High Blood Pressure and the Elderly

As we get older, we are often called to manage things that we weren't even aware of in our youth. Those salty snacks we loved as kids, for example, might become a "frenemy" in our older years. This change primarily stems from health conditions that become more common as we age. A prime example of this is high blood pressure, commonly referred to as hypertension, which constitutes a major health concern for 75% of older adults aged 60 and older.

Characterized by the chronic elevation in blood pressure levels, it remains a leading risk factor for heart disease and stroke - two major causes of death globally. And while high blood pressure can be dangerous, we are lucky in that today's science gives us great ways to measure - and manage - the condition.

Blood pressure is typically recorded as two numbers and is expressed in terms of millimeters of mercury (mm Hg).

• Systolic blood pressure: The first, or top number, is referred to as systolic blood pressure. This number indicates the pressure in your arteries when your heart beats. A normal systolic level is less than 120 mm Hg.
• Diastolic blood pressure: The second, or bottom number, known as diastolic blood pressure, represents the pressure in your arteries when your heart rests between beats. A normal diastolic level is less than 80 mm Hg.

High blood pressure, clinically known as hypertension, is a condition where either or both of these numbers are chronically elevated. Hypertension is divided into two types: primary (or essential) hypertension which has no identifiable cause and is often linked with aging, and secondary hypertension which is caused by an underlying condition. 

The normal blood pressure for older adults (aged 60+) is as follows:

Depending on the readings, blood pressure falls into one of four primary categories. These blood pressure guidelines give insights about an individual's cardiovascular health and potential risks. It's important to note that in 2017, the American Heart Association developed new blood pressure guidelines, which lowered the threshold for the hypertension stage to 130 mm Hg or higher. This means that more Americans are now classified as having Stage 2 hypertension.

• Low: A low blood pressure reading means the systolic pressure is less than 90 millimeters of mercury (mm Hg) or diastolic less than 60 mm Hg. However, doctors consider chronically low blood pressure problematic only if it causes noticeable signs and symptoms.
• Normal: A normal blood pressure reading is characterized by a systolic value high of less than 120 mm Hg and a diastolic reading less than 80 mm Hg. At this stage, individuals should maintain or adopt a healthy lifestyle to sustain normal blood pressure.
• Elevated: Elevated blood pressure is when systolic measurements consistently range from 120 to 129 mm Hg, and the diastolic reading is less than 80 mm Hg. People in this stage need to make lifestyle changes to lower their readings and avoid progressing into hypertension.
• Stage 1 hypertension: This stage is characterized by systolic blood pressure readings between 130-139 mm Hg or diastolic values between 80-89 mm Hg. At this point, doctors are likely to prescribe lifestyle modifications and may consider adding blood pressure medication based on the risk of atherosclerotic cardiovascular disease (ASCVD).
• Stage 2 hypertension: This is a serious form of high blood pressure, with systolic readings of 140 mm Hg or higher, or diastolic values of 90 mm Hg or higher. At this stage, doctors are likely to prescribe a combination of blood pressure medications along with significant lifestyle changes.
• Hypertensive crisis: This is the most dangerous and can occur suddenly when systolic rates are 180 mm Hg or higher and/or diastolic rates are 120 mm Hg or higher. Blood pressure in these levels constitutes an emergency, as it can lead to damage to organs like the brain, heart, and other organs.

So first things first; what actually causes elevated blood pressure? Turns out, there are quite a few risk factors that could drive up our readings. It's fairly likely that your last visit with your doctor covered at least a few of these, but here's a list of factors:

