Because high blood pressure can lead to other health problems, it is important to get treatment. The goal of treatment is to lower your blood pressure enough to lower your risk of heart disease, stroke, and memory impairment.  

It is important to maintain both normal systolic and diastolic pressures. However, a high systolic pressure is the one most associated with heart disease and other health problems in older adults. 

Medications (Anti-hypertensives)

Treatment for high blood pressure usually begins with changes in diet and lifestyle. Medications are used to lower blood pressure when lifestyle changes alone haven’t lowered blood pressure to the goal level. 

Usually, the goal is to reduce blood pressure slowly and steadily. For most patients, you should visit your healthcare provider every 4 to 6 weeks after starting treatment. This is long enough to see whether the medication should be adjusted and to monitor for any side effects. Keep in mind that it may take 10 to 12 weeks to experience the full effect of starting a medication or increasing its dosage. At all follow-up visits to your healthcare provider, make sure that your blood pressure is measured both while you lie down and when you stand.

Common Medications for Initial Treatment

• Thiazide-type diuretics (also known as a “water pill”)
• Calcium channel blockers
• ACE inhibitors
• Angiotensin-receptor blockers (ARBs)
• Beta blockers

 Other classes of medications used to treat high blood pressure include alpha blockers, alpha-beta blockers, central-acting agents, renin inhibitors, and vasodilators.  However, these classes should be used with caution in older adults as they are prone to a number of side effects. 

People with hypertension often may need to take more than one medication. Your healthcare provider and pharmacist can provide more information about these medicines and help you decide which ones are best for you. They will also consider other medical conditions you may have when deciding which medication to prescribe.

If your blood pressure does not reach the target level, your healthcare provider may take some additional steps. They may slowly increase the dosage, add another medication (particularly if you are not already taking a thiazide diuretic), or switch to another type of medication. It may take many months to reach the target blood pressure goal. Be sure to continue making changes in your lifestyle during this process.

Drug Complications

Research has shown that drug treatment for high blood pressure is safe and effective in older adults and has few side effects. Still, as with all treatments, you should talk with your healthcare provider about balancing the clear benefits of drug treatment with the potential side effects that may affect your daily function and quality of life.

Rise Slowly to Prevent Falls and Fainting

A potential complication of drug treatment is a sudden drop in blood pressure, which can cause you to faint or fall. This may happen after meals, or when getting up after sitting or lying down. This problem is one reason that drug treatment is started at low doses and increased slowly and carefully. While you are taking medications to lower your blood pressure, make sure to get up from a lying or sitting position slowly. This will let your body adjust. 

Low Potassium (Hypokalemia)

If you take a diuretic, especially at higher doses, you may lose potassium in your blood. Low levels of blood potassium can lead to muscle weakness or problems with your heart rhythm.

Your healthcare provider may check your potassium levels frequently during treatment and may recommend potassium supplements. Some foods are also good sources of potassium. However, some other medications used to treat high blood pressure can cause your body to hold on to potassium. Check with your healthcare provider before taking extra potassium or replacing salt with a salt substitute that contains potassium (a good reason to read the label!).

Last Updated July 2020