Consider age when changing medication

Dear Dr. Roach: I am a 91-year-old male. When I switched primary care physicians, my new doctor shook his head because my previous doctor had never told me about my low GFR readings and being borderline diabetic. I had assumed that if the doctor didn’t mention any low or high blood test results, everything must be OK. I no longer assume: I ask for a copy of the results and question them.

The new doctor referred me to a nephrologist. My blood pressure at the time was usually in the 130-140 over 60-70 range. He told me that for a person of my age, that was too low. He gave me a target of 159 over 89. Then on my next visit to primary care, I was told that my blood pressure was too high; I was prescribed losartan. I am testing my blood pressure daily, and the past few days it has been in the 170s. So, what is a good target for my blood pressure? Which doctor is correct? — A.L.

There is no absolute right answer to your question.

On one hand, overaggressive treatment of blood pressure in a 91-year-old is unnecessary and may lead to symptoms of lightheadedness, especially upon standing. Other blood pressure drugs may have additional side effects.

On the other hand, a 91-year-old has a higher risk for heart disease and stroke, and in someone with a low GFR reading (a measurement of kidney function) and borderline diabetes (which further increases the risk of heart attack and stroke), most experts would aim for a blood pressure goal that is closer to 120-130 over 80-85, as long as it isn’t causing annoying symptoms. I’m not clear why the doctor wasn’t happy with your usual blood pressure, since a level of 130-140 over 60s seems reasonable for a man your age if you aren’t having side effects. If 170 is the usual systolic pressure on your new regimen, I would ask about going back to the old one.