Wednesday, November 22, 2023

Target Blood Pressure By Age

Healthy And Unhealthy Blood Pressure Ranges

Blood pressure as we age: What is a healthy target?

Learn whats considered normal, as recommended by the American Heart Association.

Blood Pressure Chart


Note: A diagnosis of high blood pressure must be confirmed with a medical professional. A doctor should also evaluate any unusually low blood pressure readings.

The five blood pressure ranges as recognized by the American Heart Association are:

Why The Guidelines Were Updated

The updated guidelines are partly based on a landmark study called the SPRINT . This trial was conducted between 2010 and 2013, involving 9361 patients from 102 different locations throughout the United States.

All participants were diagnosed with hypertension and had systolic blood pressure between 150 mm Hg and 180 mm Hg at the start of the study.

The study volunteers were divided into two groups: one group with a target systolic pressure of 140 mm Hg and another group with a target systolic pressure of 120 mm Hg The initial plan was to monitor the participants approximately every three months for five years.

However, the intensive treatment group did so much better than the standard treatment group that investigators ended the study after a little over three years instead of completing the five-year project.

The standard treatment group had a 43% higher rate of death than the intensive treatment group. The intensive blood pressure control with the goal of systolic blood pressure below 120 mm Hg resulted in fewer deaths from stroke, heart disease, and other medical causes.

In addition to SPRINT, the updated AHA/ACC guidelines were also based on a three-year comprehensive review of hundreds of research studies pertaining to blood pressure.

What Does A Blood Pressure Reading Look Like

When you have your , you will be given two numbers, a top number and a bottom number.

  • Systolic blood pressure. This is the first, or top, number. This is the highest level your blood pressure reaches when your heart beats, forcing blood around your body.
  • Diastolic blood pressure. The second number, or bottom number, is the lowest level your blood pressure reaches as your heart relaxes between beats.

Blood pressure is measured in millimetres of mercury . If the first number is 120 and the second number is 80, this would be written as 120/80mmHg, and youd call it 120 over 80.

This video explains more about systolic and diastolic blood pressure.

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Controlling Your Blood Pressure

An alarming one in three American adults has high blood pressure. Known medically as hypertension, many people don’t even know they have it, because high blood pressure has no symptoms or warning signs. But when elevated blood pressure is accompanied by abnormal cholesterol and blood sugar levels, the damage to your arteries, kidneys, and heart accelerates exponentially. Fortunately, high blood pressure is easy to detect and treat. In the Special Health Report, Controlling Your Blood Pressure, find out how to keep blood pressure in a healthy range simply by making lifestyle changes, such as losing weight, increasing activity, and eating more healthfully.

The Blood Pressure Chart

Image result for resting heart rate chart

Once you know your numbers, you can use the blood pressure chart to see what they mean and if your blood pressure is in the healthy range. The chart is suitable for adults of any age, as the cut-off point for diagnosing high blood pressure doesnt change with age.

How to use the blood pressure chart

Simply find your top number on the left side of the chart and your bottom number on the bottom. Where the two lines meet is your blood pressure.

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The Target Of Blood Pressure Control According To The Published Guidelines

Due to the complexity of BP management in the elderly, several medical committees have released their specific guidelines on when to initiate pharmacotherapy and the best goal of BP management in elderly patients. Depending on the evolving evidence over the last few years, different targets have been suggested. Table 2 summarizes the various guidelines and the level of their evidences.

When To Call Your Doctor

The risks of both high and low blood pressure make monitoring your blood pressure at home essential to your overall health and well-being. Both Dr. Wong and Dr. Desai recommend calling your healthcare provider if your self-monitored blood pressure readings are greater than 180/120 mmHgeven if you have no other symptoms.

You should call 911 if these blood pressure readings are associated with symptoms of organ damage, such as headache, vision changes, weakness, numbness, chest pain or shortness of breath, says Dr. Wong.

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What The New Blood Pressure Guidelines Mean For Caregivers

Free Cheatsheet only publishes articles that wont be published elsewhere on the web, so I cant post the whole thing here. But here are the highlights related to the December 2013 BP guidelines:

  • A higher target BP for adults aged 60 or older. The recommended goal BP is now less than 150/90, instead of less than 140/90 .
  • A higher target BP for people with diabetes and/or kidney disease. The recommended goal BP is now less than 140/90, instead of less than 130/80.

What does this mean for you, if youre caring for aging parents or other older persons? It means you should check on how their BP has been doing.

If its been much lower than the numbers above, you should consider discussing the BP medications with your parents doctor. This is especially important if youve had any concerns about falls or balance. For specific recommendations on how to make sure your older loved one isnt getting too much blood pressure medication, read my full article at I also offer tips on checking BP in this post: Why I Love Home Blood Pressure Monitors.

Last but not least, I provide more guidance on figuring out hypertension treatment here: 6 Steps to Better High Blood Pressure Treatment for Older Adults.

