High Blood Pressure (Hypertension)

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.   Older adults 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, there are a number of changes your healthcare provider will recommend you make.  These include lowering the amount of salt in your diet, exercising more, quitting if you smoke, and losing weight if you are overweight.  If these changes do not work well enough, your provider might also suggest that you take certain medications to lower your blood pressure to a safe level. 

A person’s target blood pressure should be specific to their individual needs. For example, the ideal blood pressure goal for very old people is not clear.  This is because there have been few research studies about blood pressure that included this age group. High blood pressure can damage organs, such as kidneys.  However, this occurs much more slowly or might not be obvious in very old people. In fact, it has been found that lowering blood pressure too much in very old people does not reduce their risk of dying and actually might be harmful. 

In addition, many people over the age of 65 may feel dizzy, fall, or pass out when they stand up.  This happens when blood pressure is suddenly too low. This condition is known as postural or orthostatic hypotension. It poses a danger of fractures and other serious injuries. This is especially a concern in frail older people who often suffer as well from osteoporosis (thinning bones). They are more prone to a fracture if they fall.

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.  This avoids a sudden drop in blood pressure levels.

Click on each of the topics below to read more about how high blood pressure interacts with other health problems. 

Edema

If you have high blood pressure, you may notice swelling in some parts of your body. This buildup of fluids is called peripheral edema. It usually occurs in your ankles, feet, lower legs, hands, arms, and lungs. It is often the result of some amount of heart failure that can be caused by high blood pressure. However, it can also be linked to certain medications that your healthcare provider may prescribe to lower your blood pressure.  These medications can include calcium channel blockers. Other medications may also have this effect, such as non-steroidal anti-inflammatory drugs (NSAIDs).

If you have edema, you will notice that if you press a finger into the swollen area, it will leave an indentation. This is known as pitting. Calcium channel blocker-related edema happens more often in women and the chance of having it increases if you:

  • are older
  • are taking high doses of certain calcium channel blockers
  • spend a relatively long time standing or sitting with your feet hanging down during the day

Your healthcare provider can help the edema decrease by changing your blood pressure medication, lowering the dosage, or adding another medication.  These can include 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 blood circulation.

Another type of edema is called pulmonary edema.  This happens when fluid builds up in the lungs because of high blood pressure. It occurs when long-term high blood pressure weakens your heart’s left ventricle.  (This is normally the strongest part of your heart muscle).  Fluids then back up into the lungs, which makes it difficult to breathe. Your healthcare provider can prescribe treatment to help this.

Vascular Ulcers

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 causes blood to pool in your lower limbs, which stretches tiny blood vessels called capillaries. The weakened capillaries leak fluids into your skin. This eventually causes 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
  • also have obesity and atherosclerosis

These vascular ulcers 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 take care of alone and need careful attention. The best way to make a full recovery is trying to be as active as you can, keeping your leg elevated, and regularly seeing a podiatrist, dermatologist, surgeon, or wound care specialist.

Heart Failure

When high blood pressure is uncontrolled, it can cause changes in your heart that prevent it from pumping blood as well 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 in the heart.  The arteries 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. Follow your healthcare provider’s instructions to prevent this from happening and to stay healthy longer. Control your blood pressure by making lifestyle changes.  These changes can include getting plenty of regular exercise, eating a balanced low-salt diet, losing weight, and reducing stress.  Your healthcare provider may also prescribe medication to lower your blood pressure if needed.

Stroke

Blood pressure usually increases as we get older, especially our systolic blood pressure (the top number in a blood pressure reading). This development is common but dangerous. It is one of the main causes of stroke in older adults. This is why you should follow your healthcare provider’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 medications to lower your blood pressure. 

A stroke is an interruption of the blood flow to the brain. This 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 are serious events. They can cause loss of brain function, the inability to speak, walk, or move parts of your body, or even death. Older people often suffer many tiny silent strokes.  These damage small areas of the brain and can eventually lead to a decline in memory and the ability to think clearly.  It can 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.

