You can have high blood pressure, or hypertension, and still feel just fine. That's because high blood pressure often does not cause signs of illness that you can see or feel. But, high blood pressure, sometimes called "the silent killer," is very common in older people and a major health problem. If high blood pressure isn't controlled with lifestyle changes and medicine, it can lead to stroke, heart disease, eye problems, kidney failure, and other health problems. High blood pressure can also cause shortness of breath during light physical activity or exercise.
What Is Blood Pressure?
Blood pressure is the force of blood pushing against the walls of arteries. When the doctor measures your blood pressure, the results are given in two numbers. The first number, called systolic blood pressure, is the pressure caused by your heart contracting and pushing out blood. The second number, called diastolic blood pressure, is the pressure when your heart relaxes and fills with blood. Your blood pressure reading is usually given as the systolic blood pressure number over the diastolic blood pressure number, such as 138/72. Normal blood pressure for adults is defined as a systolic pressure of less than 120 and a diastolic pressure of less than 80. This is stated as 120/80.
Do I Have High Blood Pressure?
One reason to visit your doctor regularly is to have your blood pressure checked. Routine checks of your blood pressure will help pick up an early rise in blood pressure, even though you might feel fine. If there's an indication that your blood pressure is high at two or more checkups, the doctor may ask you to check your blood pressure at home at different times of the day. If the pressure stays high, even when you are relaxed, the doctor may suggest exercise, changes in your diet, and, most likely, medications.
What is considered high blood pressure for older adults?
Recent updates to guidelines from the American Heart Association and the American College of Cardiology changed the definition of high blood pressure or hypertension for most people. High blood pressure is now generally defined as 130 or higher for the first number, or 80 or higher for the second number (previously it was 140/90). However, there are important considerations for older adults in deciding whether to start treatment for high blood pressure, including other health conditions and overall fitness. If your blood pressure is above 130/80, your doctor will evaluate your health to determine what treatment is needed to balance risks and benefits in your particular situation.
What if Just the First Blood Pressure Number Is High?
For older people, often the first number (systolic) is 130 or higher, but the second number (diastolic) is less than 80. This problem is called isolated systolic hypertension, which is due to age-related stiffening of the major arteries. It is the most common form of high blood pressure in older people and can lead to serious health problems (stroke, heart disease, eye problems, and kidney failure) in addition to shortness of breath during light physical activity, lightheadedness upon standing too fast, and falls. Isolated systolic hypertension is treated in the same way as regular high blood pressure (130 or higher for the first number, or 80 or higher for the second number) but may require more than one type of blood pressure medication. If your doctor determines that your systolic pressure is above a normal level for your age, ask how you can lower it.
What if My Blood Pressure Is Low?
If your blood pressure is lower than 90/60, you have low blood pressure, or hypotension. You may feel lightheaded, weak, dizzy, or even faint. Low blood pressure can be caused by not drinking enough liquids (dehydration), blood loss, some medical conditions, or too much medication.
Some High Blood Pressure Risks You Can't Change
Anyone can get high blood pressure. But, some people have a greater chance of having it because of things they can't change. These are:
- Age. The chance of having high blood pressure increases as you get older.
- Gender. Before age 55, men have a greater chance of having high blood pressure. Women are more likely to have high blood pressure after menopause.
- Family history. High blood pressure tends to run in some families.
- Race. African Americans are at increased risk for high blood pressure.
How Can I Control My Blood Pressure?
High blood pressure is very common in older people. As we age, our vascular system changes. Arteries get stiffer, so blood pressure goes up. This is true even for people who have heart-healthy habits. The good news is that blood pressure can be controlled in most people.
There are many lifestyle changes you can make to lower your risk of high blood pressure:
- Keep a healthy weight. Being overweight adds to your risk of high blood pressure. Ask your doctor if you need to lose weight.
- Exercise every day. Moderate exercise can lower your risk of high blood pressure. Set some goals so you can exercise safely and work your way up to exercising at least 30 minutes a day most days of the week. Check with your doctor before starting an exercise plan if you have any health problems that are not being treated.
