Do I really need medication?
Doctors need to tread carefully when treating older adults for hypertension, explains Logan. "Chronological age is less important than overall health," he says. "I'd treat a very healthy 80-year-old as I would any [middle-aged] hypertensive. But in many older people, the target needs to be carefully adjusted to avoid complications."
High blood pressure increases the risk of heart attack and stroke, but very low blood pressure is dangerous, too, he points out. Abnormally low diastolic pressure, for instance, means not enough blood is flowing back to the heart. That can deprive the heart of oxygen, causing it to enlarge, and can rob the brain of blood.
In someone with a wide pulse pressure, getting systolic pressure down without driving diastolic pressure too low can become a real balancing act.
"Let's say a patient has 160/60," says Dr. Howard S. Weintraub, associate professor of medicine and director of the Center for the Prevention of Cardiovascular Disease at New York University Langone Medical Center. "You can't go any further in those individuals or you may see unwanted consequences of low diastolic blood pressure."
Doctors also have to be cautious about treating people who are hypertensive but have transient low blood pressure when they stand. Bringing overall blood pressure down may increase the danger of falls.
Despite the challenges of treating hypertension in older patients, researchers emphasize the importance of controlling high blood pressure.
"If you can take someone with a systolic blood pressure of 180 and get it down to 150, you knock the tar out of the stroke rate," says Izzo. And especially as people get older, a stroke can prove much more calamitous than heart disease.
What are the best drugs for me?
Medications that work well for younger people with hypertension can be dangerous in older patients. Experts caution against using beta blockers, such as Inderal or Toprol XL, in older people because they may slow already sluggish heart rates.