High Blood Pressure in Seniors
Home Blog High Blood Pressure in Elderly People – The Definitive Guide

High Blood Pressure in Elderly People – The Definitive Guide

by Dr. Nikola Djordjevic, MD

We can all agree that high blood pressure in elderly people (hypertension) is undoubtedly a condition that has to be treated, regardless of the person’s age, in order to prevent serious consequences. It’s dubbed “the silent killer” because it presents no symptoms for a long time until it’s too late to reverse its ill effects on the blood vessels, heart, brain, kidneys, and other vital organs. Prompt diagnosis and aggressive treatment for lowering blood pressure to normal levels is the right approach according to a great majority of doctors.

Or is it?

What is considered high blood pressure in the elderly? Recent studies have suggested that slightly higher than normal blood pressure in seniors has a protective effect in very old and frail people. This somewhat controversial new approach has shown that elevated blood pressure may indicate preserved heart function. Furthermore, it may actually protect the brain from dementia. The conclusion of these studies is the view that an elderly person with high blood pressure needs to be treated differently from other population groups.

You’ve read that right.

Since we are dedicated to senior health, this “new normal blood pressure for seniors“ must be addressed. We’ll explain how it makes sense. But before we do, let us first cover all the basics of blood pressure in this comprehensive overview. What is blood pressure? How do we diagnose and treat it? What levels are considered normal and what happens to our body if we leave it untreated? What are the causes of high blood pressure in the elderly? And finally, what are the risk factors we can change to prevent high blood pressure from developing or manage it before loading up on medication?

What Is Blood Pressure?

Essentially, blood pressure is the force that blood creates by pushing against the walls of the blood vessels on its way through the body. If you take a look at an elderly blood pressure chart, you can see that blood pressure is measured in millimeters of mercury (mmHg) and presented in the form of a fraction. However, it is not a fraction, but two numbers, one over the other, representing systolic pressure (the upper number) and diastolic pressure (the lower number). Systolic pressure is higher because it’s measured when the heart contracts (beats), while the diastolic pressure is measured when the heart relaxes, between beats.

Symptoms of High Blood Pressure

The biggest problem with high blood pressure in the elderly is that it usually shows no symptoms. As much as one third of people who have high blood pressure don’t know that they have it. Often, the only way to diagnose it is by taking proper blood pressure measurements. Fortunately, as you know, this is very simple and one of the first things your doctor does when performing a physical exam. Therefore, if you visit your doctor’s office regularly, high blood pressure won’t be left undiagnosed. It’s recommended for persons over the age of 21 to keep track of their blood pressure, and even more so for seniors.

When it comes to high blood pressure in the elderly, symptoms start to appear only at dangerously high levels. The symptoms of extreme hypertension can include:

  • Intense headache
  • Fatigue and confusion
  • Problems with vision
  • Difficulty breathing
  • Chest pain
  • Irregular heartbeat
  • Pulsating in the chest, neck, or ears
  • Blood in the urine

If you have any of these symptoms, you must see a doctor immediately. You could be having a hypertensive crisis which requires urgent treatment because it can lead to a heart attack or stroke.

How to Measure Blood Pressure

There are a few ways to measure blood pressure, the simplest being with an electronic sensor that goes around your wrist. You can use it by yourself, and it’s fairly accurate, but not the most sensitive device out there. They also measure your heart rate. What is the normal pulse rate for an elderly person? Normal heart rate varies from person to person, but a normal range for adults is 60 to 100 beats per minute.

There are special devices called ambulatory blood pressure monitors that record your blood pressure for the entire day and give the most accurate readings, but they’re pricey and not the standard practice. And of course, there’s the good old blood pressure cuff and stethoscope.

High Blood Pressure in Seniors

Even more important than the device you use is the way you take blood pressure measurements.

First of all, you have to measure the patient’s blood pressure multiple times before a definitive diagnosis of hypertension can be made.

Second, the person has to be properly prepared. What does that mean? For the most accurate readings, the patient needs to:

  • Sit upright with their feet on the ground
  • Relax for five minutes
  • Use the restroom if they need to
  • Wear short sleeves
  • Not smoke or drink coffee for 30 minutes beforehand

Another thing can influence the readings: some people feel anxious in a clinical setting and have elevated blood pressure only in the doctor’s office. You’ve probably heard of this phenomenon—it’s called white coat hypertension. If your doctor suspects it, they will instruct you to measure your blood pressure multiple times at home and return with the findings. Ambulatory blood pressure monitors are also used in these situations.

What Is Normal Blood Pressure for Senior Citizens?

