Aging & Health A to Z
High Blood Pressure
Unique to Older Adults
This section provides information to help older adults and their caregivers consider their disease or condition in conjunction with other health issues.
As older adults live longer, they may have more than one chronic disease. Or, they may have a health problem that can lead to another condition or injury if not properly managed. The older adult may also experience healthcare in various settings, such as the hospital, assisted living facility or at home. These situations can affect the health and function of the older adult and therefore require careful management to ensure proper care and improve or maintain quality of life.
Blood Pressure Targets are Different for Very Old Adults
High blood pressure (also called hypertension) increases your chance of having a stroke. It also increases your chances of developing kidney damage, heart disease, and many other serious health problems. If you have high blood pressure, your healthcare professional will recommend that you lower the amount of salt in your diet, take more exercise, stop smoking if you smoke, lose weight if you are overweight, and if these measures do not work well enough, might also suggest that you take certain medications to lower your blood pressure to a safe level.
The target blood pressure for most people is now 120/80 mmHg. However, the ideal blood pressure goal for very old people is not yet clear because there have been few blood pressure studies that included this age group. The damage from high blood pressure on organs, such as kidneys, occurs much more slowly or might not be obvious in very old people. In fact, getting the blood pressure down this much in very old people has not been found to reduce their risk of dying.
In addition, many individuals over the age of 65 may feel dizzy, fall or pass out when they stand suddenly due to blood pressure that is suddenly too low. This condition, known as postural or orthostatic hypotension, poses a danger of fractures and other serious injury. This is especially a concern in frail older people who often suffer as well from thinning bones (osteoporosis). Therefore, many doctors now set a target of 140/90 mmHg, 150/80 mmHg, or 150/85 mmHg for older individuals. Blood pressure medications should be started slowly in older people and increased gradually, to avoid any sudden drop in blood pressure levels.
Click on each of the topics below to read more.
You may notice swelling in some parts of your body if you have high blood pressure. This buildup of fluids, called peripheral edema, usually occurs in your ankles, feet, lower legs, hands arms and lungs. It is a result of some degree of heart failure (see below), secondary in many cases to high blood pressure, but it can be linked to certain medications (such as calcium channel blockers, or CCBs) that your healthcare professional has prescribed to lower your blood pressure. Other drugs, such as non-steroidal anti-inflammatory drugs, (NSAIDS) may also have this effect. You will notice that pressure from a finger into the swollen area will leave an indentation, known as pitting. CCB-related edema happens more often in women and the chance of having it increases if:
- you are older
- you are taking fairly high doses of certain CCBs
- you spend a relatively long time standing during the day.
Your healthcare professional can help the edema to disappear by changing your anti-hypertensive medication, lowering the dosage, or adding another medication such as a diuretic (water pill), nitrate, or ACE inhibitor. You can also try wearing compression stockings and limiting the length of time you spend standing or sitting still with legs hanging down - keeping moving improves the blood circulation. Although peripheral edema may take a while to clear up by itself, becoming more active, stopping or adjusting your CCB or adding another medication usually clears it up within a few days.
When fluid accumulates in the lungs because of high blood pressure, you have a condition called pulmonary edema. It occurs when long-term hypertension weakens your heart’s left ventricle (normally the strongest part of your heart muscle). Fluids then back up in the lungs, making it difficult to breathe. Your health professional can prescribe treatment to help this.
Vascular ulcers are skin sores that can appear in your feet, lower legs or calves. They are caused by weaknesses in the calf muscles and in the valves in the veins of your legs. This combination of factors lets blood pool in your lower limbs and stretches the tiny blood vessels called capillaries. The weakened capillaries leak fluids into your skin, eventually causing changes that prevent fresh blood from circulating properly in the skin layers. This decreases nutrition to the skin and can lead to ulcers.
You are at risk of developing vascular ulcers if:
- you are over the age of 65 and have high blood pressure,
- you also have obesity and atherosclerosis.
The wounds that result are vascular ulcers. They may take a long time to heal and can come back repeatedly. Often the wound covers quite a large area and gets very painful. A vascular ulcer can prevent you from walking easily, getting to work, or even living independently. They often become infected and in the worst cases may even lead to amputation. Vascular ulcers are difficult to look after alone, and need careful attention. Trying to be as active as you can, keeping your leg elevated, and seeing a podiatrist, dermatologist, surgeon, or wound care specialist regularly is the best way to make a full recovery.