Transient Ischemic Attacks (TIAs)

Transient ischemic attacks (TIAs) 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 they 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 vertigo (an abnormal feeling of movement)
  • 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 of the bladder or bowels
  • Loss of coordination and balance, clumsiness, or trouble walking
  • Problems with eyesight, such as 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 and require immediate medical attention.

It does not matter if the symptoms and signs of the TIA have gone away by the time you get to the hospital. A TIA diagnosis can be made based on your medical history. You will be admitted to the hospital so that the healthcare professionals can try to find the cause of the TIA and start treatment.

About one-third of people who have a TIA but are not treated eventually have a stroke.  Half of those strokes happen within a year of the TIA. 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 the hospital, it is important to follow up with your healthcare provider. You will have to manage any risk factors you have in your lifestyle for the rest of your life.  These risk factors can include high blood pressure, heart disease, diabetes, excess alcohol consumption, smoking, and lack of exercise.

Dementia

Dementia is a type of loss of brain function. It can cause memory loss, confusion, mood and personality changes, physical disabilities, and difficulty carrying out normal functions of daily life. There are many reasons why this can happen.  A few causes of dementia are reversible with treatment. Others, like Alzheimer’s dementia, cannot be cured but can be helped. 

If you have high blood pressure, you have an increased chance of developing vascular dementia. Vascular dementia 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
  • hallucinations
  • loss of social skills
  • dizziness and balance problems
  • weakness in arms or legs
  • incontinence
  • difficulty with language and speech

In vascular dementia, your brain suffers damage because of a series of small, often unnoticeable silent strokes. They repeatedly interrupt the flow of blood to your brain. This results in scarring and damage to brain tissue.

Researchers have noticed that people over the age of 65 who have high blood pressure have more scarring in their brains.  The higher their blood pressure, the more scarring is shown. Although there is no cure, the series of strokes can be slowed or stopped by making lifestyle changes and taking medications prescribed by your healthcare provider to reduce blood pressure. 

Kidney Problems

High blood pressure is one of the main causes of end-stage renal (kidney) disease. This is because it creates extra stress on the blood vessels throughout your body.  This can eventually damage your blood vessels. That can result in damage to the kidneys, where they can no longer filter wastes and remove fluids effectively. This kind of kidney failure must be treated either through a medical treatment called 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 be able to tell that you have kidney problems, but your healthcare provider can detect problems by conducting two different tests. One test measures the levels of albumin (a protein in your urine). The other test measures levels of creatinine (a waste product in your body).

After giving you these tests, your healthcare provider can then estimate your glomerular filtration rate (GFR). This test can reveal tissue breakdown in your kidneys.

Kidney problems can be prevented by lifestyle changes and medications that control your blood pressure. If kidney damage is already present, it can be slowed down.

African Americans, Hispanics, and Native Americans are at higher risk of kidney damage and failure than white Americans, even when their blood pressure is only slightly high. Therefore, blood pressure control is even more important in these populations.

Chronic kidney disease may progress slowly for people 85 and older. Therefore, people in this age range should not have blood pressure targets as low as those for younger age groups. 

Disorders of the Heart and Circulatory System

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 provider for regular medical checkups. 

Anxiety

When you are feeling stress and anxiety, they can make your blood pressure go up dramatically. When the emotion subsides, your blood pressure will drop again. Therefore, 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 high blood pressure. 

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. These can include stress reduction techniques or talk therapy or cognitive behavioral therapy with trained counselors or psychologists. You can also try meditation, yoga, or other approaches. There are also anti-anxiety medicines available if needed. Your healthcare provider will help you find the appropriate approach that will be effective for you.

Some medications for anxiety can increase blood pressure. These include mood altering pills, such as SSRIs (selective serotonin reuptake inhibitors, such as sertraline). Your healthcare provider will monitor you for this potential side effect.

 

Last Updated December 2017