Even the frailest people 65 and older live longer if they take blood pressure medication as prescribed compared to peers who don't, according to new research.
The study, which showed the healthiest older people who took their meds had the biggest survival boost, looked at public health care data on nearly 1.3 million people in the Lombardy region of northern Italy who had prescriptions for three or more high blood pressure medications in 2011-2012. Their average age was 76.
"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," lead study author Dr. Giuseppe Mancia said in a news release. He is professor emeritus at the University of Milano-Bicocca in Milan.
In the study, published Monday in the American Heart Association's journal Hypertension, researchers calculated adherence to medication by determining the percentage of time over seven years (or until death) that each person was dispensed prescriptions from Italy's public health service, which provides almost all of them for free or at a low cost.
Researchers then compared roughly 255,000 people who died during the seven-year follow-up with their peers who survived, and they divided them into four groups based on health status: good, medium, poor and very poor. Overall, for participants in good health at the beginning of the study, the probability of death was 16% by the end of it, and that increased to 64% for those in very poor health.
Compared to people who took their blood pressure medicine less than a quarter of the time, those who took it more than three-fourths of the time were 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," Mancia said.
A similar pattern was seen with cardiovascular deaths. The greatest survival benefit was among people who started in good health, and the most modest survival benefit was in those who started in very poor health.
Even so, the results may only apply to older adults living in the community because prescription medications given to people living in nursing or assisted-living homes in Italy are not included in the national database. And because Italy provides hospitalizations and blood pressure medications for free or at low cost, the findings may not be generalizable to countries with a different health care system.
But regardless of the health care system, doctors should "do your best to encourage and support patients to take their medications because adherence is crucial to getting the benefits," Mancia said. "Medications do nothing if people don't take them."
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