High Blood Pressure and Aging

Date:

February 27, 2023

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High Blood Pressure

High blood pressure is a major health problem that is common in older adults. This can be true even for people who have heart-healthy habits and don’t see or feel signs of illness. Since the chance of having high blood pressure increases as you get older, it’s important to visit your doctor regularly to have your blood pressure checked. 

People age 65 and older are much more likely than younger people to suffer a heart attack, to have a stroke, or to develop coronary heart disease (commonly called heart disease) and heart failure. Heart disease is also a major cause of disability, limiting the activity and eroding the quality of life of millions of older people.

High Blood Pressure

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How Your Heart Changes with Age

Aging can cause changes in the heart and blood vessels. For example, as you get older, your heart can’t beat as fast during physical activity or times of stress as it did when you were younger. However, the number of heartbeats per minute (heart rate) at rest does not change significantly with normal aging.

Changes that happen with age may increase a person’s risk of heart disease. A major cause of heart disease is the buildup of fatty deposits in the walls of arteries over many years. The good news is there are things you can do to delay, lower, or possibly avoid or reverse your risk.

The most common aging change is increased stiffness of the large arteries, called arteriosclerosis (ahr-teer-ee-o-skluh-roh-sis), or hardening of the arteries. This causes high blood pressure, or hypertension, which becomes more common as we age.

High blood pressure and other risk factors, including advancing age, increase the risk of developing atherosclerosis (ath-uh-roh-skluh-roh-sis). Because there are several modifiable risk factors for atherosclerosis, it is not necessarily a normal part of aging. Plaque builds up inside the walls of your arteries and, over time, hardens and narrows your arteries, which limits the flow of oxygen-rich blood to your organs and other parts of your body. Oxygen and blood nutrients are supplied to the heart muscle through the coronary arteries. Heart disease develops when plaque builds up in the coronary arteries, reducing blood flow to your heart muscle. Over time, the heart muscle can become weakened and/or damaged, resulting in heart failure. Heart damage can be caused by heart attacks, long-standing hypertension and diabetes, and chronic heavy alcohol use.

Check Your Blood Pressure

As you get older, it’s important for you to have your blood pressure checked regularly, even if you are healthy. This is because aging changes in your arteries can lead to hypertension. You may feel fine but, if not treated, high blood pressure could lead to stroke and problems with your heart, eyes, brain, and kidneys. To manage high blood pressure, exercisedietary changes, and reducing your salt intake can help, but as aging changes in the arteries often cause high blood pressure in older age, medication is often necessary. It is not uncommon to need more than one medication to control your blood pressure.

Age can cause other changes to the heart. For example:

  • There are age-related changes in the electrical system that can lead to arrhythmias—a rapid, slowed, or irregular heartbeat—and/or the need for a pacemaker. Valves—the one-way, door-like parts that open and close to control blood flow between the chambers of your heart—may become thicker and stiffer. Stiffer valves can limit the flow of blood out of the heart and become leaky, both of which can cause fluid to build up in the lungs or in the body (legs, feet, and abdomen).
  • The chambers of your heart may increase in size. The heart wall thickens, so the amount of blood that a chamber can hold may decrease despite the increased overall heart size. The heart may fill more slowly. Long-standing hypertension is the main cause of increased thickness of the heart wall, which can increase the risk of atrial fibrillation, a common heart rhythm problem in older people.
  • With increasing age, people become more sensitive to salt, which may cause an increase in blood pressure and/or ankle or foot swelling (edema).

Other factors, such as thyroid disease or chemotherapy, may also weaken the heart muscle. Things you can’t control, like your family history, might increase your risk of heart disease. But, leading a heart-healthy lifestyle might help you avoid or delay serious illness.

What is blood pressure?

