High Blood Pressure in the Elderly

What Is High Blood Pressure?

Blood pressure is the force of blood pushing against the walls of the blood vessels as the heart pumps blood. If your blood pressure rises and stays high over time, it’s called high blood pressure. High blood pressure is dangerous because it makes the heart work too hard, and the high force of the blood flow can harm arteries and organs such as the heart, kidneys, brain, and eyes.

Systolic Pressure and Diastolic Pressure

The pressure of blood against the artery walls when your heart beats is called systolic pressure. The pressure between beats when your heart relaxes is called diastolic pressure.

Blood pressure is always given as two numbers, the systolic and diastolic pressures. Both are important. Usually they are written one above or before the other -- for example, 120/80 mmHg. The top, or first, number is the systolic and the bottom, or second number, is the diastolic. If your blood pressure is 120/80, you say that it is "120 over 80."

Your blood pressure changes throughout the day. It is usually lowest when you're asleep, and it rises when you awaken. It also can rise when you are excited, nervous, or active. So it varies throughout the day.

High Blood Pressure (Hypertension)

A systolic blood pressure of 140 mmHg or higher, or a diastolic blood pressure of 90 mmHg or higher, is considered high blood pressure, or hypertension. Hypertension is the medical term for high blood pressure.

If you have diabetes or chronic kidney disease, your recommended blood pressure levels are a systolic blood pressure of 130 mmHg or lower, and a diastolic blood pressure of 80 mmHg or lower.

High blood pressure currently affects nearly 1 in every 3 American adults.

Usually Has No Symptoms

High blood pressure is often called "the silent killer" because it usually has no symptoms. Occasionally, headaches may occur. Some people may not find out they have high blood pressure until they have trouble with their heart, kidneys, or eyes. When high blood pressure is not diagnosed and treated, it can lead to other life-threatening conditions, including heart attack, heart failure, stroke, and kidney failure. It can also lead to vision changes or blindness.

Possible Effects Over Time

Over time, high blood pressure can cause

your heart to work too hard and become larger or weaker, which can lead to heart failure.
small bulges (aneurysms) to worsen in your blood vessels. Common locations for aneurysms are the aorta, which is the main artery from the heart; the arteries in your brain, legs, and intestines; and the artery leading to your spleen.
blood vessels in your kidneys to narrow, which can cause kidney failure.
blood vessels in your eyes to burst or bleed, which can cause vision changes and can result in blindness.
arteries throughout your body to "harden" faster, especially those in your heart, brain, kidneys, and legs. This can cause a heart attack, stroke, or kidney failure.

Normal Blood Pressure Levels

A blood pressure reading of 120/80 mmHg or less is considered normal. Usually, the lower, the better, although very low blood pressure can sometimes be a cause for concern and should be checked out by your doctor.

Pre-hypertension

If either your systolic or diastolic blood pressure is higher than normal (120/80) but not high enough to be considered high blood pressure (140/90), you have pre-hypertension. Pre-hypertension is a top number between 120 and 139 or a bottom number between 80 and 89 mmHg. For example, blood pressure readings of 138/82, 128/70, or 115/86 are all in the "pre-hypertension" range. (See the chart on the right for more information.)

If you have pre-hypertension, your chances of developing high blood pressure are greater than average unless you take action to prevent it. In fact, having pre-hypertension doubles a woman's chances of having heart disease or a stroke. That's a 100 percent increase. For men, the increase is 45 percent. Talk to your health care provider about lifestyle changes you can make to lower your blood pressure and prevent hypertension.

Isolated Systolic Hypertension

About two out of every three people over the age of 60 who have high blood pressure have isolated systolic hypertension. This means that only the top number, the systolic pressure, is high (140 mmHg or higher). Isolated systolic hypertension can be as harmful as when both numbers are high.

You may have isolated systolic hypertension and feel fine. As with other types of high blood pressure, it often causes no symptoms.

When your systolic and diastolic pressures fall into different categories, the more severe category is used to classify your blood pressure level. For example, 160/80 mmHg is considered stage 2 high blood pressure even though a diastolic pressure of 80 mmHg is in the pre-hypertension range.

Risk Factors

Not a Normal Part of Aging

Nearly 1 in 3 American adults have high blood pressure. Many people get high blood pressure as they get older. In fact, about two thirds of Americans age 60 and older have high blood pressure. However, getting high blood pressure is not a normal part of aging. There are things you can do to help keep your blood pressure normal, such as eating a healthy diet and getting more exercise.

