High blood pressure is one of the most common health problems in older adults. It happens when blood repeatedly pushes against artery walls with too much force, making the heart and blood vessels work harder over time.
Blood pressure is written as two numbers, such as 120/80 mmHg. The top number, called systolic blood pressure, measures the pressure when the heart squeezes and pumps blood, while the bottom number measures the pressure when the heart relaxes between beats.
High blood pressure often causes no obvious symptoms, which is why it is sometimes called a “silent killer.” If it remains uncontrolled for years, it can damage blood vessels and increase the risk of heart attack, stroke, heart failure, kidney disease and other serious problems.
Doctors have long known that lowering high blood pressure can protect health. But one important question remains: how low should blood pressure go, especially in people aged 60 and older?
A study led by Yuling Yan and colleagues examined whether older adults with high blood pressure may benefit from getting their systolic pressure below 130 mmHg. The research was published in the journal Cardiovascular Innovations and Applications.
Instead of running a new clinical trial, the researchers combined information from six previous trials. This allowed them to compare health outcomes among older people who reached different systolic blood pressure levels after treatment.
The researchers placed the participants into three broad groups. Their systolic blood pressure was either below 130 mmHg, between 130 and 139 mmHg, or 140 mmHg and above.
The clearest benefit appeared in the group whose systolic blood pressure was below 130 mmHg. Compared with people whose pressure remained at 140 mmHg or higher, they had a lower risk of major heart and blood vessel problems.
These serious problems can include heart attacks, strokes and heart failure. Because these conditions become more common with age, even a modest reduction in risk could be important for many older adults.
The study also looked at deaths related to heart and blood vessel disease. More intensive blood pressure control appeared to offer some benefit, but the differences between the groups were small, so the researchers said more evidence is needed.
The findings suggest that a systolic blood pressure below 130 mmHg may be a useful treatment goal for many adults aged 60 and older who have hypertension. However, that does not mean every older person should try to reach the same number.
Blood pressure treatment needs to be tailored to the individual. Age, other medical conditions, medications, side effects and the risk of dizziness or falls can all affect what blood pressure target is safest.
There are several ways to help control high blood pressure. Eating less salt, staying physically active, maintaining a healthy weight, not smoking and limiting alcohol can all support healthier blood pressure, while prescribed medicines are often needed as well.
Regular checks are especially important because a person can feel completely well even when their blood pressure is dangerously high. Home blood pressure monitors can also help people and their doctors see whether treatment is working over time.
The study adds to growing evidence that tighter blood pressure control may protect the heart and brain in older adults. For people with hypertension, the best approach is to discuss an appropriate target with a doctor rather than changing medicines or trying to lower blood pressure aggressively on their own.
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