High Blood Pressure: Risks & Management for Older Adults

December 15, 2019

This year, millions of Americans will be diagnosed with high blood pressure, also referred to as hypertension. According to the American Heart Association, this condition affects nearly half of the adult population in the United States. As the life expectancy of our aging population continues to increase, the prevalence of hypertension is also expected to climb.

Hypertension is often called the “silent killer” because there are usually no significant signs or symptoms associated with the condition. While high blood pressure is common in older adults, it can lead to stroke, heart disease, eye problems, kidney failure, and other health conditions if left undiagnosed or untreated.

What Is High Blood Pressure?

Blood pressure refers to the amount of force behind the blood traveling from the heart through the artery walls. Blood pressure and its measurement can be seen as a gauge for overall circulatory health. We depend on maintaining healthy levels to ensure all of our organs and body tissue get adequate supplies of oxygen and nutrients.  

Who Is At Risk?

We all are! Anyone can develop hypertension; however, a variety of components will determine who is at higher risk than others. Common “lifestyle” factors that increase a person’s risk include obesity, a poor diet, physical inactivity, alcohol abuse, or if you are a smoker. People with conditions such as diabetes and kidney disease are also likely to be hypertensive. Some people may have a predisposition to developing it based on:

  • Age: The risk naturally increases as we get older. Our plumbing (artery walls) thicken as we age, making it harder for the heart to move blood flow.
  • Gender: Before age 55, men have a greater chance of having high BP. Women are more likely to have high BP after menopause.
  • Family History: High blood pressure tends to run in families.
  • Race: African Americans are at an increased risk.

People with this condition are also at a significantly greater risk of heart failure, stroke, chronic kidney disease and damage to the arteries (similar to the damage caused by high cholesterol).

BP goals: Blood pressure is given as two numbers, such as 120/80 millimeters of mercury (mm Hg). What’s considered “normal” is a systolic pressure of less than 120 and a diastolic pressure of less than 80. Systolic (the upper number in a BP reading) refers to the pressure in the arteries caused by your heart contracting and pushing out blood when the heartbeats. Diastolic (the lower number) measures pressure in the arteries when the heart is at rest between beats. 

The Numbers

Historically, the American College of Cardiology/American Heart Association (ACC/AHA) advised that people with high blood pressure should receive treatment at 140/90 mm Hg. In 2017, the ACC/AHA revised these guidelines by lowering the threshold to 130/80 mm Hg to allow for earlier detection, prevention, intervention, and treatment of high blood pressure.

Blood pressure categories, according to the new guidelines, are:

  • Normal: Less than 120/80 mm Hg
  • Elevated:120-129/>80 mm Hg
  • Stage 1: 130-139/80-89 mm Hg
  • Stage 2: 140/90 mm Hg
  • Hypertensive Crisis: 180+/120+ 

Measuring Blood Pressure

The most effective way to detect and control hypertension is to visit your primary care physician regularly. As we age, seniors are advised to keep track of their blood pressure, not only visiting their doctors consistently but also taking measurements at home a few times a week. Some reliable monitors won’t break the bank (check your insurance coverage – some companies help cover the cost) and are easy to use. 

Measurements can fluctuate throughout the day, so it is crucial that one takes their reading at the same time of day each time. One should also avoid caffeine at least 30 minutes beforehand, and sit quietly with their back supported and legs uncrossed while recording. Keep a record of your blood pressure readings, including the time of day. 

It is not uncommon for seniors to have slightly elevated numbers and not be in danger. The elderly need to consult with their doctor to know what are “acceptable” BP measurements for them. When it comes to high blood pressure for an older adult, symptoms typically start to appear at dangerously high levels. 

The symptoms of extreme hypertension can include:

  • Intense headache
  • Problems with vision
  • Chest pain
  • Irregular heartbeat
  • Fatigue and confusion 
  • Pulsating in the chest, neck, and ears
  • Difficulty breathing
  • Blood in the urine

If you have any of these symptoms, it is crucial to contact your doctor immediately.

Maintaining A Healthy Blood Pressure

Effective blood pressure management has been shown to decrease the incidence of heart attack, stroke, and heart failure. Although you may not be able to control all of the risk factors, there are steps you can take by changing “lifestyle” habits for a heart-healthy circulatory system:

  • Eat a healthy diet: Healthy nutrition is essential in staving off most illnesses and adverse health conditions, including a diet rich in fruits, vegetables, whole grains, and low-fat dairy products.
  • Cut down on salt: As we age, our bodies become more sensitive to sodium (salt). Salt indirectly increases the volume of blood (by adding water to the bloodstream). Most of our salt intake comes from processed foods such as canned soup and baked goods. Consider a low salt diet and putting the salt shaker away.
  • Exercise Daily: Moderate exercise can reduce your risk of high blood pressure. National guidelines recommend exercising 30 minutes a day, most days of the week. For seniors, simple changes like walking more often and engaging in household chores suffice. 
  • Keep a healthy weight: Obesity is a significant risk factor for this condition. Weight loss is possible with a healthy diet and exercise. Consult with your physician before starting any exercise routine.
  • Don’t smoke: Nicotine in cigarettes causes blood vessels to narrow, increasing the pressure of blood flow. If you are a smoker, consider quitting for the good of your health and others.
  • Drink less alcohol: Drinking alcohol increases the risk of high blood pressure.  
  • Manage stress: It is not always easy to manage stress; however, mindful practice of yoga, meditation, and other relaxation techniques can go a long way in helping to relieve stress.  
  • Get a good night’s sleep: The recommended amount of sleep for a healthy adult is at least seven hours.

Sometimes changing lifestyle is simply not enough in managing high blood pressure. Medications may be prescribed if hypertension is severe enough and if measurements were not reduced by the recommendations made. Medications will not cure hypertension but can keep levels down.

Eating Smart for Brain and Heart Health

Treating high blood pressure in its varying forms can look very different for a 60-year-old patient compared to a frail 80-year-old patient. For some elderly, treatment involving medications can be a difficult subject, one that should always be considered under the guidance of a medical professional.

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