Harvard Health Publications

Blood pressure goals may need to change with age

Posted By Howard LeWine, M.D. On July 20, 2012

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.

Related Information: Hypertension: Controlling the “silent killer”

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