High Blood Pressure
Last Updated: April 4, 2013
Nearly every visit to the doctor's office-and sometimes even the
dentist's office-includes a quick blood pressure reading. Unlike
some measurements of physical health like
cholesterol, knowing one's blood pressure is quick, easy, and
fairly painless. But for how often we hear about blood pressure,
understanding its relationship to a healthy lifestyle can often be
Blood pressure is often a barometer of overall circulatory
health. Someone with high blood pressure is at a significantly
greater risk for heart failure, stroke, chronic kidney disease, and
damage to the arteries (similar to the damage caused by high
cholesterol), which can cause
It's no different for those reaching their senior years. While
nearly one in three Americans suffers from hypertension-as high
blood pressure is often called-blood pressure typically increases
with age, especially once one has passed middle age. According to
the National Heart, Lung, and Blood Institute, someone with healthy
blood pressure at age 50 has a 90 percent chance of developing
hypertension later in life.
Fortunately, the senior years are not too late to take an active
role in lowering blood pressure. Managing blood pressure can be as
simple as increasing physical activity and regulating one's diet.
In those cases when a change in lifestyle doesn't significantly
impact hypertension, prescription drugs have proven very effective
in regulating blood pressure.
Blood Pressure: What It Is and Why It's Important
InThe Blood Pressure Book: How To Get It Down and Keep It Down,
Dr. Stephen P. Fortmann compares blood pressure to a garden hose.
The heart pumps blood throughout the body in a network of arteries.
When those arteries become too narrow (often caused by plaque
build-up from high cholesterol), the volume of blood that the
arteries can handle is restricted. Like water in a narrow garden
hose, narrow arteries lead to an increase in blood pressure-and
high blood pressure can cause damage to artery walls and the heart
itself. Damage to the circulatory system-and the complications that
can result from it-is the primary reason to maintain one's blood
pressure at a healthy level.
But what is a healthy blood pressure level? The exact range
considered acceptable can vary. For those individuals with a family
history of hypertension or with related complications, like chronic
kidney disease, it's even more important to stay at a low level. A
blood pressure reading is composed of two numbers that measure the
pressure in your arteries when the heart beats (called systolic
pressure) and the pressure in your arteries between heartbeats
(called diastolic pressure). A healthy blood pressure should
measure below 120/80 (the numbers represent millimeters of
mercury). The National Heart, Lung, and Blood Institute provides
the following guidelines for understanding normal blood pressure
- Normal blood pressure: 120/80, though the risk of heart disease
can begin to increase once blood pressure reaches levels of
- Prehypertension: A systolic pressure range of 120 to 139 and a
diastolic pressure range of 80 to 89. Diagnosis with
prehypertension provides an opportunity to work hard-through
physical activity, diet, and possibly medication-to reduce blood
pressure to a healthy level. Within four years of diagnosis with
prehypertension, one in three adults ages 35 to 64 will develop
definite high blood pressure. One in two adults over age 65 will
develop definite high blood pressure.
- Stage 1 hypertension: A systolic pressure range of 140 to 159
and a diastolic pressure range of 90 to 99.
- Stage 2 hypertension: A systolic pressure of 160 or higher and
a diastolic pressure of 100 or higher.
It should also be noted that systolic pressure-the blood
pressure measured during heartbeats-becomes increasingly important
for those individuals past age 50. The most common form of blood
pressure in these individuals is a condition called isolated
High Blood Pressure in the Elderly
Surprisingly, there hasn't been a great deal of research that
looks at the elderly as a separate population in terms of blood
pressure control, says Dr. Suzanne Watnick, a professor of medicine
at Oregon Health Sciences University. Watnick advises strict
monitoring of prehypertension in order to ensure that it doesn't
have a more serious impact on health. She also warns that rising
blood pressure is common in the elderly: "For a 70-year-old person,
as you age your blood pressure does go up a bit," she says. "People
think that it's because your blood vessels are a bit more fibrotic
[meaning they develop excess connective tissue] and there's more
damage to the blood vessels over time." Above-average blood
pressure in the elderly is still a concern, but it should still be
considered in the context of age. A 40-year-old with a blood
pressure of 150/70 is much more likely to develop complications
from hypertension than a 70-year-old with the same blood
According to Watnick, the risk factors for the elderly are very
similar to those for the population at large. "Those at highest
risk of high blood pressure are those who suffer from obesity,
those suffering from
diabetes, and those with chronic kidney disease," she explains.
