypertensives received such advice, only 46% of hypertensives with a healthy weight or underweight were advised about proper eating.

Similar trends were seen in relation to salt reduction, exercise and alcohol intake. While there are some good data that blacks are more likely to be salt-sensitive, we just don’t know enough about how sodium affects blood pressure in all people, and so it’s reasonable to give that advice across the board.

Salt-reduction advice:

• Patients receiving antihypertensive therapy were almost twice more likely to receive advice than those with high BP who were not treated with medications.

• Blacks (80%) and Hispanics (77%) were more likely to receive advice than whites (66%).

They know that if they could get the population as a whole to reduce sodium consumption, they could lower the entire population’s distribution of high blood pressure and that would have favorable effects on the health of the public.

Exercise advice:

• More middle-aged hypertensives (84%) received advice to exercise than either younger (67%) or older (75%) patients.

• Overweight (77%) and obese (88%) hypertensives were more likely to receive advice about exercise than those with healthy weight or underweight (62%).

Alcohol advice:

• Overall, only 44% of hypertensive adults were advised to reduce their intake of alcohol.

• Alcohol advice was more likely to be given to men, younger or middle aged hypertensives, nonwhites, those with lower educational levels, and those who were overweight or obese.

They do know that motivating any patient, be they younger or older, to adopt lifestyle changes can be a challenge. But studies have shown that lifestyle modification is an effective way of controlling BP in older patients and can reduce their need for BP medications by 30%.

Noting that time constraints of outpatient care may be a major factor, that lifestyle changes are important for all hypertensive patients and should never be abandoned.

What they want patients and physicians to remember is that lifestyle modifications are part of the management for all hypertensive patients, including the elderly and those already taking blood pressure medications.