blood pressure Archives - Better Health While Aging

New High Blood Pressure Guidelines Again:
What the Cardiology Hypertension Guidelines Mean for Older Adults

And once again, high blood pressure is making headlines in the news: the American Heart Association and the American College of Cardiology (AHA/ACC) have just released new guidelines about hypertension.

Since this development is likely to cause confusion and concern for many, I’m writing this post to help you understand the debate and what this might mean for you and your family.

By the way, if you’ve read any of my other blood pressure articles on this site, let me reassure you: I am not changing my clinical practice or what I recommend to others, based on the new AHA/ACC guidelines.

The core principles of better blood pressure management for older adults remain the same:

Take care in how you and your doctors measure blood pressure (more on that here),
Start by aiming to get blood pressure less than 150/90 mm Hg, as recommended by these expert guidelines issued in 2017 and in 2014,
And then learn more about what are the likely benefits versus risks of aiming for more intensive BP control.

Perhaps the most important thing to understand is this: treatment of high blood pressure in older adults offers “diminishing returns” as we treat BP to get lower and lower.

Scientific evidence indicates that the greatest health benefit, when it comes to reducing the risk of strokes and heart attacks, is in getting systolic blood pressure from high (i.e. 160-180) down to moderate (140-150).

From there, the famous SPRINT study, published in 2015, did show a further reduction in cardiovascular risk, when participants were treated to a lower systolic BP, such as a target of 120.

However, this was in a carefully selected group of participants, it required taking three blood pressure medications on average, and the reduction in risk was small. As I note in my article explaining SPRINT Senior, in participants aged 75 or older, pushing to that lower goal was associated with an estimated 1-in-27 chance of avoiding a cardiovascular event. (The benefit was even smaller in adults aged 50-75.)

SPRINT did not include people who have certain common conditions, including diabetes, heart failure, past stroke, or dementia. Hence it’s not clear that the (small) benefits of intensive blood pressure control would apply to those older adults who would not have qualified for the SPRINT trial.

I will come back to the SPRINT study later in the article, since it undoubtedly influenced the recent AHA/ACC guidelines. But first, a little on why the new guidelines are notable. [Read more…]

6 Steps to Better High Blood Pressure Treatment for Older Adults

by Leslie Kernisan, MD MPH 82 Comments

Have you been concerned about high blood pressure (hypertension)? Or are you worried about an older relative having a stroke or heart attacks?

You’re not alone. After all, hypertension is the most common chronic condition among older adults, and medications for blood pressure (BP) are among the most commonly taken drugs in the US.

Even more important: poorly controlled hypertension is a major contributor to the most common causes of death and disability in older adults: strokes, heart attacks, and heart failure.

So it’s certainly sensible for older adults – and for those helping aging parents – to think about blood pressure.

And once you start thinking about high blood pressure, you’ll probably start to wonder.

Are the blood pressure medications you’re taking enough? Is your blood pressure at the “right” level or should you and your doctors work on changing things?

And what about that major research – the SPRINT trial — that made the news in 2015? (In this study, older adults randomized to aim for a lower BP did better than those who got “standard” BP treatment.)

These are excellent questions to ask, so I’d like to help you answer them.

Now, I can’t provide exact answers on the Internet. But what I can do is provide a sensible process that will help you successfully address these questions.

In this article, I’ll share with you the process that I use to:

Assess an older person’s blood pressure management plan, and
Determine whether we should attempt changes.

If you’re an older adult, you can use this approach to get started assessing your own BP management plan. This will help you to better work with your doctors on assessing and managing your blood pressure.

If you are helping an older relative manage health, you can follow these steps on behalf of your relative. [Read more…]

Choosing & Using a Home Blood Pressure Monitor, & What to Ask the Doctor

by Leslie Kernisan, MD MPH 16 Comments

In another article, I’ve explained the key reasons that I recommend older adults and their caregivers have a blood pressure (BP) monitor at home.

