The new recommended target for BP treatment in people aged 60+ is 150/90.
This is controversial among some experts but generally applauded by those of us in geriatrics.
Also, a recently published study found that people aged 70+ on blood pressure medication had more serious falls (fractures, dislocations).
Significant hypertension should certainly be treated, but in my own experience many older adults are taking more medication than they probably need. I do a lot of scaling back the BP meds, as do the other geriatricians I know. Hope this info helps!
Normal BP is 120/80. However, I recently read an article saying doctors now believe slightly higher numbers may be the real "normal" for an older person. By slightly higher they meant a max of 140/90. The medical community is not in agreement about this as of now.
Some people run higher than what is "normal". Some lower. My dad always had a low blood pressure and I had to always convey that any time he had his blood pressure taken. So a blood pressure of 120/80 which is within normal limits would not be normal for my dad.
If someone's BP varies from this "normal" it doesn't necessarily mean there's a problem. Medications can affect blood pressure as can diseases and ailments. If someone is in pain their blood pressure may increase or if someone is on diuretics they're blood pressure may be low.
Yes... it gets confusing, especially (in our case) where the primary doctor doesn't communicate with the heart doctor... (the heart doctor says to 'listen' to the primary doctor... who is overloaded with patients)
I don't know if they are available in your area, but I strongly suggest anyone over the age of 65 see a doctor who is board certified in geriatric medicine. Note: Board Certified. Any doctor can claim they take care of the elderly, however are they board certified?
My mother lives in a city where there is a practice like this and all her doctors report to her geriatrician. Her health has improved dramatically because geriatricians don't dismiss the aches and pains older people may have that are often attributed to 'old age' by regular doctors.
This is a growing field I learned about fifteen years ago.
Rather than worry about a number (assuming you're within a reasonable range, anyway) I'd look out for marked changes in an individual.
On the other hand, if there is a sudden change, your first thought should be "check it again, please" - hurried readings, wonky cuffs, there are dozens of reasons why b.p. readings can be plain wrong.
The second thought should be a reluctance to tinker unless there's anything else wrong. If you've got a pre-1930 model puttering along happily, don't fiddle with it unless you have to. But good doctors will be adopting this attitude anyway.
Interesting article Dr. Kernisan. Taking bp at home can reduce the number of elevated readings at medical facilities due to "white coat syndrome". Low sodium diets are also encouraged to bring down BP numbers. Are the parameters lower than 150/90 for 60 somethings with known cardiac disease such as aortic stenosis, left ventricular hypertrophy or previously diagnosed coronary artery disease? Thanks!
Hi norestforweary, Good questions. The guidelines recommend a goal of 140/90 for people with diabetes or chronic kidney disease, regardless of age. They don't seem to specify anything for coronary artery disease, but diabetes is often considered a "coronary artery disease equivalent." You can read about the guidelines in Harvard's newsletter here: https://www.health.harvard.edu/blog/new-guidelines-published-for-managing-high-blood-pressure-201312186953 Or you can try combing through the guideline statement in JAMA (free, but long) website: jama.jamanetwork/article.aspx?articleid=1791497
I don't know about specific recs for aortic stenosis and left ventricular hypertrophy...in general I think ideal BP would depend on how bad the conditions are, and whether the heart seems to pump better when BP is lowered to certain levels. This is something that is somewhat testable for a particular patient, by following symptoms, BP, and possibly echocardiograms. For a "youngish" person in their 60s, it might be worth doing.
But I think the point of recent research is that lower is not always better. I was drilled to treat to BP less than 130/80 for diabetes and kidney disease in med school, and finally the medical establishment is admitting that overall there is not good evidence that this results in better outcomes than getting people below 140.
For older people who are frail, the downsides of tight BP control can be substantial. I think it's less likely to be harmful in people in their 60s however; most are medically "middle-aged" and not as vulnerable as the patients I take care of.
I have found that the offices that use the electronic cuffs, my mom's blood pressure is always high but if they use the old fashion manual cuff and stethoscope it is in her normal range. I now insist that is the only way for them to take it. My mom is diabetic, CHF, and stage 3 renal disease.
https://www.agingcare.com/articles/what-new-blood-pressure-guidelines-mean-for-caregivers-164338.htm
The new recommended target for BP treatment in people aged 60+ is 150/90.
This is controversial among some experts but generally applauded by those of us in geriatrics.
Also, a recently published study found that people aged 70+ on blood pressure medication had more serious falls (fractures, dislocations).
Significant hypertension should certainly be treated, but in my own experience many older adults are taking more medication than they probably need. I do a lot of scaling back the BP meds, as do the other geriatricians I know. Hope this info helps!
If someone's BP varies from this "normal" it doesn't necessarily mean there's a problem. Medications can affect blood pressure as can diseases and ailments. If someone is in pain their blood pressure may increase or if someone is on diuretics they're blood pressure may be low.
It just all depends.
My mother lives in a city where there is a practice like this and all her doctors report to her geriatrician. Her health has improved dramatically because geriatricians don't dismiss the aches and pains older people may have that are often attributed to 'old age' by regular doctors.
This is a growing field I learned about fifteen years ago.
http://en.wikipedia.org/wiki/Geriatrics
You can also Google Geriatric Medicine.
On the other hand, if there is a sudden change, your first thought should be "check it again, please" - hurried readings, wonky cuffs, there are dozens of reasons why b.p. readings can be plain wrong.
The second thought should be a reluctance to tinker unless there's anything else wrong. If you've got a pre-1930 model puttering along happily, don't fiddle with it unless you have to. But good doctors will be adopting this attitude anyway.
Good questions. The guidelines recommend a goal of 140/90 for people with diabetes or chronic kidney disease, regardless of age. They don't seem to specify anything for coronary artery disease, but diabetes is often considered a "coronary artery disease equivalent."
You can read about the guidelines in Harvard's newsletter here:
https://www.health.harvard.edu/blog/new-guidelines-published-for-managing-high-blood-pressure-201312186953
Or you can try combing through the guideline statement in JAMA (free, but long)
website: jama.jamanetwork/article.aspx?articleid=1791497
I don't know about specific recs for aortic stenosis and left ventricular hypertrophy...in general I think ideal BP would depend on how bad the conditions are, and whether the heart seems to pump better when BP is lowered to certain levels. This is something that is somewhat testable for a particular patient, by following symptoms, BP, and possibly echocardiograms. For a "youngish" person in their 60s, it might be worth doing.
But I think the point of recent research is that lower is not always better. I was drilled to treat to BP less than 130/80 for diabetes and kidney disease in med school, and finally the medical establishment is admitting that overall there is not good evidence that this results in better outcomes than getting people below 140.
For older people who are frail, the downsides of tight BP control can be substantial. I think it's less likely to be harmful in people in their 60s however; most are medically "middle-aged" and not as vulnerable as the patients I take care of.
See All Answers