High blood pressure and the elderly

As you get older, you may need to pay closer attention to health factors you rarely thought about in your youth. Those salty snacks you once loved as a child, for example, may become less friendly to your health in later years. That’s partly because certain health conditions become more common with age. One important example is high blood pressure, also called hypertension, which affects about 75% of older adults age 60 and older.

High blood pressure means your blood pressure levels remain chronically elevated over time. It’s a leading risk factor for heart disease and stroke, two major causes of death globally. Although high blood pressure can be dangerous, today’s tools, treatments, and scientific knowledge can help you measure and manage it.

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High blood pressure: what do the two numbers mean?

Blood pressure is typically recorded as two numbers and measured in millimeters of mercury (mm Hg).

• Systolic blood pressure: The first, or top, number is your systolic blood pressure. It shows the pressure in your arteries when your heart beats. A normal systolic level is less than 120 mm Hg.

• Diastolic blood pressure: The second, or bottom, number is your diastolic blood pressure. It shows the pressure in your arteries while your heart rests between beats. A normal diastolic level is less than 80 mm Hg.

High blood pressure, clinically known as hypertension, occurs when either or both numbers remain chronically elevated. There are two types of hypertension. Primary, or essential, hypertension has no identifiable cause and is often associated with aging. Secondary hypertension is caused by an identifiable underlying condition.

The normal blood pressure figures presented for older adults age 60 and older are as follows:

• Men: Systolic: 133 mm Hg; Diastolic: 69 mm Hg

• Women: Systolic: 139 mm Hg; Diastolic: 68 mm Hg

Blood pressure chart for older adults

• Elevated: Systolic: 120–129 mm Hg; Diastolic: Less than 80 mm Hg

• Stage 1 hypertension: Systolic: 130–139 mm Hg; Diastolic: 80–89 mm Hg

• Stage 2 hypertension: Systolic: 140 mm Hg or higher; Diastolic: 90 mm Hg or higher

• Hypertensive crisis: Systolic: 180 mm Hg or higher; Diastolic: 120 mm Hg or higher

From low blood pressure to hypertension

Depending on your readings, your blood pressure can fall into several categories, from low blood pressure to hypertensive crisis. These guidelines offer insight into your cardiovascular health and possible risks. It’s important to note that, in 2017, the American Heart Association issued new blood pressure guidelines that lowered the threshold for hypertension to 130 mm Hg or higher. As a result of this change, more Americans are now classified as having hypertension.

• Low: A low blood pressure reading means the systolic pressure is less than 90 millimeters of mercury (mm Hg), or the diastolic pressure is less than 60 mm Hg. However, doctors generally consider chronically low blood pressure a concern only when it causes noticeable signs and symptoms.

• Normal: A normal blood pressure reading has a systolic value of less than 120 mm Hg and a diastolic value of less than 80 mm Hg. At this stage, maintaining or adopting a healthy lifestyle can help you sustain normal blood pressure.

• Elevated: Blood pressure is elevated when systolic measurements consistently range from 120 to 129 mm Hg and the diastolic reading is less than 80 mm Hg. People at this stage may need to make lifestyle changes to lower their readings and avoid progressing to hypertension.

• Stage 1 hypertension: This stage includes systolic readings of 130–139 mm Hg or diastolic readings of 80–89 mm Hg. At this point, doctors are likely to recommend lifestyle changes and may consider adding blood pressure medication based on the person’s risk of atherosclerotic cardiovascular disease (ASCVD).

• Stage 2 hypertension: This is a serious form of high blood pressure, with systolic readings of 140 mm Hg or higher, or diastolic readings of 90 mm Hg or higher. At this stage, doctors are likely to prescribe a combination of blood pressure medications and significant lifestyle changes.

• Hypertensive crisis: This is the most dangerous category and can occur suddenly when the systolic reading reaches 180 mm Hg or higher and/or the diastolic reading reaches 120 mm Hg or higher. Blood pressure at these levels is an emergency because it can damage the brain, heart, and other organs.

What causes high blood pressure?

You may be wondering what actually causes blood pressure to rise. Several different risk factors can affect your readings, and your doctor may have discussed at least some of them with you during a recent visit. These factors include:

• Unhealthy diet: Diets high in sodium, trans fats, and cholesterol can increase blood pressure. Too much salt, in particular, may cause your body to retain fluid, putting added pressure on your blood vessels.

