Sun Sentinel Palm Beach Edition
BP goals can be complicated
Dear Dr. Roach: My husband is 75. I am 68. Our family doctor says that our blood pressure average is fine at 140⁄80 with no medicine. We thought it should be
120⁄70, but he says the limit is higher for seniors in order to decrease falls. Do you think it’s OK? — S.M.
The best goal for blood pressure has been the subject of controversy. For the overall population, a level of 120⁄80, slightly less than the average blood pressure in the U.S. and Canada, is associated with a lower risk of heart disease, stroke and death than a blood pressure of 140⁄80. But the difference is pretty small. A blood pressure of 160⁄90 has a significantly higher risk, and at blood pressures above 160 systolic (that’s the first or “top” number), the risk for stroke and heart disease rises steeply.
A recent trial (the SPRINT trial) showed that among older people with high blood pressure who had increased risk for heart attack, a systolic blood pressure goal of 120 was better at reducing risk than a blood pressure goal of 140. Both groups had a diastolic (the second or “bottom” number) goal of less than 90. However, the goal among people at lower risk is not as clear.
Most experts would not treat people with medication unless their average blood pressure is over 140 systolic or over 90 diastolic. In people treated with medication, some experts prefer a goal of less than 130/less than 90, while others would treat to less than 120/less than 90. It is true that more blood pressure medication and more intensive goals can lead to greater side effects, including falls. However, in the SPRINT trial, there was NO increase in fall risk and a 0.6 percent increase in the risk of fainting.
Non-drug therapy, which includes modest salt restriction, regular exercise and stress reduction, can lower the blood pressure enough that people do not need medication.