Blood pressure often becomes harder to manage as people get older.
Arteries naturally become stiffer with age, which can push blood pressure higher and increase the risk of heart disease, stroke, kidney problems, and other serious health conditions.
A blood pressure reading has two numbers. The top number, called systolic blood pressure, measures pressure in the arteries when the heart beats, while the lower number measures pressure when the heart relaxes between beats.
For older adults, doctors have long debated how low systolic blood pressure should go. Lowering very high blood pressure clearly protects health, but pushing it too low may cause problems in some people, including dizziness, fainting, kidney injury, or changes in important minerals in the blood.
One major study helped change the way doctors think about this question. The Systolic Blood Pressure Intervention Trial, better known as SPRINT, compared more intensive blood pressure treatment with standard treatment in 9,361 adults aged 50 and older who had an increased risk of heart disease.
The participants had systolic blood pressure of at least 130 mm Hg, but they did not have diabetes or a previous stroke. Researchers randomly assigned them to aim for a systolic pressure below 120 mm Hg or below 140 mm Hg.
The main SPRINT results were published in 2015 in The New England Journal of Medicine. The trial was funded by the U.S. National Institutes of Health and became highly influential in discussions about how aggressively high blood pressure should be treated.
The results showed an important benefit from more intensive treatment. People assigned to the lower target had about a 25% lower relative risk of a group of major heart and blood vessel problems, including heart attack, stroke, heart failure, and death from cardiovascular causes.
They also had a lower risk of dying from any cause during the trial. A later final report, published in The New England Journal of Medicine in 2021, continued to support the main finding that intensive blood pressure control reduced major cardiovascular events and deaths in this group.
However, aiming lower was not completely risk-free. Serious problems such as very low blood pressure, fainting, abnormal blood mineral levels, and acute kidney injury occurred more often with intensive treatment, although the original trial did not find a higher rate of falls causing injury.
This is why a blood pressure target should not simply be chosen based on age alone. A healthy and active person in their 60s may tolerate intensive treatment well, while someone who is frail, frequently dizzy, taking many medicines, or living with other serious illnesses may need a different approach.
Blood pressure measurements also need to be accurate. Readings can change depending on stress, recent activity, caffeine, the size of the blood pressure cuff, and whether a person has rested before the measurement.
Healthy habits remain an important part of blood pressure control at any age. Regular physical activity, eating a balanced diet, limiting excess salt, maintaining a healthy weight, not smoking, and taking prescribed medicines correctly can all help reduce cardiovascular risk.
For people over 60, the lesson from SPRINT is not that everyone must reach exactly the same number. Instead, lower blood pressure can offer major benefits for many people at increased cardiovascular risk, but treatment needs to consider the person’s overall health and possible side effects.
Anyone considering a change in blood pressure treatment should discuss it with a doctor rather than changing medication on their own. The safest target is one that provides strong protection against heart disease and stroke while avoiding unwanted effects from treatment.
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