• Lack of physical activity: Regular physical activity strengthens your heart, helping it pump more blood with less effort. As your physical fitness improves, there is less pressure on your arteries, supporting a more normal blood pressure.

• Excessive alcohol consumption: Although you may enjoy a glass of wine or two in the evening, excessive alcohol use can significantly raise blood pressure and damage the heart.

• Obesity: Obesity is a major contributor to high blood pressure. Weight gain places more strain on the heart, making it harder for the heart to circulate blood and contributing to elevated blood pressure.

• Smoking: Tobacco products contain chemicals that damage blood vessels, narrow the arteries, and contribute to high blood pressure. Nicotine also temporarily raises blood pressure after each use.

• Marijuana: More research is needed, but some studies suggest that regularly smoking marijuana or vaping it, rather than using other forms, may increase the risk of heart disease and stroke because of the toxic effects of other inhaled substances.

• Stress: Chronic stress can raise blood pressure. It may also lead to habits such as unhealthy eating, excessive alcohol use, and physical inactivity, all of which can contribute to hypertension. Researchers also believe hormones such as cortisol that are produced during the body’s stress response can raise blood pressure.

• Age and genetics: You have little control over this risk factor. Natural physical changes associated with aging and certain genetic predispositions can make you more susceptible to high blood pressure. As you get older, your blood vessels gradually lose some of their natural elasticity, which can contribute to higher blood pressure.

• Existing medical conditions: Certain chronic conditions, such as kidney disease, diabetes, and hormonal disorders, can increase the risk of high blood pressure. These conditions can change how your body manages fluids and salts, leading to higher blood pressure.

• Medications: Some medicines, including over-the-counter pain relievers, cold medicines, birth control pills, steroids, and antidepressants, can cause or worsen high blood pressure. Certain medicines may narrow blood vessels, cause the body to retain more sodium and fluid, or increase the heart rate.

• Menopause: The hormonal changes associated with menopause can contribute to higher blood pressure in some women. Estrogen is believed to help protect the heart and blood vessels. As estrogen levels decrease during menopause, blood vessels may tighten and blood pressure may rise.

• Sleep apnea: Interrupted breathing during sleep can change blood pressure and contribute to elevated readings. Researchers believe the drops in oxygen levels that occur during periods of apnea may cause chemical changes that raise blood pressure.

New research on causes of high blood pressure

Additional research on high blood pressure suggests that the following factors may also affect your readings:

• COVID-19: A study found that people who had COVID-19 were more likely to develop high blood pressure in the following months. Researchers believe the virus may damage the heart and blood vessels or trigger inflammation, leading to high blood pressure.

• Exposure to air pollution: New research found that people exposed to higher levels of air pollution were more likely to have high blood pressure. Researchers believe air pollution may damage blood vessels or cause inflammation, leading to high blood pressure.

Treatment options: how to lower high blood pressure

Managing high blood pressure can be challenging, but most people can lower their readings by making meaningful and consistent lifestyle changes. Some of the most common recommendations for supporting healthier blood pressure include:

• Adopt a healthy diet: A diet rich in whole grains, fruits, vegetables, and low-fat dairy products can help lower blood pressure. The Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets are examples of eating patterns that can support healthier blood pressure. Limiting the amount of sodium in your diet may also help.

• Exercise regularly: Regular physical activity for at least 30 minutes on most days of the week can lower blood pressure. You might choose simple activities such as walking, cycling, swimming, or gardening. The key is consistency.

• Maintain a healthy weight: Blood pressure often rises as weight increases. If you’re overweight, losing even a small amount of weight can help lower your blood pressure.

• Limit alcohol: Alcohol can raise your blood pressure and should be limited to moderate levels.

• Avoid tobacco: Avoid tobacco, including exposure to secondhand smoke.

• Manage stress: Chronic stress can contribute to high blood pressure. Identifying your sources of stress and finding ways to manage them may help you maintain healthier readings. Whether meditation, deep breathing, yoga, spending time with friends, or another approach works for you, find something you can follow consistently.

• Monitor your blood pressure: Checking your blood pressure regularly at home with a home blood pressure monitor can help you track your readings and see whether your lifestyle changes are working. Regular checkups with your doctor are also important. If lifestyle changes aren’t enough, your doctor may prescribe medication to lower your blood pressure. Always take it as directed.

