Have you been concerned about high blood pressure (hypertension)? Or are you worried about an older relative having a stroke or heart attacks?
You’re not alone. After all, hypertension is the most common chronic condition among older adults, and medications for blood pressure (BP) are among the most commonly taken drugs in the US.
Even more important: poorly controlled hypertension is a major contributor to the most common causes of death and disability in older adults: strokes, heart attacks, and heart failure.
So it’s certainly sensible for older adults – and for those helping aging parents – to think about lowering blood pressure.
And once you start thinking about high blood pressure, you’ll probably start to wonder.
Are the blood pressure medications you’re taking enough? Is your blood pressure at the “right” level or should you and your doctors work on changing things?
And what about that major research – the SPRINT trial — that made the news in 2015? (In this study, older adults randomized to aim for a lower BP did better than those who got “standard” BP treatment.)
These are excellent questions to ask, so I’d like to help you answer them.
Now, I can’t provide exact answers on the Internet. But what I can do is provide a sensible process that will help you successfully address these questions about lowering blood pressure.
In this article, I’ll share with you the process that I use to:
- Assess an older person’s blood pressure management plan, and
- Determine whether we should attempt changes.
If you’re an older adult, you can use this approach to get started assessing your own BP management plan. This will help you to better work with your doctors on assessing and managing your blood pressure.
If you are helping an older relative manage health, you can follow these steps on behalf of your relative.
But first, let’s review a few blood pressure fundamentals, namely:
- Key terms related to blood pressure
- What’s considered normal blood pressure by age
- How to measure blood pressure (very important!)
Key terms about blood pressure and hypertension
- Systolic blood pressure (SBP): the “top number” when BP is checked. This reflects the pressure in the arteries when the heart squeezes. It’s by far the most important number to consider when it comes to older adults.
- Diastolic blood pressure (DBP): the “lower number” when BP is checked. This reflects the pressure in the arteries when the heart relaxes.
- Pulse: the heart rate. Automatic BP monitors report pulse along with BP. Doctors must evaluate a person’s heart rate when considering a change in BP medication.
- Hypertension (also known as “high blood pressure”): Usually defined as SBP> 130 and/or DBP > 80. If only the systolic BP is high, this is called “isolated systolic hypertension.” This type of hypertension is very common in older adults, as aging is associated with both increases in systolic BP and decreases in diastolic BP.
What is considered normal blood pressure in older adults?
As of 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) are defining normal blood pressure and high blood pressure using the same ranges for all adults, regardless of age or gender.
Here is the definition of normal blood pressure (and hypertension) per the ACC/AHA:
BP CATEGORY | SYSTOLIC BP | DIASTOLIC BP | |
---|---|---|---|
Normal | <120 mm Hg | and | <80 mm Hg |
Elevated | 120–129 mm Hg | and | <80 mm Hg |
Hypertension | |||
Stage 1 | 130–139 mm Hg | or | 80–89 mm Hg |
Stage 2 | ≥140 mm Hg | or | ≥90 mm Hg |
In short, if you are wondering what is “normal” blood pressure by age: whether a person is in their 60s, 70s, 80s, or 90s, normal blood pressure is considered to be a BP less than 120/80.
Furthermore, the definition of normal blood pressure does not vary between men and women.
(For more on BP guidelines, see my article What the Blood Pressure Guidelines — & Research — Mean For Older Adults.)
How to measure blood pressure
As you can imagine, a key component of optimizing BP management is to measure an older person’s BP and pulse.
Measuring BP allows us to:
- Diagnose people with hypertension,
- Determine how severe it is (which helps us all decide how important it is to intervene),
- Evaluate how well people are responding to a treatment plan, whether that plan involves lifestyle changes or medication or both.
Measuring BP to get blood pressure readings usually sounds straightforward.
People assume it’s just a matter of finding out what the BP was at the doctor’s office, or getting a reading from a home monitor, or maybe even a reading from a health fair or drugstore.
But in fact, research has shown that a single office-based BP reading often does not represent a person’s usual BP. One study even found that the “usual” way of measuring BP misdiagnosed 24-32% of volunteers!
