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Heart & Vascular Health | Heart News
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How High Is Too High for Your Blood Pressure?

Patient health, history key to treating adults over 60

If you’re over 60 and your doctor is treating you for high blood pressure, your health status and patient history play a key role in that treatment.

In deciding on the upper limit for blood pressure, your doctor is striking a balance between the risk of stroke and the hazards of falls from dizziness that older adults may experience.

Experts are reaffirming the importance of assessing each patient individually in the wake of a recent easing of guidelines for the upper limit of blood pressure for older adults – and the controversy that followed the guideline adjustment.

A minority group within the Joint National Committee (JNC) that recently reviewed and made changes to blood pressure guidelines for physicians disagreed with one committee recommendation: raising target blood pressure for patients 60 years and older from 140/90 to 150/90. 

Balancing act

Minority opinion members on the JNC panel published their concerns in the April 2014 issue of the Annals of Internal Medicine. They say the recommended increase in blood pressure limits for those 60 years and older (absent diabetes or kidney disease) is unwise.

The JNC panel based the disputed recommendation, in part, on review of two large studies of older patients, many who were 70-plus years of age. The panel focused on the issue of balance and falls.

Leslie Cho, MD, Director of Cleveland Clinic’s Women’s Cardiovascular Center, says she understands the reasoning behind the JNC decision. “Looking at whether tight control below 140 was more beneficial, it turned out that the older you got, having lower and lower blood pressure was associated with dizziness and falling, which is a very, very serious complication in the elderly. So that is why JNC has embraced the 150/90 guideline,” Dr. Cho said.

Minority opinion objections

However, objectors say the change might:

  • Reduce the intensity of treatment for high-risk patients, including African Americans and patients with existing cardiovascular disease (CVD)
  • Reverse the successes achieved over recent decades in reducing deaths caused by CVD and stroke

Clinical experience

But Dr. Cho says, “What I have done … is, for any patient who is diabetic or who has evidence of renal dysfunction, regardless of age, we keep that blood pressure extremely tight, because we really believe in the notion that lower blood pressure is better for those risk factors.”

Despite the liberalization of blood pressure limits presented in the JNC, Dr. Cho says, “In general, we still for the most part, aim for the target of 140/90 for patients from 60 to 80 years of age.”

Increased stroke risk

Adding fuel to the fire is a recent study conducted at the Southern Medical University in Guangzhou, China that says even slightly elevated blood pressure adds significant risk of stroke.

Irene Katzan, MD, Director of the Center for Outcomes Research and Evaluation for Cleveland Clinic’s Neurological Institute, says she agrees with the Chinese study’s conclusions. “This concept of pre-hypertension or this slight elevation … is really important. The study estimates that … pre-hypertension is responsible for 20 percent of strokes and that is really significant,” she says.

Researchers found that people with pre-high blood pressure (blood pressure between 120/80 and 139/89) were 66 percent more likely to develop a stroke than people who had normal blood pressure. The study found that treating people with even a slightly elevated blood pressure could prevent many strokes.

Dr. Katzan stresses, “We know that high blood pressure – hypertension — is the most important modifiable risk factor for stroke. It’s responsible for 30 percent of strokes. And now this study suggests that even a slight elevation in blood pressure is significant.” 

What is best

The bottom line for top limits on blood pressure? Doctors should continue to tailor treatments for their patients on a case-by-case basis. Many factors go into determining the best course of treatment for patients. Doctors need to rely on experience and focus on the individual for the best possible outcomes.

Tags: blood pressure, heart, heart and vascular institute, heart health, high blood pressure, stroke
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  • jcmmom

    How about an article on Pernicious Anemia? I and several people I know have it and aren’t sure what exactly it is?

  • Greg

    When is BP too low, ran 94 over 53 this a.m. heart rate of 65, felt fine, should I be concerned??

    • The_Beating_Edge_Team

      94/53 may not be too low for you, with a heart rate of 65 especially if you felt fine. It would depend on your normal blood pressure – what is normal for you; how you feel; and if you have a medical condition, what BP your doctor wants you to be at. As long as you feel fine, it should not be a problem – here is a link for more information – http://www.nlm.nih.gov/medlineplus/lowbloodpressure.html betsyRN

      • Eugene Golden

        Mine was that low sometimes and then i would get light headed or a bit dizzy with a slight staggering walk. Other times it was about the same level and I would feel fine. I had been on 3 kinds of BP reduction medication. first the doctor eliminated HTZ ,,,still would dip too low. Then reduced the atenolol by 50 percent. Still would dip too low. Then dr. suggested I may try to reduce the lisinopril by 50 percent. Still was too low after a few weeks. She then told me i may need to discontinue the lisinopril but if the pressure went high to take it again or try another 50 percent reduction. i guess she figured I had enough sense to try to balance it out myself before my next 3 month appointment appointment. I did have to go back on the lisinopril at a further 50 percent reduction and BP has been stable since. I am 58 and a pharmacy tech so I guess she knew I would not do myself any harm and get it within normal levels. I just wonder why all of a sudden all these meds started driving my pressure too low. I have not lost a lot of weight or anything but have increased my exercise activity level and was also placed on a statin. I guess when i go back to my PCP next month she will either agree with my current meds or make changes to them again.

        • The_Beating_Edge_Team

          Eugene – thanks for your note. It can be a tricky balance to find the right medications – sometimes people take their blood pressure prior to taking their meds for guidance on whether to take or not. It is great your are exercising and you may want to follow the DASH diet as well for blood pressure control (http://www.nhlbi.nih.gov/health/health-topics/topics/dash/). You sound like you are very knowledgeable about your condition and If you are in balance right now, then stick with your current regiment. If not – then you may want to see a specific blood pressure specialist along with your PCP. betsyRN

  • Greg

    Usually runs in the area of 113 over 60 resting heart rates 54-60.

  • Shirley

    Concerning stroke…Can a 31 year old female whose blood pressure has been consistently running 156/96 or higher have a stroke? Or even a mini stroke? With a family history of stoke (mother’s, father had several and that is what killed him).

  • Mona

    I get several different arrhythmias. I have had SVTs from the age of 19 associated with RBBB; about 15 years ago I noticed symptomatic bradycardias, especially with medication for hypertension. More recently I have been getting PVCs, up to 12 per minutes and going on for prolonged periods, perhaps 30 minutes or so; I can easily get 1000 PCVs a day. My cardiologist has not advised any particular treatment. Could all these arrhythmias have one underlying cause, such as a gap junction protein mutation ie Connexin 40? Or am I just unlucky. My heart is structurally normal.

  • Eugene Golden

    after reading this article I know no more than i did to start with and i am a pharmacy tech.

  • Debi

    I am currently taking 100mgs of Metoporol daily. I have very, very much stress in my life, and suffer from anxiety attacks. Went to Doc’s the other day, my bp was, PLEASE SIT DOWN, 204/148. Yes, I know that is way too high. The next day, 212/104. I need a new Doctor, I think. He didn’t even address this at the time. The strange thing is, I have no indication that my bp is rising. I am 62, very active, but as I said, I have a lot going on in my life. I am tired of hearing that I need to handle my stress, I all ready know that. I take my bp daily, and it has come down somewhat in the past few days. I just wish I had a doctor that would address this and help me. I also take enaparil, and thyroid medicine. I feel healthy, except for this bp problem. Aside from diet, exercise, and trying to deal with my daily life, as well as having a very sick husband, where do I start. Probably by finding a new doctor. I do not want to end up in the hospital or have a stroke or any other problems that can occur with this. Any suggestions?