Risk Factors

Anyone can develop high blood pressure. But your chances of getting high blood pressure are higher if you

are overweight or obese
are a man over the age of 45 or a woman over the age of 55
have a family history of high blood pressure
have pre-hypertension, a reading of 120-139/80-89 mmHg.

Other things that increase your chances of developing high blood pressure are

eating too much sodium (salt)
drinking too much alcohol
being physically inactive
smoking
not getting enough potassium in your diet.
having long-lasting stress.

African Americans at Higher Risk

In the U.S., high blood pressure occurs more often in African Americans. Compared to other groups, blacks

tend to get high blood pressure earlier in life
usually have more severe high blood pressure
have a higher death rate from complications related to high blood pressure, such as stroke, heart disease, and kidney failure.

Prevention

Steps You Can Take

You can take steps to prevent high blood pressure by adopting these healthy lifestyle habits.

Maintain a healthy weight, and lose weight if you are overweight or obese.
Be physically active. Get at least 2 and one-half hours of moderate physical activity each week.
Follow a healthy eating plan like DASH (Dietary Approaches to Stop Hypertension), which emphasizes fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts. Also, choose and prepare foods with less sodium (salt).
If you drink alcoholic beverages, do so in moderation. Women should have no more than one drink a day, and men should have no more than two drinks a day.
Quit smoking.
Learn to cope with and manage stress.

Overweight and Obesity

More than 2 out of 3 Americans ages 20-74 are either overweight or obese. Overweight and obesity increase your chances of developing high blood pressure and diabetes, which, in turn, increase your chances of developing heart disease. Blood pressure rises as body weight increases. Losing even 10 pounds can lower blood pressure -- and it has the greatest effect for those who are overweight and already have hypertension.

Talk to your health care provider about lifestyle changes that can lower your blood pressure and prevent hypertension. If you are overweight or obese, work with your health care provider to develop a plan to help you reduce your weight and maintain a healthy weight. Aim to reduce your weight by 7 to 10 percent over six months, which can lower your risk for health problems. For example, if you are overweight at 200 pounds, try to lose 14 to 20 pounds over six months. After that, you may have to continue to lose weight to get to a healthy weight.

Are You Overweight?

How do you know if you’re overweight? Two key measures are used to determine if someone is overweight or obese. These are body mass index, or BMI, and waist circumference.

Body mass index (BMI) is a measure of weight in relation to height, and provides an estimate of your total body fat. It applies to both men and women, but it does have some limits.

It may overestimate body fat in someone who is very muscular or who has swelling from fluid retention (called edema).
It may underestimate body fat in older persons and others who have lost muscle mass.

That’s why waist measurement is often checked as well. Another reason is that too much body fat in the stomach area also increases disease risk. A waist measurement of more than 35 inches in women and more than 40 inches in men is considered high.

Overweight is defined as a BMI of 25 to 29.9; obesity is defined as a BMI greater than or equal to 30. As your BMI goes up, so do your chances of getting high blood pressure, heart disease, and other health problems.

A portion of a body mass index chart is on the right. The full chart is available from NHLBI (National Heart, Lung, and Blood Institute).

If You Need To Lose Weight

If you need to lose weight, it’s important to do so slowly. Lose no more than 1/2 pound to 2 pounds a week. Begin with a goal of losing 10 percent of your current weight. This is the healthiest way to lose weight and offers the best chance of long-term success.

There’s no magic formula for weight loss. You have to eat fewer calories than you use up in daily activities. Just how many calories you burn daily depends on factors such as your body size and how physically active you are.

One pound equals 3,500 calories. So, to lose 1 pound a week, you need to eat 500 calories a day less or burn 500 calories a day more than you usually do. It’s best to work out some combination of both eating less and being more physically active.

And remember to be aware of serving sizes. It’s not only what you eat that adds calories, but also how much. As you lose weight, be sure to follow a healthy eating plan that includes a variety of foods.

Dietary Approaches to Stop Hypertension (DASH)

Following an eating plan that emphasizes fruits, vegetables, fat-free or low-fat milk and milk products, and whole grains, and that is low in saturated fat, cholesterol, and total fat is even more effective when you also reduce your sodium (salt) intake and calories.

One such eating plan is called DASH. DASH stands for Dietary Approaches to Stop Hypertension. This is the name of a study sponsored by the National Institutes of Health that showed that this kind of eating plan can help you prevent and control high blood pressure. The study also showed that combining this kind of eating plan with cutting back on salt in your diet is even more effective at lowering your blood pressure.

To learn more about DASH, see Lowering Your Blood Pressure with DASH.