When high blood pressure is uncontrolled, it can cause changes in your heart that prevent it from pumping blood as efficiently as it should. This can lead to heart failure, which is the main cause of illness and death associated with hypertension. In older people, about 70% of all heart failure cases are caused by high blood pressure.
In addition to injuring your heart muscle, high blood pressure can also damage the walls of the arteries that supply fresh blood to your heart and the electrical system that controls the regular rhythm of your heartbeat. Over time, your left ventricle (the strongest part of your heart muscle) may become weak as it attempts to keep pumping blood throughout your body. As your heart muscle gets weaker, you may begin to develop the symptoms of congestive heart failure, including tiredness, shortness of breath, and water retention. To prevent this from happening and to stay healthy longer, follow your healthcare professional’s instructions. Control your blood pressure by making lifestyle changes, getting plenty of regular exercise, eating a balanced low-salt diet, losing weight, reducing stress, and taking anti-hypertensive medicines if needed, as prescribed by your doctor.
Blood pressure usually increases as we get older, especially our systolic blood pressure (the top number in a blood pressure reading). This common but dangerous development is one of the main causes of stroke in older adults, which is why you should follow your doctor’s recommendations to lower your blood pressure if necessary. Usually, a blood pressure over 160/90 mmHg suggests that you should be making lifestyle changes, and perhaps taking blood pressure-lowering medications.
A stroke is an interruption of the blood flow to the brain, which prevents oxygen and nutrients from reaching the brain’s nerve cells. This can occur because of a blood clot (thrombotic stroke) or from a bleed (hemorrhage) from one of the blood vessels carrying blood to the brain. Both types are associated with high blood pressure, and both are serious events, which can cause loss of brain function, inability to speak, walk, or move parts of your body, or even death. Older people often suffer many tiny silent strokes, which damage small areas of the brain and can eventually lead to a decline in your memory and your ability to think clearly, and may even lead to a type of dementia known as vascular dementia.
Medications to reduce systolic blood pressure have been proved to be safe and effective, and can substantially lower your risk of having a stroke.
These are sometimes called “mini strokes”. They occur when the blood flow to part of the brain is briefly interrupted. This could be for any of the following reasons:
- A blood clot in an artery of the brain
- A blood clot that travels to the brain from somewhere else in the body, for example, from the heart (embolism)
- An injury to blood vessels
- Narrowing of a blood vessel in the brain
- Narrowing of a blood vessel leading to the brain, for example in the neck.
High blood pressure is the number one risk factor for TIAs and stroke. The symptoms of a TIA:
- Begin suddenly
- Last only a short time, usually from a few minutes to 1 - 2 hours, but might last for up to 24 hours
- Go away completely, but -
- Might occur again at a later time.
Any of the following can be symptoms of a TIA:
- Dizziness or an abnormal feeling of movement (vertigo)
- Numbness, tingling or muscle weakness, especially on one side of the body
- Change in alertness (sleepiness, less responsive, unconscious)
- Confusion, or loss of memory
- Inability to recognize objects or people
- Trouble speaking or understanding others who are speaking
- Difficulty writing or reading
- Difficulty swallowing
- Loss of control over the bladder or bowels
- Loss of coordination and balance, clumsiness, or trouble walking
- Problems with eyesight – double vision or loss of all or part of vision
A TIA is a medical emergency. Call 911, or another local emergency number right away, do not delay! Do not ignore symptoms just because they go away. They may be warning signs of a future stroke.
If the symptoms and signs of the TIA have gone away by the time you get to the hospital this does not matter. A TIA diagnosis can be made based on your medical history. You will be admitted to hospital so that the health practitioners can try to find the cause of the TIA and get treatment started.
About 1 in 3 people who have a TIA and are not treated, eventually has a stroke, with about half of these strokes happening within a year. The stroke may occur on the same day as the TIA or at a later time. Some people have only a single TIA episode, and some have more than one.
After you have been evaluated and treated in hospital, it is essential to follow up with your health care provider to manage for the rest of your life any risk factors in your life style, such as high blood pressure, heart disease, diabetes, excess alcohol consumption, lack of exercise and smoking.
Dementia refers to a loss of brain function that can cause memory loss, confusion, mood and personality changes, physical disabilities, and a failure to carry out normal functions of daily life. There are many reasons why this can happen, some of them reversible with treatment, and others, like Alzheimer’s dementia, that cannot be cured but can be helped.
