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Lowering blood pressure too aggressively may harm an older patient’s ability to think clearly, according to researchers.
They found that people over 70 who had mild hypertension actually thought more clearly than those whose blood pressure was lower. Another expert said the study suggested that doctors should take care when prescribing drugs to lower blood pressure in older patients and should perhaps tailor their treatments.
"This study seems to show that people whose blood pressure is lowered excessively do seem to have their ability to think clearly and creatively impaired," said Dr. Michael Weber, an editor of the American Journal of Hypertension, which published the study.
"It really creates a dilemma for us because we do know that people whose blood pressure is reduced to a large extent do get better protection from strokes and heart attacks and other serious events," added Weber, a professor of medicine at the State University of New York in Brooklyn.
Dr. Esther Paran and colleagues studied 495 people aged 70 to 85. Some had normal blood pressure, some were being treated for high blood pressure and some had uncontrolled high blood pressure. They gave their volunteers standard tests of cognitive functioning, also measuring memory, concentration, visual retention and verbal fluency.
Men and women with high blood pressure that was not fully controlled by drugs performed the best, while those with normal blood pressure did the most poorly on the tests, Paran’s group said.
Only verbal fluency was not affected, they said.
High blood pressure is an epidemic in many countries. One in five Americans -- an estimated 50 million -- have high blood pressure, which raises the risk of heart attack, stroke, heart failure and other fatal conditions.
High blood pressure is defined as a measurement of 140/90. A U.S. committee of experts recently added a new definition of "pre-high" blood pressure, starting at 120/80.
The National High Blood Pressure Education Program Coordinating Committee recommended that doctors start treating high blood pressure earlier, and more aggressively, to get it down.
Weber said the Paran study suggested this may not be the best way to go with older patients.
"It may be very important to individualize treatment in each patient and for doctors to be sensitive to the possibility that reducing blood pressure too quickly in elderly people may create problems," he said in a telephone interview.
Paran’s team said the medication did not seem to affect their findings. Most of the patients were taking drugs called ACE inhibitors and calcium channel blockers.
Weber said it would be important to see if the patients were also taking beta-blockers, a class of drugs that can slow thinking. He said studies have shown that lowering blood pressure does not affect thinking in younger people.
"But elderly people do lose some capacity known as auto-regulation," he said. "Auto-regulation is the process by which when our blood pressure goes down, our brain adjusts its blood supply so it is still able to function in a perfectly normal way."
Doctors of older patients may need to adjust treatment carefully, according to the patient’s response, Weber said.
