I read a health newsletter article the other day that was reviewing “Keys to healthy aging”. One paragraph spoke to the need to lower blood pressure to LESS THAN 120/80. This caught my eye since there is strong evidence that suggests we need to rethink that goal. First, let us all understand the importance of controlling blood pressure to an appropriate target level in order to reduce the risk of a stroke, one of the most disabling events an older adults can experience. It is clear that by reducing the systolic blood pressure, the upper number, can lead to a significant reduction in the risk of a stroke. However, the question that remains is how low do we go? I can guarantee that we don’t need to do the limbo?
There are many studies, the first that came out several years ago and based in an elderly, male Veteran’s population, showed that lowering blood pressure too low is actually wrought with more harm than good. We also now have evidence from other studies that going far below 130/90 doesn’t necessarily produce any further risk lowering benefit, and may actually cause harm. This newer evidence, which actually isn’t that new but just coming to the surface in review committees who make consensus recommendations, is especially strong for people with diabetes. Studies such as the ACCORD trial, INVEST, ABCD, and HOT were well-designed studies and proper interpretation of these studies shows that aggressive lowering of blood pressure is not always aligned with good outcomes.
So what is a good target blood pressure? Any target blood pressure goal should be individualized, to consider life-expectancy, fall risk, and risk for adverse medication effects. What’s the point of lowering blood pressure in a 92 year old to 110/70 if the person is lethargic and dizzy all the time and, as an outcome, falls, breaks a hip and then experiences the negative sequelae thereafter, eg. pneumonia, immobility, chronic pain and fear of falling. Blood pressure goals in the older adult should be about 130/90, in general, but also individualized, as mentioned above. In general, going far below 130/90 is not associated with strong evidence to suggest any further benefit.