Lowering Salt Intake

In general, the lower your salt intake, the lower your blood pressure. Older adults should limit their sodium intake to 1,500 milligrams (mg) daily (about 2/3 of a teaspoon of salt). The key to reducing the amount of salt we eat is making wise food choices. Only a small amount of the salt that we eat comes from the salt shaker, and only small amounts occur naturally in food. Most of the salt that we eat comes from processed foods -- for example, canned or processed meat, baked goods, certain cereals, soy sauce, and foods that contain seasoned salts, monosodium glutamate (MSG), and baking soda. Food from fast food restaurants, frozen foods, and canned foods also tend to be higher in sodium.

See tips to reduce salt in your diet.

Read Food Labels

Be sure to read food labels to choose products lower in salt. Look for foods and seasonings that are labeled as low-salt or "no added salt." Look for the sodium content in milligrams and the Percent Daily Value. Aim for foods that are less than 5 percent of the Daily Value of sodium. Foods with 20 percent or more Daily Value of sodium are considered high. You should eat no more than about 1 teaspoon, or 2300 mg, of salt a day.

To learn more about reading nutrition labels, see Reading the Label.

Be Physically Active

Being physically active is one of the most important steps you can take to prevent or control high blood pressure. It also helps reduce your risk of heart disease. Getting at least 2 and one-half hours of moderate exercise, or one hour and 15 minutes of vigorous activity, each week, preferably spread out across the week in at least 10-minute intervals, can help maintain or improve your cardiovascular health.

Most people don’t need to see a doctor before they start a moderate-level physical activity. You should check first with your doctor if you

have heart trouble or have had a heart attack
are over age 50 and are not used to moderate-level physical activity
have a family history of heart disease at an early age, or if you have any other serious health problem.

See examples of exercises for older adults at Exercises to Try.

For more on exercise and physical activity for older adults, visit Go4Life®, the exercise and physical activity campaign from the National Institute on Aging.

If You Drink

If you drink alcoholic beverages, do so in moderation. Drinking too much alcohol can raise your blood pressure. Men should limit their intake to 2 drinks per day, and women should limit their intake to one drink per day.

See how drinking alcohol can affect you as you age.

Frequently Asked Questions

2. Why are older people more sensitive to alcohol's effects than younger people?

One reason that older adults are more sensitive to alcohol's effects is that they metabolize, or break down, alcohol more slowly than younger people. So, alcohol stays in their bodies longer. Also, the amount of water in the body goes down with age. As a result, older adults will have a higher percentage of alcohol in their blood than younger people after drinking the same amount of alcohol.

Watch a video on how to cut back on drinking alcohol.

Don't Smoke

Smoking injures blood vessel walls and speeds up the process of hardening of the arteries. It increases your chances of stroke, heart disease, peripheral arterial disease, and several forms of cancer. If you smoke, quit. If you don't smoke, don't start. Once you quit, your risk of having a heart attack is reduced after the first year. So you have a lot to gain by quitting.

See how to start a smoking quit plan geared to older adults.

Worksheets For Your Quit Plan

Now that you understand how your addiction affects your health and your loved ones, you have probably decided that now is the best time to quit. Creating your own Quit Plan is a good way to proceed. A Quit Plan can help you stay focused and motivated and can improve your chances of quitting for good.

Quit Plan Steps and Worksheets

Below are 8 Quit Plan Steps and 8 Quit Smoking Worksheets. Each worksheet corresponds to a step in the Quit Plan. The worksheets can help you get started and will guide you through the quit process. They will also provide you with a written record of your Quit Plan.

How To Proceed

First, read the list of steps to see what a Quit Plan involves. Also watch the video above, "What's Involved in a Smoking Quit Plan?" Then download and complete the worksheet for the first step, "Pick A Quit Date." Proceed through the rest of the steps of the Quit Plan, using the appropriate worksheets, until you have completed the quit process. Keep your worksheets where you will see them often. Referring to them can help you through the hard times.

You have the option of completing the worksheets online and printing them out when you are done or printing out the worksheets first and then completing them by hand. When you exit a worksheet, you can choose to save the information to your computer or you can exit without saving it. The information you fill in on a worksheet will only be available to you. No other record of the information will be kept.

Symptoms and Diagnosis

High blood pressure is often called the "silent killer" because you can have it for years without knowing it. The only way to find out if you have high blood pressure is to have your blood pressure measured.

How Blood Pressure Is Checked

Most doctors will check your blood pressure several times on different days before making a diagnosis. Only if you have several readings of 140/90 mmHg or higher (or 130/80 mmHg or higher if you have diabetes or chronic kidney disease), will your doctor diagnose you with high blood pressure

Having your blood pressure measured is quick and easy. Your doctor or nurse will use some type of gauge, a stethoscope or electronic sensor, and a blood pressure cuff.