New research on how to lower blood pressure

• New medications: A type of blood pressure medication called an ARNI (angiotensin receptor-neprilysin inhibitor) has been shown to lower blood pressure, including in people with resistant hypertension, which is high blood pressure that is difficult to control with other medications.

• Intermittent fasting: Some research has shown that intermittent fasting may lower blood pressure in some people. This approach involves alternating periods of eating and fasting.

• Certain probiotic supplements: Probiotics have shown a moderate effect on lowering blood pressure in some studies. Probiotics are live microorganisms similar to the beneficial bacteria that naturally live in your gut.

• Exercise leg muscles: Exercise that specifically targets the leg muscles has been shown to lower blood pressure more effectively than other forms of exercise, such as aerobic exercise. These large lower-body muscles contain almost a quarter of the body’s capillaries, so increasing blood flow through them may help blood vessels receive oxygen and dilate.

• Dietary supplements: Omega-3 fatty acids and green tea may have small but beneficial effects on maintaining healthy blood pressure.

How to take your blood pressure reading

At the doctor’s office

If you’ve ever been to the doctor, you’ve probably rolled up your sleeve to have your blood pressure measured as part of the visit. But how does a blood pressure cuff work, exactly?

A blood pressure cuff measures your reading by constricting and then slowly releasing pressure on the brachial artery in your arm. Here’s how the step-by-step process works:

• The cuff is wrapped around your upper arm and inflated. As it inflates, the cuff presses down on the brachial artery and temporarily stops blood flow.

• As the cuff slowly deflates and releases pressure, your doctor or nurse listens or monitors for blood flow to return.

• When blood begins flowing through the artery again, it creates a rhythmic, pulsing sound. The gauge reading at that moment is your systolic pressure, or top number. It represents the force on your artery walls as your heart contracts.

• The cuff continues to deflate until the pulsing sound stops. At that point, the brachial artery is no longer constricted and blood flow is uninterrupted. The gauge reading is your diastolic pressure, or bottom number, which indicates the pressure in your arteries while your heart rests.

At home

If you’re an older adult managing your blood pressure, you can also use a home blood pressure monitor to check and track your readings between appointments with your doctor.

Many Medicare, Medicare Advantage, and private insurance plans offer free blood pressure monitors to beneficiaries. You may also be able to buy one using a Flexible Spending Account funded by pretax paycheck contributions. Monitors are available online and at local pharmacies, with costs ranging from $20 to $100.

The key to getting accurate and consistent readings at home is to follow the proper instructions. Stay still, measure your blood pressure at the same time each day, take more than one reading at each sitting, and keep a log of your results.

Side effects of high blood pressure

You may know that high blood pressure can be dangerous, but you may be less familiar with its specific health effects. It can affect many different parts of your body. Possible risks include:

• Damage to arteries: High blood pressure can cause small tears and injuries in artery walls, leading to hardened or narrowed arteries. This may restrict the flow of oxygen-rich blood to your organs and affect how they function.

• Heart problems: Long-term high blood pressure can lead to coronary artery disease, heart failure, and other heart-related complications. These conditions can result in chest pain, heart attack, or even sudden death.

• Kidney damage: High blood pressure can damage blood vessels and filters in the kidneys, leading to several types of kidney disease. Your kidneys may become less able to remove waste from your blood, potentially making you reliant on dialysis.

• Brain health: High blood pressure can contribute to stroke, dementia, mild cognitive impairment, and transient ischemic attack, also called a mini-stroke. It can disrupt the supply of blood to the brain and affect how the brain functions.

• Vision loss: High blood pressure can strain or damage blood vessels in the eyes, potentially resulting in conditions such as retinopathy and choroidopathy.

• Sexual dysfunction: For men, high blood pressure can contribute to erectile dysfunction by affecting blood flow to the pelvic region. For women, reduced blood flow can decrease sexual desire and satisfaction.

• Bone loss: High blood pressure may reduce blood flow to the bones and bone marrow, which can contribute to loss of bone density and a higher risk of fractures.

High blood pressure is a significant health concern for older adults and can affect overall well-being and quality of life. However, it can often be managed with early detection, appropriate treatment, and consistent lifestyle changes. Regular monitoring, taking medications as prescribed, exercising, eating a balanced diet, and managing stress can all support healthier blood pressure. Work with your doctor to understand your readings, discuss any concerns, and decide which next steps are appropriate for your health. With the right medical guidance, ongoing attention, and healthy habits, you can continue supporting an active life, your overall health, and your quality of life.