- Eat a healthy diet. A diet rich in fruits, vegetables, whole grains, and low-fat dairy products may help to lower blood pressure.
- Cut down on salt. As you get older, the body and blood pressure become more sensitive to salt (sodium), so you may need to watch how much salt is in your diet. Most of the salt comes from processed foods (for example, soup and baked goods). A low-salt diet, such as the DASH diet, might help lower your blood pressure. Talk with your doctor about eating less salt.
- Drink less alcohol. Drinking alcohol can affect your blood pressure. Men should not have more than two drinks a day and women no more than one a day to lower their risk of high blood pressure.
- Don't smoke. Smoking increases your risk for high blood pressure, heart disease, stroke, and other health problems. If you smoke, quit. You are never too old to quit, and the health benefits of quitting can be seen at any age.
- Get a good night's sleep. Tell your doctor if you've been told you snore or sound like you stop breathing for moments when you sleep. This may be a sign of a problem called sleep apnea. Treating sleep apnea and getting a good night's sleep can help to lower blood pressure.
- Manage stress. Relaxing and coping with problems can help lower high blood pressure.
If these lifestyle changes don't lower your blood pressure to a safe level, your doctor will also prescribe medicine. You may try several kinds or combinations of medicines before finding a plan that works best for you. Medicine can control your blood pressure, but it can't cure it. You will likely need to take medicine for the rest of your life. Plan with your doctor how to manage your blood pressure.
High Blood Pressure Facts
High blood pressure is serious because it can lead to major health problems. Make a point of learning what blood pressure should be. And, remember:
- High blood pressure may not make you feel sick, but it is serious. See a doctor to treat it.
- You can lower your blood pressure by changing your day-to-day habits and by taking medicine, if needed.
- If you take high blood pressure medicine, making some lifestyle changes may help lower the dose you need.
- If you take blood pressure medicine and your blood pressure goes down, it means medicine and lifestyle changes are working. If another doctor asks if you have high blood pressure, the answer is, "Yes, but it is being treated."
- Tell your doctor about all the drugs you take. Don't forget to mention over-the-counter drugs, vitamins, and dietary supplements. They may affect your blood pressure. They also can change how well your blood pressure medicine works.
- Blood pressure pills should be taken at the same time each day. For example, take your medicine in the morning with breakfast or in the evening after brushing your teeth. If you miss a dose, do not double the dose the next day.
- Don't take more of your blood pressure medicine than your doctor prescribes. Do not stop taking your medicine unless your doctor tells you to stop. Don't skip a day or take half a pill. Remember to refill your medicine before you run out of pills. If you cannot afford your medicines, talk with your doctor or pharmacist.
- Before having surgery, ask your doctor if you should take your blood pressure medicine on that day.
- Get up slowly from a seated or lying position and stand for a bit before walking. This lets your blood pressure adjust before walking to prevent dizziness, fainting, or a fall.
- As you get older, high blood pressure, especially isolated systolic hypertension, is more common and can increase your risk of serious health problems. Treatment, especially if you have other medical conditions, requires ongoing evaluation and discussions with your doctor to strike the best balance of reducing risks and maintaining a good quality of life.
If your doctor asks you to take your blood pressure at home, keep in mind:
- There are many home blood pressure monitors for sale. Ask your doctor, nurse, or pharmacist which monitor you need and how to use it. Have your monitor checked at the doctor's office to make sure it works correctly.
- Avoid smoking, exercise, and caffeine 30 minutes before checking your blood pressure.
- Make sure you are sitting with your feet uncrossed and on the floor, and that your back is resting against something.
- Relax quietly for 5 minutes before checking your blood pressure.
- Keep a list of your blood pressure numbers, what time you measured your blood pressure, and when you took your blood pressure medication (if you take it). Share this information with your doctor, physician's assistant, or nurse.
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For More Information About High Blood Pressure
American Heart Association
National Heart, Lung, and Blood Institute
National Library of Medicine
National Cancer Institute