• Unhealthy diet: Diets high in sodium, trans fats, and cholesterol can increase blood pressure levels. Consuming too much salt, in particular, could raise your blood pressure by causing your body to retain fluid which puts pressure on your blood vessels.
• Lack of physical activity: As much as we might resist it, regular physical activity makes the heart stronger, which means it can pump more blood with less effort. The more physically fit you are, the less pressure on your arteries, which leads to more normal blood pressure.
• Excessive alcohol consumption: While many of us enjoy a glass or wine (or two) in the evening, drinking alcohol excessively can significantly increase blood pressure, not to mention damage the heart.
• Obesity: Obesity is a major contributor to high blood pressure. Weight gain increases the strain on the heart, meaning it's harder for the heart to circulate blood, leading to elevated blood pressure.
• Smoking: It's widely known that tobacco products contain chemicals that damage blood vessels, narrowing the arteries and causing high blood pressure. Not to mention that the nicotine in tobacco raises blood pressure temporarily after each use.
• Marijuana: While more research is needed, some studies suggest that regular smoking of marijuana or vaping (as opposed to other avenues of ingestion) can increase their risk of heart disease and stroke from the toxic effects of other inhaled substances. 
• Stress: While chronic stress is bad all around, it can also increase blood pressure. Stress may lead to behaviors such as unhealthy eating, excessive alcohol use, and lack of exercise, all of which can contribute to hypertension. It is also thought that hormones, such as cortisol, produced during the body's stress response increase blood pressure.
• Age and genetics: For better or for worse, this factor is one over which we have little control. Both natural physiological changes that come with aging and certain genetic predispositions can make an individual more susceptible to high blood pressure. As people age, their blood vessels gradually lose some of their elastic quality, which can contribute to increased blood pressure.
• Existing medical conditions: Certain chronic conditions like kidney disease, diabetes, and hormonal disorders can all increase the risk of high blood pressure. These conditions can alter the way your body manages fluids and salts, thus leading to raised blood pressure.
• Medications: Some medicines, like over-the-counter pain relievers, cold medicines, birth control pills, steroids, and antidepressants can cause or worsen high blood pressure. This happens because some medicines may restrict blood vessels, causing the body to retain more sodium and fluid, or by increasing the heart rate.
• Menopause: Menopause is associated with hormonal changes, which can can contribute to an increase in blood pressure in some women. Estrogen is believed to have protective effects on the heart and blood vessels and as estrogen levels taper during menopause, this can lead to a tightening of blood vessels, causing blood pressure to rise.
• Sleep apnea: Interrupted breathing during sleep can cause changes in blood pressure and contribute to an elevated blood pressure. It's believed that the drops in oxygen levels that occur during periods of apnea can lead to chemical changes that increase blood pressure.

New research on causes of high blood pressure

Additionally, there is some new research on high blood pressure which suggests that the following influences may impact your readings:

• COVID-19: A study found that people who had COVID-19 were more likely to develop high blood pressure in the following months. The researchers believe that the virus may damage the heart and blood vessels, or trigger inflammation, which can lead to high blood pressure.
• Exposure to air pollution: New research found that people who were exposed to higher levels of air pollution were more likely to have high blood pressure. The researchers believe that air pollution may damage the blood vessels or cause inflammation, which can lead to high blood pressure.

While managing high blood pressure can be a challenge, it is possible for most people to lower their blood pressure by making  serious lifestyle changes. Some of the most common recommendations are:

• Adopt a healthy diet: Eating a diet that is rich in whole grains, fruits, vegetables, and low-fat dairy products can lower your blood pressure. The Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets are great examples of ideal diets that can help improve your blood pressure. Limiting sodium intake in your diet can also help.
• Exercise regularly: Engaging in regular physical activity for at least 30 minutes most days of the week, can lower your blood pressure. It can be simple activities like walking, cycling, swimming, or even gardening; the key is consistency.
• Maintain a healthy weight: Blood pressure often increases as weight increases. If you're overweight, losing even a small amount of weight can help reduce your blood pressure.
• Limit alcohol: Alcohol can raise your blood pressure and should be limited to moderate levels.
• Avoid tobacco: void tobacco, including second-hand smoke.
• Manage stress: Chronic stress can contribute to high blood pressure. Identifying what causes stress for you and learning ways to manage it can assist in maintaining healthy blood pressure. Whether your fix is meditation, deep breathing, yoga, socializing with friends, or something else - just find the thing that works for you and stick with it.
• Monitor your blood pressure: Regularly monitoring your blood pressure at home with a home blood pressure monitor can help you keep tabs on it, ensuring that your lifestyle changes are working. Regular check-ups with your doctor are also important.When lifestyle modifications are not enough, your doctor may prescribe medication to lower your blood pressure. Always ensure you take your medication as advised.