To very briefly recap:

Many of the problems of older adults (including falls) can be related to blood pressure.
Home blood pressure measurements can help:
- evaluate for drops in blood pressure with standing (a common cause of dizziness in elders)
- check for serious illness, since these often (but not always) cause the blood pressure and pulse to be very different from usual
- follow-up on blood pressure after a change in medication, which can help doctors and families figure out the best medication dosing for an older person much faster. This is safer for seniors.

In this post, I’ll share some tips on choosing and using a home BP monitor.

And don’t worry: I won’t tell you that you have to plan on checking every day for the rest of your lives. Although there are times when it’s great to check daily — like the week after a change in medication — the most important thing is to have a good BP monitor at home and know how to use it at least occasionally.

Tips for choosing a home blood pressure monitor

[Read more…]

New Blood Pressure Study: What to Know About SPRINT-Senior & Other Research

by Leslie Kernisan, MD MPH 11 Comments

In the summer of 2016, a major study about hypertension treatment in older adults was published in the prestigious JAMA journal: “Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial.”

When an important study like this is published, people often wonder: does this mean they should change the way their hypertension — or their parent’s hypertension — is being managed? Is their blood pressure (BP) at a good level? Should they be on more medication?

In this post, I review the most essential things to know about these blood pressure research findings. This will enable you to take full advantage of a related post, in which I share with you a step-by-step process you can use, to start to figure out whether an older person’s BP management plan might need to be revised.

Warning: this is one of those medically nerdy posts. But I have to write it, as it’s a foundation for later answering your questions on what your parents’ BP (or your own BP) should be, and whether you should consider a change in medication or treatment. If you just want to know the essentials, skip down to the key takeaways at the end. [Read more…]

What the New Blood Pressure Guidelines — & Research — Mean For Older Adults

by Leslie Kernisan, MD MPH 90 Comments

Are you caring for an older person with hypertension, also known as high blood pressure? Or does your parent take medication to lower blood pressure?

If so, you are probably wondering just what is the right blood pressure (BP) for your older relative, especially given the 2015 publication of the Systolic Blood Pressure Intervention Trial (abbreviated as “SPRINT”) research results.

[Looking for information related to the November 2017 new high blood pressure guidelines? See here: New High Blood Pressure Guidelines Again: What the Cardiology Hypertension Guidelines Mean for Older Adults.]

The SPRINT study first made headlines in September 2015, in part because the findings seemed to contradict the expert hypertension guidelines released in December 2013, which for the first time had proposed a higher goal BP ( a systolic BP of less than 150mm mercury) for most adults aged 60 or older.

In particular, SPRINT randomly assigned participants — all of whom were aged 50 or older, and were at high risk for cardiovascular events — to have their systolic blood pressure (that’s the top number) treated to a goal of either 140, or 120. Because the study found that people randomized to a goal of 120 were experiencing better health outcomes, the study was ended early.

For those of us who specialize in optimizing the health of older adults, this is obviously an important research development that could change our medical recommendations for certain seniors.

But what about for you, or for your older relative? Do the SPRINT results mean you should talk to the doctor about changing your BP medications?

Maybe yes, but quite possibly no. In this article, I’ll help you better understand the SPRINT study and results, as well as the side-effects and special considerations for seniors at risk for falls. This way, you’ll better understand how SPRINT’s findings might inform the BP goals that you and your doctors choose to pursue.

Here’s what this post will cover regarding the SPRINT study:

Who was included and excluded from SPRINT, and what the research intervention involved, including the type of BP medications that were used most often
What the actual likelihood of benefits and harms was within SPRINT, and what you might expect if you are similar to the SPRINT participants
Why you probably need to make a change in how your blood pressure is measured before considering a SPRINT-style systolic BP goal of 120.
What this means for new blood pressure guidelines

[Read more…]

Tips for choosing a home blood pressure monitor

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