Preparing for the Test

You should be sitting down and relaxed when your blood pressure is taken. There are other things you can do to prepare for the test.

Don't drink coffee or smoke cigarettes for 30 minutes beforehand.
Sit for five minutes with your back supported and your feet flat on the floor. Rest your arm on a table at the level of your heart.
Wear short sleeves so your arm is exposed.
Go to the bathroom prior to the reading. A full bladder can change the reading.

Write Down Your Readings

Ask the doctor or nurse to tell you your blood pressure reading in numbers and to explain what the numbers mean. Write down your numbers or ask the doctor or nurse to write them down for you. (The wallet card on the right can be printed out and used to record your blood pressure numbers.)

Checking Your Own Blood Pressure

You can also check your blood pressure at home with a home blood pressure measurement device or monitor. It is important that the blood pressure cuff fits you properly and that you understand how to use the monitor. A cuff that is too small, for example, can give you a reading that is higher than your actual blood pressure. Your doctor, nurse, or pharmacist can help you check the cuff size and teach you how to use it correctly. You may also ask for their help in choosing the right blood pressure monitor for you. Blood pressure monitors can be bought at discount chain stores and drug stores.

When you are taking your blood pressure at home, sit with your back supported and your feet flat on the floor. Rest your arm on a table at the level of your heart.

After a Diagnosis

If you're diagnosed with high blood pressure, your doctor will prescribe treatment. Your blood pressure will be tested again to see how the treatment affects it.

Once your blood pressure is under control, you'll still need treatment. "Under control" means that your blood pressure numbers are in the normal range. Your doctor will likely recommend routine blood pressure tests. He or she can tell you how often you should be tested.

The sooner you find out about high blood pressure and treat it, the better. Early treatment may help you avoid problems such as heart attack, stroke and kidney failure.

See tips for talking with your doctor after you receive a medical diagnosis.

Frequently Asked Questions

18. What questions should I ask my doctor once I am given a diagnosis?

A diagnosis identifies your disease or physical problem.

The doctor makes a diagnosis based on the symptoms you are experiencing and the results of the physical exam, laboratory work, and other tests.

Understanding your diagnosis, or health problem, can help you make decisions about what you would like to do about it. Also, if you know how the health problem may affect your life and activities and what may happen if the condition gets worse, you may be better prepared to deal with the problem.

Here are some questions you may want to ask your doctor about your health problem.

What is the name of the condition? How do you spell it?
Why do you think I have this health problem? What may have caused it?
How long might this problem last? Will it be permanent?
How will this problem affect me? Will I need to change some of my activities?
Are there long-term effects of this problem?
Can my health problem be cured? How can it be treated or managed, made better?
How can I learn more about my condition?

Treating High Blood Pressure

A Lifelong Focus

If you have high blood pressure, you will need to treat it and control it for life. This means making lifestyle changes, and, in some cases, taking prescribed medicines, and getting ongoing medical care.

In most cases, your goal is probably to keep your blood pressure below 140/90 mmHg (130/80 if you have diabetes or chronic kidney disease). Normal blood pressure is less than 120/80. Ask your doctor what your blood pressure goal should be.

Treatment can help control blood pressure, but it will not cure high blood pressure, even if your blood pressure readings appear normal. If you stop treatment, your blood pressure and risk for related health problems will rise. For a healthy future, follow your treatment plan closely. Work with your health care team for lifelong blood pressure control.

Healthier Habits Can Help

Some people can prevent or control high blood pressure with these healthy lifestyle habits.

Follow a healthy eating plan that includes fruits, vegetables, fat-free and low-fat milk products, whole grains, fish, poultry and nuts. See how the DASH diet (Dietary Approaches to Stop Hypertension) can help with blood pressure control.

Cut down on salt and sodium in the diet. Try not to eat more than 1,500 milligrams of sodium per day, about 2/3 teaspoon of salt. See tips to reduce sodium in your diet.

Lose weight if overweight or obese and stay at a healthy weight. Blood pressure rises as body weight increases, and losing even 10 pounds can lower blood pressure. Body mass index (BMI) and waist circumference are measures used to determine if someone is overweight or obese. See the BMI calculator to determine your body mass index.

Be physically active for at least 2 and one-half hours a week. Regular physical activity is one of the most important steps you can take to prevent or control high blood pressure. It also helps reduce your risk of heart disease. Check out Exercises to Try for older adults, or visit Go4Life®, the exercise and physical activity campaign from the National Institute on Aging.

