Treating High Blood Pressure in Older Adults

New and stricter blood pressure guidelines may complicate treating older Americans for hypertension, experts have suggested. Most adults with measurements of 130 for the top number (systolic) or 80 for the bottom number (diastolic) are now considered hypertensive, or having high blood pressure, under guidelines updated in November.

But the question of treating hypertension in seniors is complicated because blood pressure commonly increases with age, so more people in their 70s and 80s have the condition. Doctors have debated for years whether lower targets for controlling blood pressure are effective, or even safe, for seniors. They are more likely to be taking medications for other conditions that are also risk factors for heart disease, such as diabetes and high cholesterol.

For example, a guideline from the American College of Physicians and the American Academy of Family Physicians has suggested patients older than 60 be treated only to a level below 150/90, if they have no history of cardiovascular disease. But new studies have indicated that blood pressure targets lower than that are beneficial for older adults who are able walk or move around on their own and aren’t in a nursing home.

A recent clinical trial, sponsored by the National Institutes of Health, studied people 50 and older who had high blood pressure and at least one other risk factor for heart disease. Researchers found that using medicines to reduce systolic blood pressure, the top number in a reading, to near 120 reduced the combined rate of having a heart attack, acute coronary syndrome, heart failure, stroke or death from cardiovascular disease by nearly one-third.

Medical experts now agree that the risk of heart attacks, strokes and death can be reduced in adults older than 65 if they are treated for high blood pressure the same way younger people are — when readings hit 130/80.

“In general, high blood pressure is under-treated or goes undetected for too long,” says Felipe De Los Rios, M.D., medical director of the Stroke Program at Baptist Health Neuroscience Center. “Anything that brings more attention and awareness to this very common condition is a positive. People can now start addressing high blood pressure earlier on, and not waiting for the condition to become stage 2 or 3, or begin organ damage.”

Under the new guidelines announced late last year by the American Heart Association (AHA) and the American College of Cardiology, a blood pressure of less than 120/80 will still be considered normal, but levels above that – up to 129 – will be called “elevated,” according to a statement by the AHA. The redefined reading of high blood pressure is now 130/80, down from 140/90.

The stricter standard is the first major shift in blood pressure guidelines in 14 years and means that 46 percent of U.S. adults, including an increasing number under the age of 45, now will be considered hypertensive. Under the previous guidelines, 32 percent of U.S. adults were considered to have high blood pressure.

Dr. De Los Rios adds doctors need to be extra vigilant when treating elderly patients, because of other possible health issues that are common as we age and because of higher rates of frailty.

“When it comes to the elderly, you have to be a little more cautious about not over-treating, but I would say this group is in the minority,” he said. “Most people will benefit from the new guidelines.”

Blood pressure categories according to the new guidelines:

  • Normal: Less than 120/80 mm Hg;
  • Elevated: Systolic between 120-129 and diastolic less than 80;
  • Stage 1: Systolic between 130-139 or diastolic between 80-89;
  • Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;
  • Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.

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