Free Cheatsheet

Related Articles:New Blood Pressure Study: What to Know About SPRINT-Senior & Other Research

What Causes Low Blood Pressure

Intensive Blood Pressure Control in Adults Aged 75 Years or Older

There are many possible reasons for low blood pressure, according to both Dr. Wong and Dr. Desai, including:

  • Heart problems like heart failure or low heart rates
  • Endocrine problems, such as parathyroid disease, adrenal insufficiency or hypoglycemia
  • Side effects of medications for high blood pressure, prostatic hypertrophy, Parkinsons disease, depression and erectile dysfunction
  • Massive weight loss
  • Rapid heart rate

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Why The Hypertension Management In The Elderly Is Special

For many years, HTN was considered a physiological response of aging related to degeneration of elastic fibers and deposition of calcium and collagen in the arterial walls. However, various studies have shown that HTN is not a benign finding in elderly patients but can be a strong independent risk factor of morbidity and mortality of cardiovascular diseases. Besides, many clinical trials have proven that appropriate management of HTN reduces the risk for cardiovascular diseases, cerebrovascular diseases, and death.

That being said, the strict control of BP in geriatric population raises valid concerns of increasing the risk of hypotension, especially in those older than 80 years. Interestingly, it is estimated that more than half of octogenarian and nonagenarian patients are at risk of having masked hypotension which means they may develop hypotension at home even if they have normal BP in the office visit. This risk was especially reported in those with diabetes, coronary heart disease, or who are on many antihypertensive medications. Due to frailty, hypotension in the elderly can associate with a higher risk of falls, leading to serious fractures and immobility. Moreover, several studies have shown that hypotension due to antihypertensive agents can result in frequent incidences of stroke and acute renal failure, besides an increase in all-cause and cardiovascular mortalities.

Sprint Results Do Not Apply To Very Frail Sick Patients

For older patients with hypertension, a high burden of comorbidity, and a limited life expectancy, the 2017 guidelines defer treatment decisions to clinical judgment and patient preference.

There have been no randomized trials of blood pressure management for older adults with substantial comorbidities or dementia. The âfrailâ older adults in the SPRINT trial were still living in the community, without dementia. The intensively treated frail older adults had more serious adverse events than with standard treatment. Those who were documented as being unable to walk at the time of enrollment also had more serious adverse events. Institutionalized older adults and nonambulatory adults in the community would likely have even higher rates of serious adverse events with intensive treatment than the SPRINT patients, and there is concern for excessive adverse effects from intensive blood pressure control in more debilitated older patients.

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Using The Sprint Study For New Guidelines

The studys findings come from a randomized trial of 1,167 participants.

Researchers gathered information from the Systolic Blood Pressure Intervention Trial . They included data from individuals who had experienced strokes, heart attacks, changes in kidney function, cognitive impairment, quality of life reduction, or who had died.

About 27% of them had a history of heart disease. The majority had three or more chronic health conditions.

The mean age of the participants was 84, with about 3% older than 90. More than half of those included were regularly taking five or more medications.

The average baseline systolic blood pressure of the participants was approximately 142 mmHg. The researchers randomly divided the participants into two equal groups, with one group receiving assistance in getting their systolic readings below 140 mmHg.

The researchers sought to determine if a more aggressive control of high blood pressure would benefit peoples health, lower their risk of heart disease events, cognitive decline, or death, or increase health risks in any way.

The scientists were also interested in seeing if cognitive or physical impairments would affect the benefits of any lower systolic measurement.

To these ends, the second group received what researchers considered intensive treatment to bring their systolic reading down below 120 mmHg.

The development of dementia was about the same in both groups.

What Is Systolic Blood Pressure

Pin on Resting and Target Heart Rate Chart

Systolic blood pressure measures how much pressure your blood exerts against your artery walls. The pressure within our arteries changes with every heartbeat, says Ian Del Conde Pozzi, M.D., a cardiologist and vascular medicine specialist at the Miami Cardiac & Vascular Institute. When the heart contracts, it pumps extra blood into the circulatory system, increasing the pressure. That increase is measured by systolic blood pressure.

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What Do The Readings Mean

As a general guide:

140/90mmHg or over you may have high blood pressureMost doctors use 140/90mmHg as the cut off for point for diagnosing . This is the point where your risk of serious health problems goes up. They might prescribe and advise you to make changes to your to bring your blood pressure down. 120/80mmHg up to 140/90mmHg pre-high blood pressureAlso called high-normal blood pressure. This is not high blood pressure, but it is a little higher than it should be and means you could go on to develop high blood pressure. See how you can make to lower it. 90/60mmHg up to 120/80mmHg ideal blood pressureAlso called normal blood pressure. Your blood pressure reading is healthy. At this level you have a much lower risk of heart disease and stroke. Following a will help you to keep it in the healthy range. 90/60mmHg or lower you may have low blood pressure usually isnt a problem, but it can sometimes make you feel faint or dizzy or could be a sign of another health problem.

The video below explains how your blood pressure numbers are linked to the risk of stroke and other disease.

