The treatment of high blood pressure has garnered unexpected attention in the past few years. Who would have guessed that the question of how high is too high could become so controversial? Although some guidelines allow for higher blood pressure among older individuals, not all doctors are comfortable with that approach.
There are reasons for that. A Swedish study found that older people whose blood pressure was higher than 140/90 even though they took three medications were more likely to have heart attacks or strokes (Holmqvist et al, Journal of Hypertension, Sep. 27, 2017). In addition to being more likely to die prematurely, they were more likely to develop heart failure than people whose hypertension was more treatable. Still, there are concerns about the consequences of multiple blood pressure drugs.
Are Older People Taking Too Much Blood Pressure Medicine?
Q. I have read that people over 60 don’t need to take blood pressure medicine unless their numbers go over 150/90. It appears that getting pressure below 140/90 can require high doses of blood pressure medicine or multiple medications that may cause side effects.
I myself am in that age category and am taking amlodipine. My knees are swollen and hurt a lot when I walk. I often feel dizzy and tired.
My blood pressure runs about 140/60. How can I stop taking this drug?
A. Guidelines published in JAMA (Feb. 5, 2014) suggest that when blood pressure is below 150/90, drug treatment is not always necessary for those over 60. If your medicine is making it hard to walk or exercise, ask your doctor if you can try other ways to control hypertension. Physical activity has important health benefits, after all.
The SPRINT Study:
These guidelines are controversial, however. A study called SPRINT (Systolic Blood Pressure Intervention Trial) showed that aiming for a systolic blood pressure of 120 rather than 140 led to fewer heart attacks, strokes and cardiovascular deaths (SPRINT Research Group, New England Journal of Medicine, Nov. 26, 2015). People being treated to the lower blood pressure target were more likely to experience dizziness, fainting, electrolyte imbalances and kidney damage.
Further analysis showed that these outcomes applied to high-risk SPRINT participants over 75 years old (Williamson et al, JAMA, June 28, 2016). Despite this, a thorough unbiased evaluation concluded that there’s not enough evidence to tell whether lower blood pressure is truly better for older people (Garrison et al, Cochrane Database of Systematic Reviews, Aug. 8, 2017). That leaves considerable latitude for patients and their physicians to determine what is best.
Non-Drug Approaches to Controlling Blood Pressure
Even though your blood pressure is currently below the specified range, deciding whether you can get off your blood pressure medicine should be a joint effort between you and your physician. To help with that discussion, we are sending you our Guide to Blood Pressure Treatment with many non-drug approaches. You may want to find a balance with exercise, deep slow breathing, a diet high in vegetables and low-fat dairy products and low in meat (a DASH diet) or adding some “extras” to your daily intake, such as beets, dark chocolate or pomegranate.
Doctors are encouraged to get blood pressure down to 120/80 even for elderly patients if it can be achieved “without undue burden” (Hansell, Mann & Kirk, Journal of Family Practice, Sep. 2017). The same precaution against undue burden should hold for lowering blood pressure naturally. If you have tried a non-drug approach for high blood pressure, let us know what you did and how it worked in the comment section below.
Revised 10/5/17
