IS TREATMENT OF HIGH BLOOD PRESSURE REALLY NEEDED BY THE ELDERLY?
Yes, but many people mistakenly believe that some degree of high blood pressure is acceptable as they age. Aiding and abetting them, some physicians used to say that the elderly need a higher than normal blood pressure to force an adequate flow of blood through their hardened and narrowed arteries. These beliefs, unfortunately, are sometimes used to rationalize a do-nothing attitude.
Now, dispelling any doubts about the need for treatment of hypertension in older persons, we have the findings of a study involving several thousand people in Framingham, Mass. who were examined annually for 20 years. The Framingham study, according to Geriatrics (35:34), unequivocally links even slightly raised blood pressure to an increased incidence of strokes in the elderly.
On the other side of the coin, Geriatrics cautions against excessive lowering of the blood pressure in older people. Although high blood pressure can cause stroke (brain damage) due to bleeding from a burst artery, excessively low blood pressure can do the same thing, but in a different way. When the blood pressure is too low, clots may form in the blood, lodge in an artery, and thereby cut off part of the brain’s blood supply.
According to the Lancet (1:581), it has been found that hypertensive patients do better if the diastolic BP (the lower of the paired readings) does not come down below 90. While higher than “normal,” this seems to be a safer level for people being treated for hypertension. Those whose pressures are brought down below 90, research shows, are less likely to have strokes but have a much greater chance than normal of having coronary heart attacks, especially if they have already had coronary symptoms such as angina (chest pain).
This is understandable because, in such cases, the flow of blood through the heart’s coronary arteries is already reduced (by cholesterol deposits). By lowering the BP, we reduce the pumping pressure of the circulation and thus the amount of blood flowing through narrowed arteries as well. So, if you are on a BP medication, tell your doctor if your pressure goes very low, or if you feel unusually tired.
Since dehydration reduces the blood volume and thereby exaggerates the effects of medication that lowers blood pressure, people receiving drugs for hypertension should always take an extra amount of fluid. This is particularly important when fever, sweating, diarrhea, etc., cause increased fluid loss. Also, whenever people taking high blood pressure medication feel faint or dizzy, they should lie down, drink some water, and not get up again until the feeling of faintness goes away. If they do not feel better in a few minutes, medical help should be sought without delay.
According to a review in Modern Medicine, the best blood pressure is the lowest one compatible with normal function. This conclusion is based on a study sponsored by the insurance industry which found that “…the untoward effect of blood pressure elevation does not begin at any particular level above the average, but rises progressively with each increase in systolic and diastolic levels recorded. Thus, the life expectancy in patients with below average blood pressure is decidedly better than average.”
So, if your blood pressure is 110/70, you stand a better chance of living longer than someone whose pressure is 120/ 80, everything else being equal, of course.
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