If you have high blood pressure, you have an increased chance of developing vascular dementia, which is second only to Alzheimer’s disease as a cause of dementia in older adults. About half of all cases of vascular dementia are caused by high blood pressure.
Other symptoms of vascular dementia include:
- slowed thinking
- loss of social skills
- dizziness and balance problems
- weakness in your arms or legs
- difficulty with language and speech.
In vascular dementia, your brain suffers damage because of a series of small, often unnoticeable silent strokes that repeatedly interrupt the flow of blood to your brain and result in damage to brain tissue and scarring.
Researchers have noticed that people over the age of 65 who have high blood pressure have more scarring in their brains—the higher the blood pressure, the more scarring is evident.
Although there is no cure, the series of strokes can be slowed or stopped by making lifestyle changes and taking medicines recommended by your healthcare professional to reduce blood pressure.
High blood pressure is one of the main causes of end-stage kidney (renal) disease because it creates extra stress on the blood vessels throughout your body. This can eventually damage your blood vessels, resulting in damage to the kidneys that can mean your kidneys can no longer filter wastes and remove fluids effectively. This kind of kidney failure must be treated either through dialysis or with a kidney transplant.
If your kidneys can no longer remove extra fluids, the pressure can build even more within your blood vessels. This then raises your blood pressure in a vicious cycle that can be difficult to regulate.
In its early stages, you will not know that you have kidney problems, but your healthcare professional can detect problems by testing for:
- Albumin (a protein in your urine) or
- Creatinine level in your blood and urine and how quickly the kidney moves this from blood to urine (creatinine clearance).
Your healthcare professional can then estimate your glomerular filtration rate (GFR), which can reveal tissue breakdown in your kidneys. Lifestyle changes and medications can control your blood pressure so that kidney problems can be prevented, and slowed down if kidney damage is already present. African Americans, Hispanics and Native Americans are at higher risk of kidney damage and failure than Caucasians, even when blood pressure is only slightly high. Therefore, in these populations, blood pressure control is even more important.
For very elderly people, those 85 and older, whose chronic kidney disease may progress slowly, if at all, blood pressure targets should not be as low as for younger age groups.
Hypertensive heart disease is the main cause of death linked to high blood pressure. A number of conditions result from the damage caused by high blood pressure:
- heart failure
- coronary artery disease (narrowing of the arteries that supply the heart muscle)
- heart rhythm problems
- left ventricular hypertrophy (thickening of the left ventricle)
- ischemic heart disease (heart muscle damage from lack of oxygen)
- atherosclerosis (narrowing and hardening of the arteries).
Heart disease and narrowing of the arteries caused by hypertension is treated by reducing blood pressure, using anti-hypertensive drugs, diuretics (water pills), vasodilators (drugs that relax your blood vessels), and lifestyle changes. Limit your intake of salt and eat foods high in fiber and potassium. Get regular exercise and lose weight if you need to. Avoid alcohol, or use it in moderation, (maximum of one drink daily for women, two for men), avoid all tobacco products and make sure to see your healthcare professional for regular medical checkups.
Stress and anxiety can make your blood pressure go up dramatically while you are feeling these emotions. When the emotion subsides, your blood pressure will drop again, so a little stress should not produce long-term high blood pressure. But feeling anxious or stressed every day can result in damage to your heart, kidneys, and blood vessels, as if you had chronic hypertension.
When you feel anxious or stressed out, you may also be more likely to smoke, drink alcoholic beverages, or eat too much and resort to junk food. Unfortunately, just knowing that you have high blood pressure can also increase your anxiety levels.
We often cannot control how much stress we have in our life, but we can influence how we react to the anxiety it produces. There are many effective ways to reduce anxiety levels. Non medication therapies are a good way to start, such as stress reduction techniques, talk therapy or cognitive behavioral therapy with trained counselors or psychologists. There are also anti-anxiety medicines available if needed. You can also try meditation, yoga, or other approaches. Your healthcare professional will help you find the appropriate approach that will be effective for you. Make sure that the medication that you take will not increase your blood pressure, as some mood altering pills, such as SSRIs (selective serotonin reuptake inhibitors like sertraline) have been known to do.
Updated: March 2012
Posted: March 2012