Do older people benefit from higher blood pressure? - Houston Chronicle

Q: I am a pharmacologist, recently retired at age 71. In my opinion, the blood pressure guidelines need to be carefully considered in those of us who are healthy, thin and active with a BP in the 140/90 range.

I think I am more apt to suffer a decrease in my quality of life on BP drugs and will fight any physician who thinks I need to take these meds! What's more, overmedicated elderly people have a higher incidence of falls, which can be devastating.

A: The American Heart Association and the American College of Cardiology issued new guidelines for treating high blood pressure earlier this year. People who are otherwise healthy but have systolic blood pressure between 130 and 140 need to use nondrug approaches initially to lower their BP. Anything above 140/90 requires "pharmacologic therapy."

These guidelines do not take age into account, though. A new study in JAMA Internal Medicine (Dec. 13, 2021) found that older people may actually do better with slightly higher blood pressure.

Those between age 70 and 95 were less likely to develop dementia when their systolic blood pressure was above the old cutoff of 130. Doctors need to take fall risk into account when prescribing for older patients.

People who are interested in a variety of strategies for managing hypertension may wish to consult our eGuide to Blood Pressure Solutions. This online resource is available under the Health eGuides tab at PeoplesPharmacy.com.

Q: You recently answered a question from a man taking metformin following his prostate cancer treatment. I am puzzled. What does a diabetes drug have to do with prostate cancer?

A: Researchers have noted that people with Type 2 diabetes who were taking metformin were less likely to develop cancer. That observation prompted studies showing that metformin has anticancer activity.

A recent systematic review and meta-analysis involving 27 studies and 123,212 participants found that people taking metformin had better prostate cancer outcomes (Biomedical Research International, Oct. 8, 2021). This link was especially strong if men received radiation therapy.

Q: I saw a television commercial for cold medicine that is safe for people with high blood pressure. I can't remember what it was. Can you help me out?

A: The problem with multisymptom cold, flu and cough medicines is that they often contain decongestants. Ingredients such as phenylephrine or pseudoephedrine are vasoconstrictors. That means they narrow small blood vessels, which can in turn raise blood pressure.

Because pseudoephedrine (found in Sudafed and other products) can be used illicitly to make methamphetamine, it is no longer available on pharmacy shelves. Pseudoephedrine is sold "behind the counter" though, and does not require a prescription.

You may have seen a commercial for Coricidin HBP Cold & Flu. It contains acetaminophen to lower a fever and the antihistamine chlorpheniramine to help dry out nasal secretions. Other formulas contain dextromethorphan to calm a cough.

There are lots of cold remedies that do not contain the decongestant phenylephrine. They should not raise your blood pressure. Whether any of them will actually speed recovery from an upper respiratory tract infection, though, remains controversial.

Contact the Graedons at peoplespharmacy.com.

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