Hypertension in the Elderly

High blood pressure is considered to be a major risk factor for the development of heart and vascular diseases in older individuals.

There is no set definition of being “older”, for example, 65 years. Studies that have looked at hypertension or other diseases have used age groups such as 60 to 74 years, 75 to 84 years and over 85 years to help us to understand the risks of high blood pressure, and benefits and risks of treatment in relation to age.

With age, the diastolic blood pressure decreases slightly, but the systolic blood pressure often increases. Average blood pressures of more than 140 mm Hg systolic and 90 mm Hg diastolic (140/90 mm Hg) are a matter of concern. At this level of blood pressure, there is a significant increase in the risk of future cardiovascular disease. This does not necessarily mean that drug treatment has to be started at this level. However, the higher the pressure, the higher the risk, and the more likely your doctor will start treatment.

The incidence of hypertension increases with age; 56 percent of men and 52 percent of women over the age of 65 years have a blood pressure higher than it should be. The systolic pressure (the higher number) in particular increases with age. Although it was one thought that the diastolic pressure (the low number) was more important, in older people the systolic pressure indicates the level of risk slightly better. Thus, the systolic pressure is now given more weight in deciding when to treat.

In some cases, the systolic pressure can increase without any change in the diastolic pressure (for example, 170/80 mm Hg). This type of high blood pressure is called Isolated Systolic Hypertension.

The blood pressure of persons over the age of 65 years should be checked at least once a year. If it is higher than 140 mm Hg, then more frequent readings are taken by a nurse or a physician to determine a proper course of action. Only if the blood pressure remains high treatment may be needed.

Treating isolated systolic hypertension can prevent 24,000 strokes and 50,000 severe cardiovascular problems, including heart attack, each year. Another study from Europe found a 40 percent reduction in strokes among people being treated for isolated systolic hypertension.

Losing weight if you are overweight and walking daily to stay active can help reduce your blood pressure. Since you may become more sodium-sensitive with age, limiting sodium to no more than 2,400 milligrams daily also can help control high blood pressure.

If the person needs medication, a diuretic, calcium antagonist or a diuretic combined with a beta blocker is often most effective.