Milan, Italy—Despite calls for discontinuation of some protective medications in older people, a new study finds significant benefits for blood pressure medication, even in the most-frail elderly.

The report in Hypertension found that drugs lowering blood pressure were linked to decreased mortality, with the greatest survival boost in the healthy elderly.

“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 lead author Giuseppe Mancia, MD, professor emeritus at the University of Milano-Bicocca in Milan, Italy.

Researchers sought to assess the relationship between adherence with antihypertensive drugs and the risk of death in frail versus nonfrail older people. To do that, they used the database of the Lombardy Region (Italy), identifying nearly 1.3 million residents aged 65 years and older that fit their criteria. The mean age of the cohort was 76 years, and all had three or more prescriptions of antihypertensive drugs between 2011 and 2012. 

Over the 7-year observation period, those with high adherence—defined as more than 75% of the time covered by prescriptions—exhibited a lower risk of all-cause mortality across clinical status. Compared with patients with very low adherence with antihypertensive treatment—defined as less than 25% of follow-up time covered by prescriptions—the difference for patients with high adherence decreased progressively (−44%, −43%, −40%, and −33%) from good to very poor clinical status. 

“Adherence with antihypertensive drug treatment was also associated with a lower risk of cardiovascular mortality,” the researchers write. “Adherence with antihypertensives appears to be protective in frail old patients, but the benefit is less marked than in patients with a good clinical status.”

The study team calculated that the probability of death over 7 years was 16% for people rated in good health at the beginning of the study. Mortality probability increased progressively to 64% for those rated in very poor health. Yet people with high adherence to antihypertensives were found to be 44% less likely to die if they started in good health and 33% less likely to die if they started 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,” Dr. Mancia said, urging healthcare professionals to “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.” 

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