Doctors face a particular challenge in treating older men and women for high blood pressure because they have more health problems than younger adults and because they're more likely to suffer from medication side effects.
See also: Six foods to fight high blood pressure.
On April 25, an expert panel convened by the American College of Cardiology (ACC) and the American Heart Association (AHA) offered a number of concrete recommendations for treatment of people over 65.
"We have very good data to show that treatment is beneficial at least up to the age of 80," says cardiologist Jerome Fleg, M.D., of the National Heart, Lung and Blood Institute, and co-chair of the ACC-AHA writing committee. "After that the data are sparser although they still suggest a benefit."
Here are some key recommendations to doctors from the consensus document, plus suggestions of steps you can take to lower your blood pressure.
Base a diagnosis of hypertension on three blood pressure measurements taken on at least two office visits.
What you can do: "If your blood pressure was high when you had it taken at a health fair or at a pharmacy, don't just assume it was a bad day and forget about it," says cardiologist Richard Stein, M.D., of New York University School of Medicine, who was not involved with writing the document. "Follow up with a visit to your doctor."
- Set a systolic/diastolic target of less than 140/90 mm Hg in people 65 to 79 years old. For those 80 and over, aim for a systolic number between 140 and 145 mm Hg.
What you can do: If your numbers are in the red zone for high blood pressure, "allow your doctor to start treatment and don't kid yourself by saying you're fine," says Stein. "Medications that control blood pressure reduce the risk of a heart attack by almost 40 percent and the risk of a stroke by more than 30 percent."
- To avoid side effects, start with a single medication at the lowest dose and increase it gradually. If the response is inadequate, determine possible reasons the drug isn't working and add a second drug if necessary.
What you can do: Tell your doctor if you regularly forget to take your pills, if you experienced uncomfortable side effects and stopped taking the pills, or if you didn't get the prescription filled because you couldn't afford it. Otherwise your doctor may prescribe a second drug in the mistaken belief that the first isn't working.
Lifestyle changes may be the only treatment needed for milder hypertension.
"The most useful lifestyle changes you can make are to restrict the amount of sodium in your diet, lose weight if you're overweight and start a regular exercise program."
What you can do: "The most useful lifestyle changes you can make are to restrict the amount of sodium in your diet, lose weight if you're overweight and start a regular exercise program," says Fleg. "I firmly believe that lifestyle factors can prevent conditions such as hypertension, obesity and diabetes as well as be useful in their treatment."
"How high blood pressure is treated depends on the patient and the doctor," says Fleg, noting that the treatment recommendations should be individually tailored. "But," he emphasizes, "high blood pressure is not something to disregard. The important message is that it should be treated and not ignored."
Nissa Simon is a freelance writer who lives in New Haven, Conn.
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