New research on how to lower blood pressure

• New medications: A new type of blood pressure medication called ARNI (angiotensin receptor-neprilysin inhibitor) has been shown to be effective in lowering blood pressure, even in people with resistant hypertension (high blood pressure that is difficult to control with other medications).
• Intermittent fasting: Some research has shown to lower blood pressure in some studies. Intermittent fasting involves alternating periods of eating and fasting.
• Certain probiotic supplements: Probiotics have been shown to have a moderate effect on lowering blood pressure in some studies. Probiotics are live microorganisms that are similar to the beneficial bacteria that naturally live in the gut.
• Exercise leg muscles: Exercise that specifically targets the leg muscles has been shown to lower blood pressure more effectively than other types of exercise, such as aerobic exercise. The reason is simple; these larger and lower muscles house almost a quarter of our capillaries, so increasing their blood flow makes it easier for blood vessels to get oxygen and dilate.
• Dietary supplements: Omega 3 fatty acids and green tea may have small, but beneficial effects on maintaining healthy blood pressure.

At the doctor's office

If you've ever been to the doctor, it's guaranteed that you've rolled up your sleeve to have your blood pressure measured. But how does it work, exactly?

A blood pressure cuff works by constricting and then slowly releasing pressure on the brachial artery in your arm. Here's the detailed step-by-step process:

• The cuff is wrapped around your upper arm and then inflated. The inflation causes the cuff to press down on the brachial artery, temporarily stopping the blood flow.
• As the cuff depressurizes, your doctor or nurse listens or monitors for the return of the blood flow.
• The moment blood starts flowing through the artery again (indicated by a rhythmic pulsating sound), the reading on the gauge at that instance is the systolic pressure (top number). This is the force exerted on the artery walls as the heart contracts.
• The cuff continues deflating until there is no pulsating sound. At this point, the brachial artery is no longer being constricted, thus blood flow is not interrupted. The gauge reading at this point is the diastolic pressure (bottom number) which indicates the pressure in the arteries when the heart is at rest.

At home

The great news is that for older adults trying to manage blood pressure levels, there is now a blood pressure monitor that can be used at home.

Many Medicare, Medicare Advantage, and other private insurers usually offer free blood pressure monitors to benefiaries. You can also purchase these with your Flexible Spending Accounts from contributions you make that are deducted from your paycheck and reduce the amount eligible for taxes. You can buy this online or local pharmacy at costs ranging from $20 to $100.

The key to ensuring accurate readings at home is to follow proper instructions. Stay still, measure your blood pressure at the same time daily, take more than one reading at each sitting, and keep a log of your readings. 

We've been told that having high blood pressure is a bad thing, but what exactly are the risks? Turns out, there are quite a few:

• Damage to arteries: High blood pressure can cause small tears and injuries in the artery walls, leading to hardened or narrowed arteries. This could restrict the flow of oxygen-rich blood to the organs, affecting their function.
• Heart problems: Long-term high blood pressure can lead to coronary artery disease, heart failure, and other heart-related complications. These conditions can result in chest pain, heart attack, or even sudden death.
• Kidney damage: High blood pressure can damage both blood vessels and filters in the kidneys, leading to several types of kidney disease. This might mean your kidneys can't eliminate waste from your blood effectively and make you reliant on dialysis.
• Brain health: High blood pressure can lead to stroke, dementia, mild cognitive impairment, and transient ischemic attack (mini-stroke). It affects the supply of blood to the brain, leaving it unable to function correctly.
• Vision loss: High blood pressure can strain or damage the blood vessels in the eyes, which may result in conditions like retinopathy and choroidopathy. 
• Sexual dysfunction: For men, high blood pressure can lead to erectile dysfunction as it affects blood flow to the pelvic region. For women, it can reduce sexual desire and satisfaction by diminishing blood flow as well.
• Bone loss: High blood pressure diminishes the blood flow to the bones and bone marrow, which in turn can lead to loss of bone density, increasing the risk of fractures.

High blood pressure is a significant health issue among the elderly population, affecting their overall well-being and quality of life. However, with early detection, proper management, and lifestyle modifications, individuals can effectively control their blood pressure levels and reduce the risk of associated complications. Regular monitoring, adherence to prescribed medications, and adopting healthy habits such as exercise, maintaining a balanced diet, and stress reduction techniques are crucial for maintaining optimal blood pressure levels. By prioritizing their health and seeking appropriate medical guidance, elderly individuals can continue to lead active and fulfilling lives, free from the burdens of high blood pressure.