Blood Pressure And The Elderly

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An estimated 1.13 billion people worldwide have high blood pressure (“hypertension”). The condition becomes more common with age. Low blood pressure is unhealthy, too. When it comes to abnormal changes in blood pressure, either too high or too low, the most affected are the elderly, as they tend to have more associated conditions and develop more complications.

Healthy Blood Pressure Levels 

It is normal for blood pressure to change throughout the day, being at its lowest when you are sleeping, and increasing when you wake up. It is also normal to have higher blood pressure readings when you exercise, feel anxious, or feel excited. During the day, however, blood pressure should stay relatively stable and lower than 120/80 mmHg. For the general public, doctors recommend medication when blood pressure is over 130/80 mmHg. For elderly adults, the blood pressure threshold is slightly higher. 

Guidelines For Seniors 

For elderly adults, the optimal blood pressure is still debated. It is well known that blood pressure increases with age. Therefore, the elderly will have higher “normal” blood pressure in comparison with young adults. In addition, there is increased frailty, associated conditions like diabetes, kidney and neurological diseases that make the decision about the best time to start a treatment. 

Back in 2014, the Eighth Joint National Committee provided guidelines for blood pressure management. According to these guidelines, everyone 60 years of age or older should keep the blood pressure levels below 150/90 mmHg. In the case of diabetes or chronic kidney diseases, the blood pressure readings should be below 140/90 mmHg (regardless of age). 

In 2017, the American Heart Association provided new guidelines, recommending an early and more aggressive treatment of high blood pressure. Elderly adults who are 65+ (and not living in nursing homes) should keep the blood pressure levels below 130 mmHg. 

Considering comorbidities that are more common in the elderly, the treatment plan should take into account the risks and benefits. Geriatricians suggest that keeping the blood pressure below 150/90 would be a good target. 

If you are older than 60 years of age, it is best to talk to a geriatrician to get a treatment plan based on your needs. 

Changes In Blood Pressure That Come With Age 

The increase in blood pressure with age comes from structural changes in the arteries. Blood vessels become more stiff, increasing the risk of high blood pressure (especially systolic blood pressure).

The building up of fatty plaques further increases the risk of heart problems. However, research suggests that in the elderly, the most powerful predictor of cardiovascular risk is increased pulse pressure. Pulse pressure is equal to the top number (systolic pressure) minus the bottom number (diastolic pressure). If your blood pressure is 120/80 mmHg, your pulse pressure is 120-80=40. Pulse pressure greater than 40 is considered abnormal. 

Older adults are more likely to have higher pulse pressure due to decreased diastolic and increased systolic pressure. 

Drugs That Can Cause Low Or High Blood Pressure And Polypharmacy

People age 65 and older represent 12% of the American public but account for 34% of all prescription medication use and 30% of all over-the-counter medication use. People taking more than four medications (called “polypharmacy,” which is a common scenario for older adults in the US) have an increased risk of injurious falls. The risk of falling increases greatly with each medication, regardless of type. Polypharmacy is associated with poor quality of life and increased mortality. The goal is to have your blood pressure well controlled without using too many drugs. 

Many of the most commonly prescribed drugs affect blood pressure. For example, the following drugs can cause low blood pressure:

  • antihypertensive drugs: diuretics (i.e. furosemide, hydrochlorothiazide)
  • Alpha-blockers (i.e. prazosin) and beta-blockers (i.e. atenolol, propranolol)
  • anti-Parkinson’s (i.e. pramipexole and drugs containing levodopa)
  • antidepressants (i.e.  doxepin,  imipramine)
  • Drugs for erectile dysfunction (i.e. sildenafil,  tadalafil, especially when taken with nitroglycerin)

The following drugs increase the risk of high blood pressure:

  •  Non-steroid anti-inflammatory drugs (NSAIDs such as ibuprofen and naproxen)
  • Cough and cold medication (i.e. pseudoephedrine) – Some of these drugs also prevent blood pressure medication from working properly.
  • migraine/headache medication
  • Weight loss drugs

Tips To Optimize Your Blood Pressure 

If you already follow healthy habits that prevent heart disease, you can reduce your need for medication, better control your blood pressure, and thereby lower your risk for complications. Focus on:

  1. Eating a healthy diet. Avoid highly processed foods, which are very high in salt, sugar, unhealthy fats, and artificial preservatives. The DASH, Mediterranean, and low carb diets are all heart-healthy.
  2. Manage stress. Emotional stress has a significant impact on your blood pressure levels, in addition to increasing the risk for depression, anxiety, and even dementia. Include at least 10 minutes of mindfulness meditation and some yoga stretches each and every day. 
  3. Sleep well. Sleep regulates the stress hormone, cortisol. If you don’t sleep well on a regular basis, the nervous system isn’t able to regulate cortisol, which can lead to elevated blood pressure (and more stress).
  4. Exercise. Aim for 30 minutes on most days of the week. Any exercise is better than no exercise, but aerobic, resistance training, and high-intensity interval training (HIIT) are some of the most effective workouts for heart health.