This is because people are often anxious when at the doctor’s office, which can temporarily raise BP. Studies estimate this “white-coat hypertension” affects 10-20% of people.
Furthermore, BP is constantly changing a bit, moment to moment. So experts agree that it’s much better to obtain several readings and average them, in order to properly assess a person’s usual BP.
For instance, in the ground-breaking SPRINT trial of intensive BP lowering in older adults, the researchers checked BP by having participants first rest quietly in a room for five minutes. Then an automatic monitor checked BP three times in a row, with a one-minute interval between each check. The average of these three readings was then used to assess BP and make changes to hypertension medications, if necessary.
As you can imagine, this is not the way most people’s blood pressure is measured by their doctors.
So what’s better?
Currently, the “gold standard” for evaluating blood pressure is called “ambulatory blood pressure monitoring” (ABPM). It involves wearing a special monitor that checks BP every 15-60 minutes over 24 hours. The doctors then receive a report showing the average daytime BP and average nighttime BP.
Such monitoring provides excellent information for patients and doctors. In fact, research shows that ABPM is a better predictor of future cardiovascular events (e.g. heart attacks, strokes) than conventional office-based BP measurements are. However, ABPM is not yet widely available, since it requires special equipment and may not be covered by insurance.
So what is considered next best? Research shows that home blood pressure measurements are better than “usual-care” office BP measurements. Meaning, home BP measurements correlate better to the BP that is measured if one uses the fancy 24-hour ambulatory monitoring approach.
Based on these facts, in 2008 the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association issued a joint scientific statement calling for home BP measurements to become a routine component of BP measurement in people with known or suspected hypertension.
They also suggested that clinicians review a week’s worth of home BP readings before making a clinical decision or changing a person’s medications.
(You can read the American Heart Association’s 2019 guidelines on measuring blood pressure at home here, in section 4. You can also learn more about home BP monitoring here: Home Blood Pressure Monitoring: Current Status and New Developments.)
Now that I’ve made the case for checking BP carefully at home, let me share the six-step process you can use to assess your blood pressure management plan.
6 steps to better high blood pressure treatment in aging
1.Obtain a high-quality home blood pressure monitor.
Why: Studies have found that home-based measurements are better than office-based BP measurements. They better reflect a person’s BP over 24 hours.
Notes: See “Choosing & Using a Home Blood Pressure Monitor” for more details on choosing a monitor. Be sure to get one that measures BP at the upper arm (those wrist ones are not accurate enough!). Ask your doctor for help validating that your home monitor is getting accurate readings.
2. Check blood pressure twice a day, every day for one week.
Why: Since blood pressure is constantly changing a bit — or sometimes a lot — in the body, checking several days in a row means that you’ll have several readings that can be averaged.
Aim to check at the same times every day. An average of several daily readings provides a more accurate picture of a person’s BP.
Checking in the morning and evening is recommended by many experts. This is because BP can vary during the day, especially in people who are taking BP medications. But if checking twice a day seems too hard, just check once a day.
Experts also often say to check BP in the morning before any medications are taken. However, if there have been any concerns about falls, I like to review readings taken about an hour after medication. This is because I want to make sure the BP isn’t falling too low when a person takes their medication.
Optional but helpful: Use a “three measurements in a row” technique if possible. The SPRINT trial measured BP by letting participants rest quietly for five minutes, and then having the monitor check the BP three times in a row, with a one-minute pause between each check. Those three readings were then averaged into a reading for the day.
Some home blood pressure monitors have a feature that makes this easy to do.
3. Make an up-to-date list of all current medications.
Why: Your doctors will need to know exactly what medications you are taking, in order to evaluate your blood pressure treatment plan.
Notes:
- Start by listing those for heart or BP.
- But list all others, because some medications that are not prescribed for BP can still affect BP (such as Flomax, which can be used to improve urination when a man has an enlarged prostate).
- Also list all supplements, vitamins, herbs, and over-the-counter medications.
