Keeping blood pressure in a healthy range becomes especially important as people get older.
High blood pressure can slowly damage blood vessels and raise the risk of heart attack, stroke, heart failure and other serious health problems.
A blood pressure reading has two numbers. The top number, called systolic blood pressure, measures the pressure in the arteries when the heart beats, while the lower number measures pressure when the heart relaxes between beats.
For many years, doctors often aimed to keep systolic blood pressure below 140 mmHg in older adults. More recent research, however, has suggested that some people may benefit from bringing it lower, as long as treatment does not cause troublesome side effects.
One of the most important studies was the SPRINT trial, which included more than 9,000 adults aged 50 and older who had an increased risk of heart disease but did not have diabetes. A large group of participants were aged 75 or older, making the findings especially useful for understanding blood pressure treatment later in life.
Researchers compared two treatment approaches. One group received more intensive treatment aimed at a systolic blood pressure below 120 mmHg, while the other group followed a standard target below 140 mmHg.
The results showed important benefits from the lower target. People receiving intensive treatment had fewer major cardiovascular problems, including heart attacks and heart failure, and they also had a lower risk of death.
The main SPRINT findings were published in The New England Journal of Medicine in 2015. A later analysis focusing on adults aged 75 and older was published in JAMA in 2016 and also found that intensive blood pressure treatment could provide substantial benefits for many older people.
However, lower is not automatically better for every person. Blood pressure medicines can sometimes cause dizziness, fainting, changes in kidney function or problems with the body’s balance of salts and fluids.
These concerns can be particularly important in older adults who are frail, take several medicines or already have other medical conditions. A person who becomes dizzy when standing, for example, may face a greater risk of falling even if the blood pressure reading itself looks good.
This is why blood pressure targets should be based on the individual rather than age alone. Many current treatment approaches aim for systolic blood pressure below 130 mmHg in older adults when that level can be reached safely, but the best target can differ from one person to another.
Health conditions also matter. Kidney disease, diabetes, previous heart disease, medication side effects and a person’s general physical condition can all affect how aggressively high blood pressure should be treated.
How blood pressure is measured is important as well. A single high reading does not always mean someone has uncontrolled high blood pressure because stress, recent activity, caffeine and even talking during the measurement can temporarily change the result.
Regular measurements taken correctly can give doctors a much clearer picture. Home blood pressure monitoring may also help show whether treatment is working and whether readings become too low at certain times of the day.
For people over 60, the main message is that controlling high blood pressure can greatly protect long-term health, but there is no perfect number for everyone. The goal is to lower blood pressure enough to reduce the risk of heart disease and stroke without creating new problems from treatment.
Anyone concerned about their blood pressure should discuss their readings, medicines and personal health risks with a healthcare professional. Treatment can then be adjusted to find a target that is both effective and safe.
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