Howard LeWine, M.D.

Blood pressure goals may need to change with age

Controlling high blood pressure is a good thing—unless you are a frail older person. Then it might be harmful. That’s the surprising finding of a study of more than 2,000 seniors published online in the Archives of Internal Medicine.

Make no mistake: high blood pressure is a definite health hazard. It damages arteries in the heart, kidneys, and throughout the body, leading to heart attack, heart failure, stroke, kidney failure, and other serious health problems. That’s why many doctors recommend aggressive steps for lowering high blood pressure.

But as we are learning about other conditions, a one-size-fits-all approach doesn’t work. What is right for controlling blood pressure in a 50-year-old might not work for a frail 80-year-old.

New findings

Researchers looked at information collected as part of the U.S. National Health and Nutrition Examination Survey. People participating in it had their blood pressure checked; they also took a walking test that measured how long it took them to cover 20 feet. Based on this test, researchers divided the participants into three groups: those who finished the 20-foot walk in under eight seconds, those who took longer than that, and those who weren’t able to complete the walk.

Blood pressure targets
Normal blood pressure is a systolic pressure of less than 120 and a diastolic pressure of less than 80. Systolic pressure (the upper number in a blood pressure reading) refers to pressure in the arteries when the heart beats. Diastolic pressure (the lower number) measures pressure in the arteries between heart beats. Blood pressure between 120/80 and 140/90 is borderline high (prehypertension), while blood pressure above 140/90 defines high blood pressure. These are the numbers that guide when to start and change drugs to lower blood pressure.

Among elderly adults, higher systolic blood pressure (the top number of a blood pressure reading) was linked to a greater likelihood of dying over the five-year study only among faster walkers. Among the participants who couldn’t even walk 20 feet, those with high blood pressure were less likely to have died.

“Older frail adults might benefit from slightly higher blood pressure,” study author Michelle Odden, a public health epidemiologist at Oregon State University, told HealthDay. “As the blood vessels get more stiff with age, it may be necessary to have more pressure to keep blood pumping to the central organs, like the brain and heart.”

It’s also possible that using multiple medications drive down blood pressure in frail older adults may do more harm than good. That’s because all medications have side effects, and these side effects may have a greater impact on older, frail adults than their healthier counterparts.

The results of this study are extremely important. I—and generations of doctors—have been trained to work hard to get our patients to lower their blood pressure, no matter how old they are or how frail. This study is prompting me to rethink this approach. The researchers provide excellent evidence to support allowing blood pressure to run higher in certain older people, especially ones that are frail.

Comments:

  1. Easterndrugs

    Trained to work hard to get our patients to lower their blood pressure, no matter how old they are or how frail. This study is prompting me to rethink this approach.

    Thanks
    Easterndrugs

  2. dodo

    many medications are not harmful for older adult only, but it’s for young or adult people as well. in fact, side effects of every drugs always affect body system. if we use vary of drugs, we can get to overdoses and lead to new diseases

  3. Anatoly

    We fully agree with Dr LeWine. Our ZhGS formulas for optimal BP determination based on theoretical model showed the same dependence between SBP,DBP,MAP,PP and age.

  4. Agatha

    I am 83 and have an unusual BP problem. I take my pressure 2 – 3 times a day and it seams it is on a cycle. I wear a pacemaker since I have bradycardia and a slow heart rate. My morning pressure averages 150 – 160 over 90 – 100 with heart rate of 60 – 85. However at 5 to 6 PM my BP often tanks to 81/58 with 79 HR or thereabouts. I stopped taking a water pill and eat 1/2 grapefruit at night which seems to work equally as well in avoiding body fluid buildup. I stopped taking BP medication when my BP started dropping so low. My pressure seems to go up at night and down during the day – right the reverse of most and during the day it is often normal around 12 PM. So weird isn’t it?

    • Mike

      As a rule your blood pressure is usually higher in the morning. This is because your body is preparing you for wakening up in the morning by raising your blood pressure. This happens to me as well and by the middle of the day it is back to normal.

  5. Ingalill

    If you keep your cell membranes more fluid through a good Omega-6 to Omega-3 ratio ( 1:1) will this result in less stiff blood vessels? If so, would it be a good thing to measure your Omega ratio? I have only found a few providers of such tests. Can anyone give me hints to where to find a good reliable test of fatty acids?