Understanding High Blood Pressure in the Elderly

Introduction

Among the most common concerns in the elderly are diabetes and high blood pressure, also known as hypertension. 

Blood pressure is the force exerted by circulating blood on the walls of the arteries. It is measured using two values: the systolic pressure, which is the pressure when the heart contracts and pumps blood and the diastolic pressure, which is the pressure when the heart is resting between beats. Naturally, the diastolic pressure is lower than the systolic pressure. 

In addition to diabetes and hypertension, other chronic conditions such as cardiovascular disease, osteoarthritis, and cognitive decline frequently affect older adults, highlighting the importance of regular health monitoring and management during this stage of life¹. 

What Blood Pressure Reading is Considered High?

For an average adult, the ideal blood pressure reading is around 120/80 mmHg. According to the current guidelines from the American College of Cardiology and American Heart Association (ACC/AHA), a normal blood pressure is defined as less than 120/80 mmHg². 

Previously, the term “prehypertension” was used to describe readings between 121-139 systolic and 80-89 diastolic. However, this term is now outdated. The 2017 ACC/AHA guidelines reclassify blood pressure levels as follows²:  

• Elevated Blood Pressure: Systolic between 120–129 mmHg and diastolic less than 80 mmHg 
• Stage 1 Hypertension: Systolic between 130–139 mmHg or diastolic between 80–89 mmHg 

Blood pressure readings of 140/90 mmHg or higher are considered high blood pressure, or hypertension. 

In older adults, a slightly higher blood pressure range of 140–150 systolic and 90–96 diastolic may be acceptable. This is because blood vessels tend to stiffen with age, making a moderately elevated blood pressure necessary to ensure adequate blood flow to vital organs such as the heart and brain². 

It is important to note that permissive hypertension in seniors, particularly those over 60 or 80 years old, depends on factors such as frailty, risk of falls, existing health conditions, and personalised treatment goals. 

The Risk of High Blood Pressure

High blood pressure can be a serious and potentially fatal condition, as it may damage vital organs such as the brain, heart, and kidneys. Many individuals remain unaware they have high blood pressure until significant complications arise, which is why hypertension is often referred to as the “silent killer³.” 

One of the dangers of untreated high blood pressure is its impact on the eyes. Rather than the optic nerve “bursting,” severe or long-standing hypertension can cause damage to the retina, a condition known as hypertensive retinopathy. In extreme cases, swelling of the optic nerve head (papilledema) or blockage of retinal blood vessels can occur, leading to visual disturbances or even blindness. 

High blood pressure also places strain on the cardiovascular system and kidneys. It can contribute to the development of aneurysms (localised arterial bulges) but these are not the usual cause of kidney or heart failure. Instead, sustained hypertension can damage blood vessels and organs over time, increasing the risk of stroke, heart attack, kidney failure, and other serious complications⁴. 

What Are the Causes of High Blood Pressure in Older Adults?

Hypertension in seniors can result from a variety of factors. These include being overweight, side effects of certain medications, genetic predisposition, elevated blood pressure or early-stage hypertension, diabetes, a sedentary lifestyle, and stress. However, in many cases, the exact cause of high blood pressure remains unknown.  

An important related concern is low blood pressure, known as hypotension, which also requires medical attention. Common symptoms such as blurred vision, confusion, dizziness, and fainting are often overlooked but can lead to serious complications if left untreated. 

Additionally, a key age-related factor in hypertension among the elderly is arterial stiffness, or loss of vascular compliance. As blood vessels become less elastic with age, it contributes significantly to elevated blood pressure in this population⁵. 

Managing High Blood Pressure in Older Adults

Adopting a healthier lifestyle can have a positive impact on blood pressure levels. The following measures are generally recommended^6,7: 

• A low-sodium diet 
• Eating fruits, vegetables, and low-fat dairy products 
• Maintaining the ideal weight 
• Exercising daily 
• Quitting cigarettes and limiting alcohol intake 
• Manage fluid intake carefully: A general recommendation is around 2 litres of water per day; however, this may not be suitable for everyone. In some cases, such as with heart or kidney conditions, fluid intake may need to be restricted. Always follow your doctor’s advice. 
• Practices like yoga, meditation, or breathing exercises can help promote relaxation and emotional well-being. 

While lifestyle changes play an essential role, they may not be sufficient on their own, especially for those with more advanced stages of hypertension. In many cases, medication is necessary and may need to be continued long term, as advised by a healthcare professional. 

To ensure treatment is effective: 

• Take your medication exactly as prescribed. 
• Avoid skipping doses. 
• Do not alter the dosage without consulting your doctor. 

Skipping medication or making changes without medical advice can lead to poor blood pressure control and increase the risk of complications. 

Also Read: What Causes Low Creatinine

Conclusion

High blood pressure is a manageable condition, especially when identified early and treated appropriately. Regular monitoring, adherence to prescribed treatment, and a healthy lifestyle can significantly reduce the risk of complications. Speak to a qualified healthcare provider for personalised advice and ongoing care. 

References

1. Currie G, Delles C. Blood pressure targets in the elderly. Journal of Hypertension [Internet]. 2018 Feb [cited 2025 Jun 27];36(2):234–6. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5884414/  
2. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 acc/aha/aapa/abc/acpm/ags/apha/ash/aspc/nma/pcna guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the american college of cardiology/american heart association task force on clinical practice guidelines. Hypertension [Internet]. 2018 [cited 2025 Jun 27];71(6). Available from: https://www.ahajournals.org/doi/10.1161/HYP.0000000000000065  
3. Jin Hee Kim, Rekha Thiruvengadam. Hypertension in an Ageing Population: Diagnosis, Mechanisms, Collateral Health Risks, Treatments, and Clinical Challenges. Ageing research reviews [Internet]. 2024 May 1 [cited 2025 Jun 27];102344–4. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1568163724001624  
4. Oliveros E, Patel H, Kyung S, Fugar S, Goldberg A, Madan N, et al. Hypertension in older adults: Assessment, management, and challenges. Clinical Cardiology [Internet]. 2020 [cited 2025 Jun 27];43(2):99–107. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021657/  
5. Aronow WS. Managing Hypertension in the elderly: What’s new? American Journal of Preventive Cardiology [Internet]. 2020 Mar [cited 2025 Jun 27];1:100001. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8315374/ 
6. Filippou CD, Tsioufis CP, Thomopoulos CG, Mihas CC, Dimitriadis KS, Sotiropoulou LI, et al. Dietary Approaches to Stop Hypertension (DASH) Diet and Blood Pressure Reduction in Adults with and without Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Advances in Nutrition [Internet]. 2020 [cited 2025 Jun 27];11(5):1150–60. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7490167/ 
7. Ojangba T, Boamah S, Miao Y, Guo X, Fen Y, Agboyibor C, et al. Comprehensive effects of lifestyle reform, adherence, and related factors on hypertension control: A review. The Journal of Clinical Hypertension [Internet]. 2023 May 9 [cited 2025 Jun 27];25(6):509–20. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10246465/ 

Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.

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