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Wednesday, November 11, 2015

Some Older Patients Are Treated Not Wisely, but Too Much - NYTimes.com


"In our health care system, we are all more scared of failing to do something than of doing too much," said Dr. Jeremy Sussman, a primary care physician and research scientist at the Ann Arbor hospital.

Under current guidelines, most older patients with diabetes don't have to get their blood sugar to rock bottom; a 7.5 or 8 percent HbA1c produces the same benefits as very low glucose.

Blood pressure readings, too, should be allowed to rise as patients age — up to 150 millimeters of mercury for systolic pressure. The previous goal was to keep it below 140.

Complicating this question, a large trial of intensive blood-pressure control, announced Monday in The New England Journal of Medicine, found that patients randomized to an extremely low blood pressure goal — 120 millimeters of mercury or below — in fact did see substantially lower death rates. The benefit was seen in patients over age 75.

But the new trial did not include people with diabetes, who are at higher risk for cardiovascular problems. A widely cited study called Accord, published in 2008 in The New England Journal of Medicine, found that intensive therapy to reduce blood glucose actually resulted in higher mortality. Expect debates among those who treat older patients about how to apply these results.

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