In fact, the risk factors for hypertension are very similar to the
risks associated with high cholesterol. Any restrictions or
blockages in the circulatory system negatively impact overall heart
health. But the kidneys, the primary organ that regulates blood
pressure, also become at risk when blood pressure rises. Severe
hypertension can cause chronic kidney disease, which in turn limits
the kidneys' ability to continue regulating blood pressure. As
Watnick says, "It's a chicken or the egg thing. You can have high
blood pressure which causes kidney disease. Or you can have kidney
disease, and that will cause high blood pressure." But regardless
of whether hypertension is simply the result of genetic
predisposition or the result of an unhealthy lifestyle, it doesn't
have to mean the end of good health.
Maintaining a Healthy Blood Pressure
For how confusing hypertension can be, learning how to maintain
a healthy blood pressure is surprisingly simple. As with other
types of circulatory health, like cholesterol, the first step to
lowering blood pressure is lifestyle change. "Whenever you're
dealing with hypertension, the first thing you need to deal with is
lifestyle change," Watnick explains. "Exercise is essential, weight
control is essential. Eating a low-salt diet is quite important."
National guidelines recommend at least 30 minutes of exercise each
day. For seniors, exercise can involve simple changes to everyday
routine, like walking more often and engaging in household chores.
In addition to improving overall cardiovascular health and
cholesterol, the presence of which can increase blood pressure by
narrowing arteries, exercise can also help with weight loss.
Related to weight loss is developing a healthy diet, another
essential tool for lowering blood pressure. Healthy nutrition is
important for all of the standard reasons (positive cardiovascular
health, additional energy, etc.) and a few unique reasons as well.
A low salt diet is particularly important for lowering blood
pressure, as salt indirectly increases the volume of blood (by
adding water to the bloodstream), which in turn increases blood
One of the most common diets recommended for those individuals
who struggle with hypertension is called the DASH diet, which
stands forDietary Approaches to Stop Hypertension. The DASH diet-a
low-sodium, low-fat diet that emphasizes fruits, vegetables, and
grains-is the result of a study by the federal government. Compared
to two control groups, one that followed a "normal" American diet
and the other a traditional diet high in fruits and vegetables,
people on the DASH diet reduced their blood pressure by an average
of 6 points of systolic pressure and 3 points of diastolic
pressure. Those people in the study who already had been diagnosed
with hypertension reduced their blood pressure by 11 systolic
points and 6 diastolic points. According to Fortmann, the DASH diet
shows the importance of diet, especially a significant reduction in
salt, to lowering blood pressure. Under the DASH diet, an
individual is advised to eat no more than one-quarter teaspoon of
salt per day. By comparison, the average American eats about four
teaspoons of salt daily, nearly fifteen times more.
But as many people know, diet and lifestyle change can often be
very difficult. Medication is also an option for many people,
sometimes because an individual has a difficult time achieving
significant lifestyle change, and sometimes because hypertension is
severe enough to mandate a combination of lifestyle change with
medication. For many, treating their high blood pressure with
medication can be a difficult subject-one that should always be
considered under the guidance of your doctor.
According to Dr. Watnick, blood pressure medication can be
categorized into three main groups:
- Thiazidediuretics are often the first course of action with
drug treatment. This medication focuses on the kidneys by helping
the body eliminate sodium, or salt, and water.
- Beta blockerscause the heart to beat slower and with less
force, working to reduce blood pressure by focusing on the center
of the circulatory system itself. Often beta blockers will be
prescribed along with thiazide diuretics (combining drugs is a
common practice that can lower blood pressure).
- Angiotensin-converting enzyme (ACE) inhibitorsare another
medication commonly prescribed along with thiazide diuretics. ACE
inhibitors counteract a natural chemical that narrows blood
vessels, which in turn eases pressure on vessels.
Of course, other types of drugs can be effective against
hypertension as well. Finding the right combination varies with
In the fight against hypertension, the best strategy is to
recognize one's individual risks-which might include genetic
history, obesity, or simple physical inactivity-and act
accordingly. For the elderly, moderately high blood pressure might
be less serious than it is in a middle-aged person. But even when
blood pressure rises minimally past age 50, it's still important to
take the proper steps to ensure healthy senior years. A normal
blood pressure is an important first step toward achieving
long-term health. Hypertension might be a common problem-but
fortunately it has plenty of solutions.
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