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New Guidelines Suggest Less Aggressive Treatment for High Blood Pressure in Older Individuals PDF Print E-mail
Written by Dr. David Lipschitz   
Thursday, 09 January 2014 06:32

High blood pressure afflicts one in three Americans, is more common in blacks than in whites and is significantly higher among the obese. Recent research published in the journal Circulation: Cardiovascular and Quality Outcomes shows 25 percent of hypertensives only becoming aware of their blood pressures after a major complication has developed. By this time, many problems are irreversible, and it's too late to prevent a shorter life expectancy due to declines in cardiovascular function.

High blood pressure occurs very gradually and is generally caused by spasm of arteries. As a consequence, more force is needed to pump blood out of the heart. This causes the top or systolic blood pressure to increase. And because blood vessels are less able to relax, the bottom or diastolic blood pressure increases as well. A higher blood pressure makes the heart work harder causing the cardiac muscle to hypertrophy and the heart to enlarge. Over time, the ability of the heart to cope decreases and heart failure can occur. Symptoms include shortness of breath with exertion and retention of fluid that leads to swelling of the ankles and legs.

Long-term spasm of arteries causes them to become irreversibly narrowed, and the inner lining to become damaged, which leads to deposition of cholesterol and a higher risk of heart attacks and strokes.

Higher blood pressure also causes significant abnormalities of kidney function. Kidney arteries become narrowed, blood supply to the kidney is reduced, and hormones are released that further raise blood pressure. This is to assure that sufficient blood flows through the kidneys so concentrations of electrolytes and other compounds in the blood remain in the normal range. A vicious cycle is created: higher blood pressure, more arterial spasm, greater release of hormones from the kidneys and elsewhere, which all leads to an even higher blood pressure. Eventually, serious and often fatal kidney failure occurs.

For these reasons, nothing can be more important than compulsive screening to identify high blood pressure. A normal blood pressure is defined as a systolic pressure of 120 or less and a diastolic blood pressure of less than 90. Anyone with a systolic blood pressure greater than 130 but lower than 140 is defined as having prehypertension. Even this mild increase in blood pressure is associated with a higher risk of heart attack and stroke. And the incidence of serious disease increases progressively as blood pressure rises.

Hypertension is never diagnosed on the basis of one blood pressure measurement. It is also better to sit and be in a relaxed state for 10 minutes or more before blood pressure is taken. And in doctors' offices, blood pressure should be taken in both arms and while lying down, sitting and standing. Anyone whose blood pressure is consistently increased should be treated to bring pressure into normal range.

For mildly elevated blood pressures, restricting dietary salt intake, prudent weight loss and exercise are often sufficient to return blood pressure to normal. And if this is not adequate, very inexpensive medications are highly effective in keeping blood pressure low and preventing serious complications.

Until recently, experts universally agreed that target reductions in blood pressure should be below 140/80. However, some research shows that for those over the age of 80, a blood pressure below 120/80 is too low, increasing the risk of illness and death. In fact, the risk of heart attack and stroke was only increased in those whose systolic blood pressures were above 155.

And now, a panel of experts reports that adults over the age of 60 should only have their hypertension treated with medications if their systolic blood pressures are above 150 or their diastolics above 90. Published in the Journal of the American Medical Association, an analysis of over 30 years of clinical studies shows that lowering blood pressure below 150/90 does not offer any additional benefit in reducing the risk of heart attack, heart failure and stroke.

These new recommendations are not universally accepted. If suffering from high blood pressure, discuss them with your physician. As we grow older and suffer from multiple chronic diseases, reducing the need for a medication could be of great value.

Dr. David Lipschitz is the author of the book “Breaking the Rules of Aging.” To find out more about Dr. David Lipschitz visit

Last Updated on Thursday, 09 January 2014 06:37

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