Ask Well: Blood Pressure Over Age 70

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While there is debate over how aggressively high blood pressure should be treated in older patients, the definition of a healthy blood pressure does not change with age for the general population.

Normal blood pressure is a reading below 120/80. The top number, 120, is systolic pressure, when the heart beats and is pumping blood. The bottom number, 80, is diastolic pressure, when the heart is at rest between beats. A healthy blood pressure would be below both these numbers, indicating a low risk of heart attacks and stroke.

High blood pressure starts at 140/90. The measurements in between are considered prehypertension.

Experts disagree about whether older patients should be treated with medication to get their blood pressure below 140/90, because that often requires using several drugs, which may interact with other medications, and the treatment can cause dizziness and increase the risk of falls.

Last year, a panel of experts relaxed recommendations for people 60 and older, saying drug treatment should only start at pressures of 150/90. Those guidelines, published in the journal JAMA, recommended that people 60 and older whose pressure is over 140/90 but less than 150/90 could take other steps like losing weight, exercising and reducing salt intake, said Dr. Paul A. James, the first author. But patients 60 or older who already take medication to get their pressure below 140/90 should not change course, he said.

The American College of Cardiology still recommends getting blood pressure below 140/90 in people up to 80 years old, and the American Heart Association says blood pressure should be under 140/90 until about age 75, at which point, Dr. Elliott Antman, the heart association’s immediate past president, said, “we might allow the blood pressure to creep up to 150.”

But treatment recommendations for everyone could soon become more aggressive. In September, federal health officials abruptly ended a large study of adults 50 and older at high risk for heart disease when it became clear that lowering their systolic pressure to under 120 rather than 140 dramatically cut the risk of heart attack, heart failure and stroke. New data from that study was released last month. Medical groups will be reviewing that data to decide how they might change current recommendations.