Blood Pressure Management for Seniors

Medication and a healthy lifestyle including good food choices can help.

High blood pressure, or hypertension, affects one in three American adults and three of every four seniors age 75 and older. 

It’s an insidious problem because it usually causes no symptoms, but it’s an important risk factor for health problems including heart attack, heart failure, stroke, chronic kidney disease, and cognitive function decline.

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Blood pressure is typically expressed as to numbers, such as 120/80 millimeters of mercury (mm Hg). The first number is systolic pressure, measured when the heart beats to pump blood. The second is diastolic pressure, measured when the heart is at rest between beats.

More recently, researchers have concentrated on the results of intensive treatment of high blood pressure in seniors, meaning a goal of 120 mm compared to a previous accepted level of 140 mm. (Clinical guidelines have historically called for systolic blood pressure of 140 and lower for healthy older adults and 130 for adults with kidney disease or diabetes.)

The Systolic Blood Pressure Intervention Trial (STINT) did the comparison in more than 9,000 adults 50 years and older and found that those treated at the lower pressure had a reduced risk of cardiovascular disease after a median follow up of about three years. 

“These findings have substantial implications for the future of high blood pressure therapy in older adults because of its high prevalence in this age group, and because of the devastating consequences that high blood pressure complications can have on the independent function of older people,” says study co-author Jeff Williamson, MD, of Wake Forest Baptist Medical Center.

If you have high blood pressure, you’ll have to control it for life. Other than medications, healthy lifestyle habits such as healthy eating, being physically active, maintaining a healthy weight, limiting alcohol intake, and managing and coping with stress can help. 

To keep changes from becoming overwhelming, try making one at a time and move to the next when you’ve achieved one goal. 

To practice healthy eating, try following the Dietary Approaches to Stop Hypertension (DASH) eating diet. That plan, based on two major studies, reduces blood pressure when you follow a diet low in saturated fat, cholesterol, and total fat, and eat more fruits, vegetables, and fat-free or low-fat milk and milk products. It includes whole grain products, fish, poultry, and nuts. 

Staying as physically active as possible also is heart healthy. Regular physical activity can lower your blood pressure and the risk of other diseases. Check out Go4Life by the National Institute on Aging to find age appropriate exercises that will keep you on the move. 

Blood pressure rises as weight increases so try to lose weight. A weight loss of just three to five percent can reduce your risk of health problems. A useful way to gauge your body weight is knowing your body mass index.

There are many blood pressure medicines on the market, and it may take a while for you and your doctor to find one that is exactly right for you. They include diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, alpha blockers, alpha beta blockers, central acting agents, and vasodilators. 

“Numerous prospective, double-blind, randomized, placebo-controlled studies have shown that antihypertensive drug therapy decreases the development of new coronary events, stroke, and CHF (chronic heart failure) in older persons. If treated appropriately, elderly individuals with hypertension will have a greater absolute reduction in cardiovascular events (such as major coronary events, stroke, CHF, renal insufficiency), and a greater reduction in dementia than younger persons,” writes Wilbert S. Aronow, MD. 

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