- Be sure to note if any medication is not being taken exactly as prescribed. It’s especially important for the doctors to know if an older person has been skipping any of the medications that affect BP.
- Note any concerns about side-effects, cost, or other concerns related to continuing the medication.
4. List the lifestyle approaches to lowering BP that you are following (or interested in).
Why: Although prescription medications are the main way doctors often try to treat hypertension, many lifestyle changes have been shown to help lower BP as well.
You’ll want to let your doctor know which of these you are using. Also, let your doctor know if you’d be interested in incorporating any of these into your BP management plan.
Many of these lifestyle changes are great for older adults, because they benefit health in many ways but have fewer risks than taking prescription medication.
Note: Proven approaches to lower high blood pressure include:
- Weight loss
- Exercise
- The DASH (Dietary Approaches to Stop Hypertension) diet
- Reducing sodium (salt) intake, especially in people who seem to be salt-sensitive
- Not smoking
- Meditation
5. Make an appointment to discuss blood pressure management with your usual doctor.
Why: Your doctor can help you identify a good target blood pressure goal, and can help you develop a plan to reach that goal. Be sure to bring up any concerns regarding falls, or other potential side-effects of treatment.
Notes:
- Bring in your home BP readings and your up-to-date medication list.
- Consider asking the doctor to check BP sitting and standing, especially if you’ve had any concerns about falls
- Ask your doctor what target BP goal they recommend for you, given your health history.
- Research indicates that the biggest benefit is in getting systolic BP down to the 140s. A systolic BP target goal of <150 is a good starting place for most frail older adults. This goal used to be recommended by major guidelines in 2013 and in 2017. More recent blood pressure guidelines recommend getting to <140.
- Results from SPRINT suggest that if you’re similar to the SPRINT participants, you may experience additional benefits by aiming for a systolic BP close to 120. If you’re considering this, be sure to read my article explaining SPRINT and related research, so that you’ll have a clear understanding of how likely you are to benefit (at best, an estimated 1 in 27 chance based on the research) and what are the risks and burdens.
- I personally generally aim for a systolic BP of 140-150 for frail older patients, and 130-135 for less frail older adults. If we get to a SBP of 130, then we consider whether to aim for an even lower BP, depending on the older person’s health and willingness to try more intensive BP treatment.
- Ask your doctor about taking most (or maybe even all) of your BP medications at night.
- A randomized trial published in 2019 found that taking BP medications at bedtime (rather than in the morning) resulted in lower ambulatory blood pressure readings and fewer cardiovascular events!
- Taking BP medications at night is likely to be a simple way to help them be more effective. For more on taking blood pressure medication at night, see this Harvard Heart Letter: Is nighttime the right time for blood pressure drugs?
6. Plan to follow up to see how your BP plan is working, and to make adjustments if needed.
Why: Whatever you and your doctors decide to do, you’ll want to make a plan for seeing how your blood pressure responds to the changes.
Note: Remember that experts say a week’s worth of home BP monitoring is more accurate than a follow-up BP check in the office.
Be sure to ask your doctor to specify:
- When should you undertake this home monitoring? (Most BP medications will take their full effect within 1 week. Lifestyle changes will take weeks to months to have an effect.)
- When will you be meeting — by phone or in-person — to discuss the results of the follow-up BP monitoring?
- What level of high (or low) BP should trigger a call to the office?
Also, be sure to let your doctor know if you’ve been having any symptoms that might be related to low blood pressure, such as light-headedness or dizziness when you stand up. Especially if your sitting systolic BP is less than 120, or if your BP drops when you stand up, you might be taking more blood pressure medication than is needed.
And that’s it!
Make the effort
Now, this approach is more work than usual. It takes a little more time and effort than just going to your doctor and having them check your blood pressure.
But the benefits make this time well spent. Think about it.
You and your doctor get a more accurate picture of what is going on inside your body.
You get to help create a blood pressure management plan that is just right for you.
You may even help prevent some serious health problems. Like a heart attack or stroke, or a serious fall due to incorrect medication.
No one likes the thought of letting a chronic condition get dangerously out of control. And no one likes to take more medication than they need to.
