High Blood Pressure

…is not always too high.

Many things have changed once one is 85 years old (I guess). As a matter of fact there seem to be more things changed than unchanged – even on a behavioral and personal level as behavioral psychologists tell us.

The same is true for physical conditions such as Blood Pressure (BP). In a recent study systolic hypertension (that’s the first figure) was not associated with higher mortality in over 85-year-olds. This has been checked out by the incredulous Dutch and more than 500 85-year-old residents in the Netherlands were followed up until the age of 90.

Three groups were formed: The first with BP from 110 to 145, the second with BP from 146 to 160 and the third with BP from 161 to 215.

At baseline (age 85) higher systolic BP correlated with better scores in a Mental State Examination and as well in an activity scale of daily living tasks.

During 5 years of follow up, higher baseline systolic BP was associated with less physical and mental decline. This apparent ‘protective’ effect of higher BP was especially prominent in those with most pronounced health problems at baseline.

Results were similar no matter if participants were taking BP medicines or not (J Am Geriatr Soc 2012 Nov; 60:2014).

Medics are considering several possible explanations, one of them being that the ones being most vulnerable to the deleterious effect of high BP have died already. But the message is clear: once you are 85 one does not need to worry too much about a mildly elevated systolic BP (and a few of our patients will be very happy to read this). To the contrary it seems to enable one to lead a better life and not lose ones marbles.

It is not unusual to lower a blood pressure medication at a higher age, because metabolism slows down in general and as a consequence, the same dose of a medicine may have stronger effects some 5 or 10 years later.

Judging health and treatments for certain physical conditions are heavily influenced by the age of the person involved. This refers to prostate-tests, gynaecological check-ups, mammograms, heart murmurs, calorie uptake, amount one should drink per day, immunizations… and BP – but only the systolic!