Limit alcohol intake. Drinking too much alcohol can raise your blood pressure. If you drink and would like to cut back, watch How Can I Cut Back on My Drinking?

Quit smoking or don't start. Smoking can damage your blood vessels and raise your risk for high blood pressure. Smoking also can worsen health problems related to high blood pressure.To get help quitting, call 1(800) QUIT-NOW or check out Quitting Smoking for Older Adults

Learn to cope with stress. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Learn about relaxation techniques that may relieve tension.

If you combine healthy lifestyle habits, you can achieve even better results than taking single steps.

Keep Up Your Healthy Habits

Although some people can control their high blood pressure with lifestyle changes alone, many people can't. Keep in mind that the main goal is blood pressure control. If your doctor prescribes medicines as a part of your treatment plan, keep up your healthy lifestyle habits. They will help you better control your blood pressure.

Common Blood Pressure Medications

Blood pressure medicines work in different ways to lower blood pressure. Some drugs lower blood pressure by removing extra fluid and salt from your body. Others affect blood pressure by slowing down the heartbeat, or by relaxing and widening blood vessels. Often, two or more drugs work better than one.

Here are the types of medicines used to treat high blood pressure.

Diuretics are sometimes called "water pills." They work by helping your kidneys flush excess water and salt from your body. This reduces the amount of fluid in your blood, and your blood pressure goes down. There are different types of diuretics. They are often given with other high blood pressure medicines and may be combined with another medicine in one pill.
Beta blockers cause your heart to beat more slowly and with less force. Your heart pumps less blood through the blood vessels, and your blood pressure goes down.
Angiotensin converting enzyme (ACE) inhibitors keep your body from making a hormone called angiotensin II, which normally causes blood vessels to narrow. ACE inhibitors prevent this narrowing so your blood pressure goes down.
Angiotensin II receptor blockers (ARBS) are blood pressure drugs that protect your blood vessels from angiotensin II. They make the blood vessels relax and become wider, and your blood pressure goes down.
Calcium channel blockers (CCBs) keep calcium from entering the muscle cells of your heart and blood vessels. This causes blood vessels to relax, and your blood pressure goes down.
Vasodilators open blood vessels by directly relaxing the muscle in the vessel walls, causing blood pressure to go down.
Alpha blockers reduce nerve impulses that tighten blood vessels, allowing blood to pass more easily and causing blood pressure to go down.
Alpha-beta blockers reduce nerve impulses to blood vessels the same way alpha blockers do, but they also slow the heartbeat, as beta blockers do. As a result, blood pressure goes down.
Nervous system inhibitors relax blood vessels by controlling nerve impulses from the brain. This causes blood vessels to become wider and blood pressure to go down.

After You Start Medication

Check and record your blood pressure often to see if the medicine is working for you. If your blood pressure continues to measure 140/90 mmHg or higher (130/80 or higher if you have diabetes or chronic kidney disease) after you start taking medicine, your doctor may need to add a second drug or try you on different medicines until you find one that helps you reach your goal.

Don’t stop taking your medicine if your blood pressure is normal. That means the medicine is working.

Be sure to talk with your doctor or health care provider about side effects from your medications, and don't make any changes to your medications without talking with your doctor first.

Remembering to Take Your Medications

It is important that you take your blood pressure medication the same time each day. There are a few tips to make this easier to remember.

Put “sticky” notes in visible places to remind yourself to take your high blood pressure drugs. You can put notes on the refrigerator, on the bathroom mirror, or on the front door.
Place your drugs in a weekly pillbox, available at most pharmacies.
Try to link taking your medication with something else that you do regularly, like brushing your teeth.
Keep your high blood pressure drugs on the nightstand next to your side of the bed.
Try keeping a chart or calendar to write down when you take your drugs. Keep this calendar posted so you can quickly see if you've taken your drugs. Use colored pens to help you keep track of more than one type of medication.
If you have a smartphone, find out about texting services and applications (apps) that can send reminders.
Establish a buddy system with a friend who also is on daily medication and arrange to call each other every day with a reminder to "take your medicine."
Ask one or more of your children or grandchildren to call you every day with a quick reminder. It's a great way to stay in touch and little ones love to help the grown-ups.
If you have a personal computer, program a start-up reminder to take your high blood pressure drugs or sign up with one of the free services that will send you reminder e-mail every day.
Remember to refill your prescription. Each time you pick up a refill, make a note on your calendar to order and pick up the next refill 1 week before the medication is due to run out.