Treating high blood pressure in older adults
Older adults often have isolated systolic high blood pressure and normal diastolic blood pressure (isolated systolic hypertension, or ISH). In isolated systolic hypertension, systolic blood pressure is elevated (above 140 mm Hg), but diastolic blood pressure stays lower than 90 mm Hg. This type of high blood pressure is more common in older adults, especially older women. In fact, the majority of people older than 60 who have high blood pressure have isolated systolic high blood pressure.1
ISH should be treated because it can cause damage to organs such as the brain, kidneys, heart, or eyes. A major study (SHEP) determined that treatment resulted in a 27% decrease in heart disease, a 36% decrease in stroke, and decreased the development of heart failure.1 However, older people are more prone to the low blood pressure (hypotensive) side effects—such as lightheadedness or slow heartbeat—of some medicines used to treat high blood pressure. Therefore, isolated systolic high blood pressure should be treated without excessively lowering diastolic blood pressure.2
How much to lower blood pressure is an issue for older people who also have heart disease. A sudden, large drop in blood pressure may reduce blood flow to the heart and brain. Therefore, reducing blood pressure gradually and modifying treatment if symptoms occur is often the best approach, especially in people with valvular heart disease.
A diastolic blood pressure of 85 to 89 mm Hg may be high enough to avoid side effects such as lightheadedness and low enough to protect against many of the complications of high blood pressure, but it's not optimal, even in older adults. Systolic pressure usually can be reduced by 10% without many of the other problems caused by reduced blood flow to the heart.
Treatment of ISH often begins with the use of a diuretic, which seems to be effective in older people. Other medicines that may be used include long-acting calcium channel blockers, beta-blockers, or angiotensin-converting enzyme (ACE) inhibitors. Some experts recommend that older adults not take a beta-blocker medicine. Beta-blockers generally are not needed in older adults who don't have any complications associated with high blood pressure, such as heart disease.
| Author: | Robin Parks, MS | Last Updated: April 24, 2007 |
| Medical Review: | Caroline S. Rhoads, MD - Internal Medicine Robert A. Kloner, MD, PhD - Cardiology Ruth Schneider, MPH, RD - Diet and Nutrition | |
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