![]() ![]() Medications that work well for younger people with hypertension can be dangerous in older patients. And especially as people get older, a stroke can prove much more calamitous than heart disease. "If you can take someone with a systolic blood pressure of 180 and get it down to 150, you knock the tar out of the stroke rate," says Izzo. ![]() Bringing overall blood pressure down may increase the danger of falls.ĭespite the challenges of treating hypertension in older patients, researchers emphasize the importance of controlling high blood pressure. "You can't go any further in those individuals or you may see unwanted consequences of low diastolic blood pressure."ĭoctors also have to be cautious about treating people who are hypertensive but have transient low blood pressure when they stand. Weintraub, associate professor of medicine and director of the Center for the Prevention of Cardiovascular Disease at New York University Langone Medical Center. "Let's say a patient has 160/60," says Dr. In someone with a wide pulse pressure, getting systolic pressure down without driving diastolic pressure too low can become a real balancing act. If that number is already low, medications can prove risky. Drugs that lower systolic blood pressure typically bring down diastolic blood pressure, too. It also poses a tricky challenge for doctors. The widening gap between the upper and lower numbers has been shown to be an independent risk factor for heart disease and stroke. Now we know it's really systolic hypertension that matters in older people."įurther, many older people develop a condition called wide pulse pressure, in which diastolic pressure drops even as systolic pressure climbs. "Up until about 10 years ago, doctors only paid attention to diastolic hypertension. "In a sense, you have almost two forms of hypertension," Logan says. Systolic hypertension occurs when the arteries close to the heart begin to stiffen, making them less responsive to blood flow. Once you hit age 60, though, it's the upper number - the systolic pressure - that can really climb, causing concern. Ideally, the goal is to bring the numbers down close to a normal reading of 120/80. "When people develop high blood pressure in middle age, the problem is typically elevated diastolic pressure, which is indicated by the lower number," says Izzo. High blood pressure in older people is very different from the condition in middle age. This phenomenon, called "non-dipping," becomes more common as people age and has been shown to increase cardiovascular and stroke risk. Ambulatory testing can identify people whose pressure doesn't fall during the night, as it should. In some cases, doctors recommend ambulatory blood pressure testing, using a device that automatically takes readings of blood pressure over a 24-hour period. Sharon Brangman, a professor of medicine at the State University of New York at Buffalo and president of the American Geriatric Society. "Blood pressure changes every second of the day," says Dr. One blood pressure reading, done in a doctor's office, isn't enough to diagnose hypertension. What can you do to ensure that your blood pressure is being treated appropriately? A good place to start is by asking your doctor a direct question: "And when a frail older person falls, it can be devastating." Logan, a hypertension expert at Mount Sinai Hospital in Toronto. "On the wrong dosages of medication, older people are at risk of fainting and falling," says Dr. Others are being undertreated - or overtreated. Some older people are being given blood pressure drugs that may be dangerous for them. ![]() Izzo, professor of medicine at the State University of New York at Buffalo and a leading expert on hypertension. Unfortunately, "many doctors are ill-prepared to treat high blood pressure in older people," says Dr. But as you age, the story those numbers tell about your health can be very different from the one they conveyed when you were a decade or two younger. ![]()
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