You can help keep this from happening.
Just follow this process for assessing a blood pressure management plan, and you’ll be on your way to confirming that you’re following a blood pressure management plan that’s right for you, or for your older parent.
This article was last reviewed and updated by Dr. Kernisan in March 2024.
Aashima says
Hi, my father (63 age) has high blood pressure and diabetes from almost 15 years now but during last 4 years, he has had multiple strokes (2 in 2017 and 4-5 in 2020). Usually each of his stroke episode happens when his BP drops below 130. The MRI’s and CT scans rarely detect any clots.
Can you suggest any natural ways to keep his BP around 150?
We are thinking of giving naturopathy a try
Nicole Didyk, MD says
I’m sorry to hear about your dad’s strokes.
Stroke is often related to high blood pressure, so it’s unusual that you mention that your dad had a lower blood pressure when he had these issues.
“Natural”, or non-medication-based approaches to reducing stroke risk would include quitting smoking, managing weight, eating a Mediterranean, low salt diet (like the MIND diet), and getting regular vigorous exercise, along with managing emotional stress.
Best of luck with the naturopath.
Kalicharan says
My father’s age is 58. His BP reading is 145/88 – 136/85. His current prescription is Telma 40 in morning and Novostat CV in night. I am bit worried as even after taking the pills his reading hasn’t come to or below 120/80
Nicole Didyk, MD says
Your dad is lucky to have such a concerned child! blood pressure targets can vary depending on a person’s age and other medical issues. Check out the American Heart Association Guidelines, here.
Abhay says
Dear Doctor, one day I found my BP 150/90 (Age- 37, Height-168cm, Weight-77kg). I went to Dr he prescribed “Prolomet AM 25” medicine for me (1pill every morning). After 1 month I went to Dr he checked my BP it was 120/80 and again he prescribed same medicine for next 3 months, since my first visit to now I reduced my weight upto 72kg and change diet. Now my BP is regularly 120/80. Now what should I do, should I continue pill or reduce more weight (my target is 68kg)? I need Your advice please..
Nicole Didyk, MD says
Hi Abhay. You’re a bit young for this forum. As a Geriatrician, I usually care for those 60 and over. The Centers for Disease Control and Prevention have some very helpful articles, which you can check out here: https://www.cdc.gov/bloodpressure/materials_for_patients.htm Thanks for your comment!
Ayush 82 says
Good Job. Great information about high blood pressure treatment .
Ethan Chloe says
My grandfather is 72 yrs. old and we’re concerned about his bp 152/77. We’ve been to his doctor many times but he’s not worried, instead, he said it’s fine. Anyway, grandpa’s general laboratories are in the normal range, just his bp been steady at 152/77 since last year. What else should we do? To get back his bp to 120/80.
Nicole Didyk, MD says
It’s great that you’re involved in your grandfather’s care and advocating for his treatment. Remember that blood pressure goals can vary according to an older person’s overall health status, and for some older adults (not necessarily your grandfather), a higher target may be acceptable. I would encourage a respectful conversation with his MD to focus on the blood pressure control, and why this target might or might not be OK.
Here’s an article that might be helpful in optimizing the lifestyle changes that you and your family can encourage: https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure. Good luck!
Leila says
Hello, I started noticing right-sided headaches/pressure/heaviness almost every day for about 3 weeks now. It happens almost every day and is present in my right eye and on top of the head, mostly to the right. I did not take any meds for it and paid goes away on its own.
For the past 3 days, I measure my BP with my mom’s home device. It is 100-106/73-75 for the past three days. My usual BP when I visit the doctor’s office is 90/65 or so. I exercise every day, but lately gained 3-4 lb. I am now at 97lb. I am 48 years old.
Is it possible that weight gain of 3-4lb can cause a rise in BP and can 100/75 be causing a headache?
Nicole Didyk, MD says
Being an expert in older adults, I don’t usually see folks in your age group.
In general, a very mild weight gain should not have a major impact on blood pressure.
