How being older affects your blood pressure

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How being older affects your blood pressure

You're more likely to develop high blood pressure as you age. But treatment with lifestyle changes and medications can pay off no matter how old you are.

There was a time when doctors didn't treat high blood pressure in older adults because they considered it a normal part of aging. Doctors now know, however, that controlling high blood pressure (essential hypertension) is important at any age.

Treating high blood pressure can prevent a host of potentially disabling and life-threatening complications. Take time to understand high blood pressure in older adults and see what steps you can take to manage this condition.

Why you're more susceptible to high blood pressure as you age

As you age, your blood pressure may change. Your systolic pressure typically creeps upward. Systolic pressure is the first number in a blood pressure reading, such as 115/75 millimeters of mercury (mm Hg). Your diastolic pressure, the second number, generally decreases, however.

These changes occur because your blood vessels become more rigid as you get older. This forces your heart to work harder to pump blood through the vessels to all areas of your body. The blood vessels, now less elastic, can't stretch as well to accommodate the blood flow, so the pressure on artery walls increases. The difference between your systolic and diastolic pressure is called pulse pressure. The wider this gap, the stiffer and more damaged your vessels likely are.

If both your systolic and diastolic pressure rise above normal levels, you have high blood pressure. If your diastolic remains normal while your systolic pressure climbs to 140 mm Hg or higher, you have a common form of high blood pressure called isolated systolic hypertension.

More than half of U.S. adults between ages 60 and 69 have high blood pressure, while more than three-fourths of those older than 70 do.

The importance of treating high blood pressure at any age

You may be more susceptible to high blood pressure as you age, but that doesn't mean you shouldn't try to prevent it or treat it effectively.

As with high blood pressure in younger age groups, you may feel just fine and not realize you have the condition. High blood pressure typically doesn't have any symptoms until it reaches later stages. Doctors used to think that if you were older and didn't have symptoms from high blood pressure, you didn't need to treat it.

But the truth is, high blood pressure can harm your body from head to toe. In fact, older adults with high blood pressure are more vulnerable than are their younger counterparts to the complications of high blood pressure. It can cause stroke and dementia, and it may also be partly responsible for memory problems associated with aging. High blood pressure can also increase your risk of blindness, heart failure, heart attack and kidney disease. And the damage it wreaks on your blood vessels can impair circulation to your hands and feet.

Some doctors remain unaware of the dangers and still don't treat high blood pressure in older adults at all or aggressively enough. In some cases, the older you are, the less likely many health care providers are to suggest lifestyle changes or medications to help treat your blood pressure. However, treating high blood pressure, even if you're in your 80s or 90s, is often worthwhile. Although blood pressure medications (antihypertensives) do have side effects, they're rarely severe enough to warrant a halt in treatment.

If you're concerned that your blood pressure isn't checked regularly or if you have high blood pressure and feel that it's not being treated adequately, talk to your doctor.

A healthy lifestyle still matters

Just what can you do to treat high blood pressure when you're older? In essence, the same things your younger counterparts do.

As with any age group, lifestyle modifications are often the best and safest way to treat hypertension when you're older. Don't let age become a barrier to getting physically active or use it as an excuse to have a dietary free-for-all or gain excess weight.

Because you typically become more sensitive to the blood-pressure-raising effects of sodium as you age, cutting back on sodium consumption can have a big impact. Resist the temptation to add more salt to your food to compensate for changes in your sense of taste, which may occur as you age. And remember that if you find yourself eating more processed or packaged foods, you may be consuming more sodium than you realize. The same is true if you eat out often — look for or request low-sodium menu items.

Tailoring treatment with medication

In some cases, especially if you have more severe high blood pressure, lifestyle changes alone aren't enough to control your blood pressure sufficiently. You may also need to take one or more medications to bring your blood pressure under control and minimize complications.

What medications are appropriate for you depend on your overall health, other conditions you may have and the severity of your high blood pressure. In many cases, your doctor will try to select blood pressure medications that may also protect you against various forms of cardiovascular disease, which are also common as you age.

The cornerstone of your medication treatment is likely to be a thiazide-type diuretic. The diuretic may be combined with other medications, such as a beta blocker, an angiotensin-converting enzyme (ACE) inhibitor, an angiotensin receptor blocker or a calcium antagonist (calcium channel blocker).

Diuretics are also preferred if you have isolated systolic hypertension. And they may also be beneficial for older women because they can protect against hip fractures by decreasing calcium lost in the urine.

Because older adults are more susceptible to postural (orthostatic) hypotension — a drop in blood pressure when you rise or stand up, which increases your risk of falls — you may need to increase doses more slowly or avoid certain blood pressure medications. And because you may also be more vulnerable to undesirable side effects, you may need to start at lower initial doses of your medications than do your younger counterparts and reduce your blood pressure more gradually.

If standard treatment isn't effective, you and your doctor may have to look elsewhere for causes of your high blood pressure. One possibility is that you may have a rare condition called pseudohypertension. This is not true hypertension, but rather the result of an inaccurate measurement of your blood pressure. This can occur if a blood pressure cuff can't inflate properly because your arteries have become severely stiffened.

It's not too late to tackle high blood pressure

Getting high blood pressure isn't simply a fact of life. Treating it early and treating it more aggressively than had previously been recommended can help delay or prevent serious complications, such as dementia and heart failure.

If you get a handle on your blood pressure, you may well enjoy a longer and happier life, even if you're already in your 70s or 80s.

Last Updated: 04/06/2005
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