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 (25 mg in the morning and evening). 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. Answer: 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, especially for someone who has already had a TIA (transient ischemic attack, which is often a predictor of a stroke). I think it’s likely that your father could take medicines that control the blood pressure better but don’t cause much if anything in terms of side effects.
A person with diabetes and high blood pressure, especially one who already has a complication like neuropathy, is at high risk for developing kidney disease from diabetes. ACE inhibitor drugs help reduce that risk as well as reduce the risk of heart attack, so I am very surprised he is not taking one. A beta blocker alone, like metoprolol, is not likely to be effective.
There remains some controversy about the ideal blood pressure goal for a person in your father’s position. 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 and may sometimes keep a person from reaching their goal. Still, blood pressure above 160 is not adequate control.
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