Blood pressure guidelines perplex
DEAR DOCTOR: What is considered a normal blood pressure for a person in their late 70s? My doctor said it should be in the area of 120/80. But I have read that older persons’ pressure may be higher — closer to 140/90 — and that pressure would not be dangerous.
DEAR READER: No, you are not alone in struggling to understand the revised blood pressure guidelines. They were issued in November 2017, and we have been receiving mail about them ever since. The questions aren’t limited to the lay public, either. Due to several issues, which we’ll address in a moment, these more stringent guidelines are also an ongoing topic of discussion among health care providers. But let’s start with your main question.
You’re correct that in the past, blood pressure goals for elderly adults were looser. They allowed for a slightly higher range for normal blood pressure compared to younger adults. However, the newest guidelines do not make the same allowances. As your doctor explained, the American College of Cardiology and the American Heart Association now define normal blood pressure for adults as readings less than 120/80. If the top number falls between 120 and 129, even with a lower number of 80 or less, this is considered to be elevated blood pressure. Readings of 130/80 and higher are the threshold for several escalating stages of high blood pressure. At this time, these guidelines apply to all healthy adults, regardless of age.
By some estimates, the updated guidelines have moved close to half of all adults into the hypertension category, basically overnight. Part of the thinking behind the update was that flagging potential hypertension
earlier would encourage patients and their doctors to discuss appropriate lifestyle changes. However, the rigor of the new goals has caused quite a bit of discussion, and even discord.
The updated guidelines are based on results from a study known as the Systolic Blood Pressure Intervention Trial, or SPRINT. In the study, participants rested quietly for five minutes before their blood pressure readings, which were taken with an automated device. Three consecutive readings were then averaged together to arrive at a final number. This is different enough from the way in which blood pressure is typically measured in a doctor’s office that many health care professionals have made the argument that the methodology had a statistically significant impact on results. In addition, they address your question, saying it’s unreasonable to expect someone in their later years to have the same blood pressure as someone in their 30s.
None of this changes the fact that hypertension is dangerous. Blood pressure that is uncontrolled raises your risk of grave health problems, which include blood clots, stroke, kidney disease, heart disease and heart attack. Not only that, the higher the numbers, the higher the risks. Our advice is to discuss the issue with your primary care physician, who is familiar with your general health, your medical history and any specific risks that you face. He or she will help you set the blood pressure goals that are right for you.
Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.