What Is The Threshold To Safely Control Blood Pressure In The Elderly

The safety of BP control is the other very important component of HTN management in the elderly particularly since several early population-based studies suggested that lowering BP in older patients may associate with worsening mortality.

Although safety was not one of the endpoint outcomes of the HYVET study, the results revealed no difference between the placebo and the active-treatment group regarding the changes in electrolytes and kidney function after 2 years of follow-up. Besides, the reported serious adverse events were comparable in the two groups.

The VALISH trial found that BP of < 140 mmHg can be safely achieved in healthy patients older than 70 years old. The rates of adverse events such as renal failure, gastrointestinal symptoms, or respiratory symptoms were similar in the two groups. This was also correct for more serious adverse events which were reported equally regardless of BP control strategy.

Wei et al. showed comparable rates of femoral fractures and vascular dementia in older patients regardless of whether they were treated to achieve BP < 140/90 or BP < 150/90. Similarly, the risk of fragility fractures was the same for different SBP targets in the cohort study conducted by Delgado et al. However, in this study, there was a high mortality in those with SBP < 135 mmHg and more heart failure when SBP was < 125 mmHg. Yet, interpreting these observational findings is somehow challenging since hypotension can be a direct result of heart failure.

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What Are Common Symptoms Of Hypertension

Hypertension is called a “silent killer”. Most people with hypertension are unaware of the problem because it may have no warning signs or symptoms. For this reason, it is essential that blood pressure is measured regularly.

When symptoms do occur, they can include early morning headaches, nosebleeds, irregular heart rhythms, vision changes, and buzzing in the ears. Severe hypertension can cause fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors.

The only way to detect hypertension is to have a health professional measure blood pressure. Having blood pressure measured is quick and painless. Although individuals can measure their own blood pressure using automated devices, an evaluation by a health professional is important for assessment of risk and associated conditions.

What You Should Know About Fluctuating Blood Pressure In The Elderly

What Is A Normal Blood Pressure By Age?

As you help monitor your loved ones blood pressure, keep in mind that if numbers fluctuate slightly throughout the day, thats normal. Several factors influence your blood pressure numbers. For example, your blood pressure may be lower if youre resting and higher if youre stressed. This means you may have a normal reading in the morning and an elevated number in the afternoon.

If youre concerned about excessive fluctuation in your loved ones blood pressure numbers, keep the following tips in mind:

  • Read the instructions to ensure youre using your home blood pressure monitor equipment correctly. Variations in how you measure your loved ones blood pressure can result in different readings.
  • Bring your home monitor to your next doctors appointment to compare readings.
  • Be aware of white coat hypertension. In some cases, a persons blood pressure may be high at a doctors office but normal at home. This could be attributed to the stress related to a doctors appointment.

Your loved ones doctor may want you to keep a blood pressure diary with several readings a day for a couple of weeks to monitor any variations.

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What Is Normal Blood Pressure

A normal blood pressure reading indicates that the heart and blood vessels are not working too hard pushing blood and that the blood is not exerting too much pressure on the walls of the vessels, says Aseem Desai, M.D., a cardiologist at Providence Mission Hospital in Southern California. Recent data from the American Heart Association suggests the optimal normal reading for adults over 20 is lower than 120/80 mmHgVirani S, et al. Heart disease and stroke statistics – 2021 update . American Heart Association Journal. 2021 143:e254-e743. .

Dr. Desai notes blood pressure can vary depending on a persons age, gender, race and ethnicity, but it should still fall within the general normal range. While numbers lower than 120/80 are generally considered normal, Dr. Desai adds, The target blood pressure for treatment varies depending on age and associated co-morbidities .

What Is Blood Pressure

Blood pressure is the force of blood pushing against the walls of arteries.

Blood pressure is measured with two numbers.

  • The systolic blood pressure is the pressure caused when the heart contracts and pushes out the blood
  • The diastolic blood pressure is the pressure when the heart relaxes and fills with blood between heartbeats

Blood pressure readings are reported as the systolic blood pressure number over the diastolic blood pressure number, such as 120/80 mmHg .

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What Did The Sprint Intervention Involve

SPRINT participants were randomly assigned to be treated to a systolic BP goal of either 140, or 120.

Participants were seen once a month for the first three months, and then every 3 months after that.

To treat blood pressure, SPRINT provided all the major classes of BP medication for free, and also allowed clinicians to use other BP medications if they saw fit. Here are the main classes of medication used Ive organized them roughly by how commonly they were used .

Blood Pressure Medications Used in SPRINT:

Those last three classes of BP medication were used in 10% of people or less, which makes sense as none of them are recommended as first-line medication choices for hypertension, heart conditions, or kidney disease.

What about non-drug methods to manage high blood pressure?

In the scholarly publication, the SPRINT investigators say that Lifestyle modification was encouraged as part of the management strategy, but they dont provide more specifics on what modifications were encouraged or how. So its hard to know how any non-drug methods diet, exercise, salt reduction, stress reduction might have factored into this study.

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