Blood pressure is the force of blood pushing against the walls of arteries as the heart pumps blood. When a health care professional measures your blood pressure, they use a blood pressure cuff around your arm that tightens and then gradually loosens. The results are given in two numbers. The first number, called systolic blood pressure, is the pressure caused by your heart contracting and pushing out blood. The second number, called diastolic blood pressure, is the pressure when your heart relaxes and fills with blood.

A blood pressure reading is given as the systolic blood pressure number over the diastolic blood pressure number. Blood pressure levels are classified based on those two numbers.

  • Low blood pressure, or hypotension, is systolic blood pressure lower than 90 or diastolic blood pressure lower than 60. If you have low blood pressure, you may feel lightheaded, weak, dizzy, or even faint. It can be caused by not getting enough fluids, blood loss, some medical conditions, or medications, including those prescribed for high blood pressure.
  • Normal blood pressure for most adults is defined as a systolic pressure of less than 120 and a diastolic pressure of less than 80.
  • Elevated blood pressure is defined as a systolic pressure between 120 and 129 with a diastolic pressure of less than 80.
  • High blood pressure is defined as systolic pressure of 130 or higher, or a diastolic pressure of 80 or higher.

For older adults, the first number (systolic) is often 130 or higher, but the second number (diastolic) is less than 80. This problem is called isolated systolic hypertension and is due to age-related stiffening of the major arteries. It is the most common form of high blood pressure in older adults and can lead to serious health problems in addition to shortness of breath during light physical activity, lightheadedness upon standing too fast, and falls.

Do I have high blood pressure?

Anyone can have high blood pressure. Some medical conditions, such as metabolic syndrome, kidney disease, and thyroid problems, can cause high blood pressure. Some people have a greater chance of having it because of things they can’t change. These include:

  • Age. The chance of having high blood pressure increases as you get older, especially isolated systolic hypertension.
  • Gender. Before age 55, men have a greater chance of having high blood pressure. Women are more likely to have high blood pressure after menopause.
  • Family history. High blood pressure runs in some families.
  • Race. African Americans are at increased risk for high blood pressure.

High blood pressure often has no signs or symptoms, but routine checks of your blood pressure will help detect increasing levels. If your blood pressure reading is high at two or more check-ups, the doctor may also ask you to measure your blood pressure at home.

Home blood pressure monitoring is not a substitute for medical visits. Home blood pressure monitors might not always be correct. Even if you get readings that are typical for you, don’t stop or change your medications or your diet without talking to your care provider first.  Mayo Clinic

How can I control my blood pressure?

You can often lower your blood pressure by changing your day-to-day habits and by taking medication if needed. Treatment requires ongoing evaluation and discussions with your doctor, especially if you have other medical conditions such as diabetes.

Lifestyle changes you can make to help prevent and lower high blood pressure:

  • Aim for a healthy weight. Being overweight adds to your risk of high blood pressure. Ask your doctor if you need to lose weight. In general, to maintain a healthy weight, you need to burn the same number of calories as you eat and drink.
  • Exercise. Moderate activity, such as brisk walking or swimming, can lower high blood pressure. Set goals so you can exercise safely and work your way up to at least 150 minutes (2.5 hours) per week. Check with your doctor before starting an exercise plan if you have any health problems that aren’t being treated.
  • Eat a heart-healthy diet. A balanced diet of vegetables, fruits, grains, protein, dairy, and oils — such as the Dietary Approaches to Stop Hypertension (DASH) eating plan — can lower your blood pressure.
  • Cut down on salt. As you get older, the body and blood pressure become more sensitive to salt (sodium), which is added to many foods during processing or preparation. Limiting your amount of salt each day may help. DASH is a low-salt diet.
  • Drink less alcohol. Drinking alcohol can affect your blood pressure. For those who drink, men should have no more than two drinks a day and women no more than one a day to lower their risk of high blood pressure.
  • Don’t smoke. Smoking increases your risk for high blood pressure, heart diseasestroke, and other health problems. If you smoke, quit. The health benefits of quitting can be seen at any age — you are never too old to quit.
  • Get a good night’s sleep. Tell your doctor if you’ve been told you snore or sound like you stop breathing for moments when you sleep. This may be a sign of a problem called sleep apnea. Treating sleep apnea and getting a good night’s sleep can help to lower blood pressure.
  • Manage stress. Coping with problems and reducing stress can help lower high blood pressure.