Your blood pressure fluctuates throughout the day. It’s lowest when you sleep, but rises when you’re active, excited, or stressed out. This is normal. However, it’s stable most of the time and should be under 120/80 mmHg. Lower is better, but very low blood pressure for elderly people is also an issue because it can make them feel lightheaded and contribute to falls.

Classification Systolic pressure Diastolic pressure
Normal Less than 120 and Less than 80
Prehypertension 120-129 and Less than 80
Stage 1 hypertension 130-139 or 80-89
Stage 2 hypertension 140 or higher or 90 or higher
Hypertensive crisis Higher than 180 and/or Higher than 120

The values above are for the general population. What should an elderly person’s blood pressure be? Senior citizens differ from younger people in many ways. Age, frailty, other diseases, and the medication an elderly person takes all influence the approach to treatment. When should we start treating high blood pressure for older adults? The most common threshold for beginning medications is 130/80 mmHg, but there have been disagreements among experts for years.

While some medical professionals strongly advocate keeping the blood pressure of seniors under 120/80 mmHg, others have set higher levels as goals because we have to think of many other factors as well. Overmedication of seniors is a serious problem. Treating multiple diseases, each with its own set of medications, can add up to over ten different pills per day, and every one of them can have side effects. Therefore, weighing the pros and cons of treating high blood pressure in seniors for every individual patient is necessary.

Another disease associated with old age is atherosclerosis. It reduces the diameter of the arteries leading to high blood pressure in older adults, but the arteries also become harder and less elastic. This causes isolated systolic hypertension because they can’t expand properly when the heart beats. The diastolic pressure may remain normal, which then leads to a big difference between the systolic and diastolic pressures.

Too much medication can also cause orthostatic hypotension, that is, a temporary drop in blood pressure upon standing up. This can, in turn, lead to dizziness and cause falls. If overmedication is the cause, we have to rethink the doses. If the issue persists, consider getting a medical alert system. So what is a normal blood pressure reading for a 70 year old woman? The goal of 150/90 mmHg may seem too high but pushing for lower levels can sometimes only add risks without offering additional benefits. As you can see, the treatment of high blood pressure is a bit of a balancing act.

On top of that, as previewed in the introduction of this article, for very old and frail people (over the age of 80), elevated blood pressure can be a good indicator. How do we explain this? Well, for a senior to have high blood pressure, their heart has to be relatively strong to pump the blood with such force. Thus, high blood pressure can indicate a strong heart. As for the second benefit, pumping more blood to an elderly person’s brain can ensure better oxygenation, which can protect the brain from developing dementia. So the blood pressure for an 85 year old male who is otherwise in good physical condition can be a little elevated.

Medical professionals have known about these benefits for years, but don’t get it wrong; they are only true for very old people and only slightly elevated levels. The causes of sudden high blood pressure in elderly adults must be identified and treated immediately, no matter the person’s age. Also, seniors with diabetes and kidney disease have to aim for lower levels. What’s the bottom line? Simple math doesn’t work here. There is no one blood pressure threshold for starting medication, and an individual approach is vital.

What Causes High Blood Pressure in Older Adults?

High blood pressure patients are divided into two groups depending on whether or not the cause of the condition is known. In a great majority of cases, a single cause of elevated blood pressure is not known. Blood pressure simply rises as we age, and many confounding factors contribute to its development. This is called primary or essential hypertension. If specific causes of high blood pressure in elderly adults are identified—for instance, kidney disease or a tumor in the adrenal gland—this is called secondary hypertension, but it is much less common.

What Are the Risk Factors?

Is blood pressure affected by age? It certainly is, but many other risk factors contribute to high blood pressure developing. Some can’t be modified, but most of them can. Healthier life choices can prevent and treat hypertension without medications.

Unmodifiable Risk Factors:

  • Age – age-related risk factors can’t be modified; men over 45 and women over 55 have the highest risk of developing hypertension; moreover, the older the person, the greater the risk they will develop high blood pressure.
  • Sex – as you can see, there’s a difference between sexes; men tend to develop high blood pressure earlier, while women are protected by estrogen until menopause; afterward, the risk becomes the same.
  • Race – Black people are most at risk of developing hypertension, followed by Caucasians, while Asians have the lowest risk.
  • Family history – people with a family history of hypertension are themselves at risk of developing it.

