No vast numbers of untreated women

Oh dear. Another article from academic medicine¹ telling us how badly we are doing. Are the authors really telling us that an asymptomatic woman in her late 80s with a casual blood pressure of 160/60 mm Hg has to reduce her systolic blood pressure to 140 mm Hg?

Why is there no mention of adverse effects or the number needed to treat to prevent 1 stroke? Why are specific drugs mentioned? Do the authors have conflicts of interests with companies making these drugs? Retrain every 6 months to take a blood pressure? Take blood pressures at every visit? Have a nonphysician take the measurements? Does anyone in the present climate have resources to divert staff for this?

I have 6 centenarian women in my small practice of 800 patients, most of whom I have looked after for decades. My municipality has the oldest cohort of people in the country. More than 60% of my patients older than 65 are taking antihypertensive drugs. There are not vast numbers of untreated patients out there.

Most older ladies die of dementia or a neurodegenerative disorder whose relationship to hypertension is unclear. A substantial number die of complications of falls, which are more often than not complications of drug therapy.

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