In addition to recommending lifestyle changes, your doctor will likely prescribe medication to lower your blood pressure to a safe level. Isolated systolic hypertension, the most common form of high blood pressure in older adults, is treated in the same way as regular high blood pressure but may require more than one type of blood pressure medication. You may try several kinds or combinations of medications before finding a plan that works best for you. Medication can control your blood pressure, but it can’t cure it. If your doctor starts you on medication for high blood pressure, you may need to take it long term.

Questions to Ask Your Doctor

Ask your doctor questions to learn more about your risk for heart disease and what to do about it. Learn what you can do if you are at increased risk or already have a heart problem.

  1. What is my risk for heart disease?
  2. What is my blood pressure?
  3. What are my cholesterol numbers? (These include total cholesterol, LDL, HDL, and triglycerides.) Make sure your doctor has checked a fasting blood sample to determine your cholesterol levels.
  4. Do I need to lose weight for my health?
  5. What is my blood sugar level, and does it mean that I’m at risk for diabetes?
  6. What other screening tests do I need to tell me if I’m at risk for heart disease and how to lower my risk?
  7. What can you do to help me quit smoking?
  8. How much physical activity do I need to help protect my heart?
  9. What’s a heart-healthy eating plan for me?
  10. How can I tell if I’m having a heart attack? If I think I’m having one, what should I do?

Research shows the benefits of controlling high blood pressure

Preventing and controlling high blood pressure is important for your heart health and may benefit your brain health as well. An NIH-funded study called the Systolic Blood Pressure Intervention Trial (SPRINT) found that lowering systolic blood pressure to less than 120 in adults age 50 and older significantly reduced the risk of cardiovascular disease and death. Results from a related study showed that lowering systolic blood pressure to less than 120 reduced the risk of mild cognitive impairment, and an analysis of several large, long-term studies of adults over age 55 found that treating high blood pressure was associated with a reduction in the risk of developing Alzheimer’s disease.

Tips for taking blood pressure medication

Untreated high blood pressure can increase your risk of serious health problems. If your doctor prescribes medication to lower your blood pressure, remember:

  • If you take blood pressure medication and your blood pressure goes down, it means medication and lifestyle changes are working. If another doctor asks if you have high blood pressure, the answer is, “Yes, but it is being treated.”
  • Healthy lifestyle changes may help lower the dosage you need.
  • Get up slowly from a seated or lying position and stand for a bit before walking. This lets your blood pressure adjust before walking to prevent lightheadedness and falls.
  • Tell your doctor about all the drugs you take. Don’t forget to mention over-the-counter drugs, as well as vitamins and supplements. They may affect your blood pressure. They also can change how well your blood pressure medication works.
  • Blood pressure medication should be taken at the same time each day as part of your daily routine. For example, take it in the morning with breakfast or in the evening before brushing your teeth. Talk to the pharmacist if you have any questions about when or how to take your medication.
  • Remember to refill your medication before you run out and bring it with you when traveling. It’s important to keep taking your medication unless your doctor tells you to stop.
  • Before having surgery, ask your doctor if you should take your blood pressure medication on the day of your operation.

Points to ponder:

  • The chance of having high blood pressure increases as people age.
  • Most people with high blood pressure don’t have signs or symptoms.
  • Serious health problems can develop if high blood pressure is left untreated.

What you can do for the older adults you care for:

  • Get blood pressure checked frequently.
  • Eat a healthy diet and exercise regularly.
  • Ask your doctor if you need medication to manage your blood pressure.

Read about this topic in Spanish. Lea sobre este tema en español.

Sources:This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date. &  National Heart, Lung, and Blood Institute


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