Modifiable Risk Factors:

  • Weight – being overweight is a big risk factor for developing hypertension; losing even ten pounds can lower high blood pressure in elderly adults; aim for a healthy BMI.
  • Diet – eating plenty of fruits and vegetables, followed by low-fat dairy, eggs, and lean meats will help you lose weight and lower your risk of developing hypertension.
  • Salt intake – salt (sodium) keeps water in your bloodstream, leading to elevated blood pressure; limit your salt intake as much as possible and avoid processed foods which contain high sodium levels.
  • Physical activity – a minimum of 30 minutes of daily aerobic physical exercise is proven to be beneficial for preventing hypertension.
  • Smoking – tobacco smoking temporarily elevates blood pressure and damages the arteries in the long run, leading to high blood pressure among many other adverse effects on the body.
  • Alcohol consumption – two drinks per day for men and one drink per day for women has a positive effect on blood pressure levels, but don’t drink more than that because it will have a negative effect on your blood pressure.
  • Stress – exposure to long-term stress raises blood pressure; find ways to manage your stress and cope with problems instead of delaying them.

High Blood Pressure in Seniors

Complications of High Blood Pressure in Seniors

Untreated high blood pressure in elderly people causes some potentially life-threatening complications. While most of these problems won’t present themselves until old age, seniors are not the only population group experiencing complications of high blood pressure. As more and more young people have hypertension, diagnosing and treating it on time is crucial for preventing the following problems:

  • Enlargement of the heart – when blood pressure is high, the heart has to pump harder, and just like any muscle, it grows to compensate; paradoxically, this thins its walls and eventually weakens it, so the heart decompensates, leading to heart failure.
  • Hardening of the arteries – the arteries harden when high blood pressure in elderly adults isn’t treated for years; the damage occurs in all vital organs and throughout the body, but especially in the heart, brain, kidneys, and legs; this can compromise the blood flow to these parts of the body and cause a heart attack, a stroke, kidney failure, or amputation of the leg.
  • Kidney failure – the same mechanism causes the arteries in the kidneys to become narrow, which damages their function; kidneys are the primary organs for controlling blood pressure by eliminating excess water from the body; so we may have the chicken and the egg situation where we can’t determine whether hypertension caused the kidneys to fail or kidney failure caused hypertension.
  • Aneurysms – just like the heart expands under pressure, so can parts of blood vessels, leading to little bulges in them that have thin walls (aneurysms); they tend to form on the aorta or the arteries in the brain; if an aneurysm bursts, it can lead to death in a matter of minutes.
  • Vision changes – damaged blood vessels in the retina can burst or bleed which may cause vision changes and lead to blindness.

How to Control High Blood Pressure in Old Age

We can treat moderately elevated blood pressure levels (prehypertension) in the elderly by making simple lifestyle changes.

This should be the first step before resorting to drugs. Thes changes can be enough for some seniors to put their hypertension under control:

  • Adopting a healthy diet with a limited sodium intake
  • Losing excess body weight and maintaining a healthy BMI
  • Being physically active every day for at least 30 minutes
  • Quitting smoking and limiting alcohol consumption

High Blood Pressure in SeniorsHigh Blood Pressure in Seniors

Blood Pressure Medications

Sometimes making the changes mentioned above isn’t enough to lower high blood pressure in elderly people to acceptable levels. We then have to resort to pharmaceutical options. More often than not, two or more medicines have to be taken daily. They will keep blood pressure down but cannot cure hypertension. It is also important to take the pills as your doctor prescribed them and take them every day at the same time.

The most common medications for treating high blood pressure in older adults include:

  • Diuretics – these pills eliminate excess water and salt from the body via the kidneys; by reducing the volume of fluid in the blood, they lower blood pressure; they are often prescribed together with one of the following medications or combined in a single pill.
  • Beta-blockers – they reduce blood pressure by making the heart beat slower and less vigorously which, in turn, decreases the pressure on the blood vessels.
  • ACE inhibitors – angiotensin-converting enzyme inhibitors reduce the production of the hormone angiotensin, which causes blood vessels to constrict and elevate blood pressure; this also reduces the stress on the heart.
  • Calcium channel blockers – calcium has multiple functions in the body, one of them is to enable the contraction of muscles; by preventing it from entering the muscle cells of the blood vessels and the heart, these pills relax them and lower blood pressure.
  • Angiotensin II receptor blockers – they target the same hormone as ACE inhibitors, but instead of preventing its creation, they stop it from working; when it comes to blood pressure in the elderly, guidelines recommend blockers for patients who don’t tolerate ACE inhibitors because this mechanism has fewer side-effects.
  • Alpha-blockers – unlike beta-blockers, these pills target the blood vessels, causing them to expand, which reduces blood pressure.
  • Alpha-beta blockers – they combine the effects of alpha-blockers and beta-blockers.


As you can see, the treatment of high blood pressure in elderly people is a complex issue. We have to take into consideration multiple factors and not just the generic threshold for high blood pressure in otherwise healthy adults. Every senior’s health has to be observed as a whole, and treatment needs to be adapted to every person’s unique needs.

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