Most of the time, the headaches that are associated with high blood pressure are when the reading is in a dangerously high range, but everyone is different, so I would advise someone like you to see a doctor about your concerns.
Annie says
I monitor my blood pressure at home and my numbers are good. I have brought my monitor to clinic to compare and it was accurate.
My problem is White Coat Syndrome or phobia of having my blood pressure taken at clinic. I had one doctor tell me to monitor it at home. I do that and bring my numbers in. Because my nervousness raises my blood pressure in the clinic I want doctors to understand I am nervous. When I get home it goes down, in the clinic it takes time to go down.
My question is how can I stop this anxiety when going to clinic. I dont want to be put on unnecessary medicine. I want to be understood and believed. Thank you.
Nicole Didyk, MD says
White coat hypertension is not uncommon but it can lead to a bit of a vicious circle whereby a person feels worries about the blood pressure being elevated in a medical office, which might cause the blood pressure to be elevated during the visit.
For this reason, a physician might ask the patient to bring in their home readings, and may decide to base their treatment plan on the home readings, which may be lower. There might be issues other than the actual blood pressure reading numbers that would lead to a decision to start a BP medication, though. So even if home readings are great, there still may be a role for medication.
Management of anxiety and “phobia” is a bigger issue that usually includes lifestyle changes, counselling and sometimes medication. This may be worth talking to your doctor about if you feel as though it’s really getting in the way of your quality of life.
Gasper ngairo says
Thanks @ Dr.Nicole Didyk for explanations if i will be having any question again SITAACHA KUULIZA ILI NIJUE, thanks alot and be blessed.
Gasper ngairo says
Hello! Hi..
It’s good intuitive and helpful article moreover it opens our mind on broad thinking about BP.
But i had question here, does there any correlation between environment factors like cloudy weather conditions or rainy weather with severity conditions of blood pressure and heart problems!!??, what is the solution or how to overcome it if there is!,.
Cause my mom has BP and heart problems and she is on daily medication for BP but her condition is obviously getting worse when there is cloudy or rainy condition.
So give me guidelines for this if any.
Nicole Didyk, MD says
I’m glad you found the article interesting.
Weather conditions can be associated with very small changes in blood pressure readings. Blood pressure is usually higher when it is colder, or if there are sudden changes in weather, like a storm, or abrupt cloud cover pattern.
These changes shouldn’t be excessive, so if a person is noticing that their blood pressure is consistently higher than it should be, even on treatment, I would recommend they talk to their doctor.
Doris Wade says
I’m a 71 year old black female. I’ve never had high blood pressure., it’s usually 116-130 over 65-75. I recently went to my primary care doctor for my annual physical
because of COVID I was filled with anxiety. I tried to calm down but just was not able to. My BP was 160/90. He let me set for about 10 mins and took it again it was 166/85 my pulse rate was 105 He told me to take my BP at home for a week, 3 times a day. My reading at home ranged from 119-132 over 62-77. Returned to my doctor a week latter with my reading and my blood pressure monitor. Again in his office anxiety, BP 158/85 pulse rate over 100. He took it on my monitor also, readings were very close. He told me take it at home for another week. I don’t understand this but every time I get ready To take it now, at home, my pulse rate is over 100 my breathing is rapid and my BP readings are high. 130-150 over 65-85. I don’t understand why I’m having anxiety at home. Is this crazy or what?
Nicole Didyk, MD says
Hi Doris. It sounds like you’re describing what we refer to as “White Coat Hypertension”, that is that a person has a high BP in a medical office, presumably because of anxiety.
It is a bit unusual to have that happen at home, but if a person forms a psychological association with having the BP checked, they could experience sufficient anxiety at home to elevate the blood pressure and heart rate.
When I am trying to distinguish between anxiety and high blood pressure, I order a 24 hour ambulatory blood pressure monitor test. That way, blood pressure can be measured over a longer period of time. It’s unlikely that someone could sustain a high anxiety level for the whole 24 hours, so a 24 hour BP monitor is a great way to get a more accurate BP reading, and to determine whether someone needs BP medication or not.