BP goal needs to be individualized

Dear Dr. Roach: My father is 91 years old, and I am concerned that his elevated blood pressure isn’t being properly addressed. Recently, it seems to run in the mid-170s to mid-80s (176⁄86).

He has a number of health issues, such as a kidney stent every three months, diabetic neuropathy and a transient ischemic attack. He takes metoprolol. I sent a note to his doctor suggesting his blood pressure meds need to be reevaluated, and the doctor’s response was to check his blood pressure several times daily for a month then let him know the average. He said the goal was an average blood pressure below 160⁄90 more than half the time.

I think a goal of 160 is too high and that four weeks is too long to wait before deciding if his meds need to be adjusted. I would like your opinion. — L.F.

Your father’s doctor may not want to use too many blood pressure medicines and cause symptoms that could affect your father’s quality of life at age 91. On the other hand, a goal of 160⁄90 is not optimal. I think it’s likely that your father could take medicines that control the blood pressure better.

A person with diabetes and high blood pressure is at high risk for developing kidney disease from diabetes. ACE inhibitor drugs help reduce that risk as well as the risk of heart attack. A beta blocker alone is not likely to be effective.

One recent study would suggest a goal of 120 is better than the older goal of less than 140. However, the blood pressure goal needs to be individualized. Side effects from blood pressure medications need to be carefully managed.

It’s best to get as much data as possible before making a change in blood pressure medication. Four weeks is usually reasonable, but with your father’s too-high blood pressure, two weeks should be enough time to confirm high blood pressures at home.