We’re all guilty of not doing the right things for our health even when we clearly know better. The chicken salad or the cheese burger with fries? To exercise or not exercise? In the end, we’re allowed to enjoy ourselves once in a while. It’s the difference between moderation versus poor health habits. Poor habits build up over time and can affect our health quite seriously, especially when it comes to your blood pressure.
We know all of the warning signs and all of the things we’re supposed to do, but we somehow find a way to look for alternatives or the magic potion that cures blood pressure. The topic of blood pressure comes up quite frequently whenever health is discussed. From TV pharmaceutical commercials, internet ads, the first thing that’s measured at your doctor’s visit, or a common topic that’s discussed amongst your friends – we can’t seem to escape it.
Despite the repetitiveness of what you may have heard about blood pressure, there’s a reason it’s brought up periodically. If you have uncontrolled ‘high blood pressure’, it increases your chance for heart disease. If your blood pressure is maintained at a normal level, your risk for heart disease decreases substantially. Heart disease covers a large array of different health issues that we’ll touch on later.
What works and what doesn’t work to maintain a healthy blood pressure? What myths or magic potions have you read about or have heard second hand from your friends that they swear by has helped? Because the repercussions of having uncontrolled high blood pressure for a long period of time are extremely serious, it’s crucial to stick to the facts of what has actually shown to work.
In this article, we provide research based facts about how to manage blood pressure among older adults, share the most effective ways to manage your blood pressure, and hear what others have said about why it’s difficult to maintain a healthy blood pressure.
Facts: Understanding Blood Pressure
Let’s face it, most people aren’t really concerned about their blood pressure numbers until a health event occurs or a doctor brings it up as ‘problematic’ during a clinical visit. The typical story goes like this – we don’t pay attention to our blood pressure numbers until we have to and then it seems to be the only number that we pay attention to.
Before we dive into managing blood pressure correctly, it’s important to understand what blood pressure is and why it must be taken seriously. Blood pressure (measured in mm Hg) is taken with two numbers that look similar to a fraction, the systolic (top number) and diastolic (bottom number).
- Systolic blood pressure: indicates how much pressure your blood is exerting against your artery walls when the heart beats. This measurement is usually regarded as more important because it poses a higher chance for heart disease in older adults.
- Diastolic blood pressure: indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats.
You’ve probably heard multiple times on the news or from educational sessions about what the ideal number your resting blood pressure should be. Blood pressure ranges are currently broken down into four levels:
- Normal: systolic blood pressure <120 mm Hg and diastolic blood pressure <80 mm Hg.
- Elevated: systolic blood pressure 120-129 mm Hg and diastolic blood pressure <80 mm Hg.
- Hypertension Stage 1: systolic blood pressure 130-139 mm Hg and diastolic blood pressure 80-89 mm Hg.
- Hypertension Stage 2: systolic blood pressure ≥140 mm Hg and diastolic blood pressure ≥90 mm Hg.
- Any readings of blood pressure above the normal range is considered ‘high blood pressure’.
- An incredible amount of research has shown hypertension among older adults is the leading cause of developing heart disease and other forms of disability.
Many things can contribute to an inaccurate or poorly represented reading of your resting actual blood pressure. Things like feeling exceptionally tired, just having finished a cup of coffee, eating a large meal with a lot of salt, feeling stressed, or finishing a workout can contribute to elevated blood pressure readings. Let’s take a look at a shortened version of the guidelines for a proper blood pressure reading:
Step 1: Proper Preparation
- Be relaxed in a sitting position with feet on the floor, back supported for at least five minutes.
- Avoid caffeine, exercise, and smoking for at least 30 minutes before measurement.
- Make sure you don’t have an immediate urge to urinate.
- Don’t speak during the measurement.
- Remove any clothing items covering the location of the cuff.
Step 2: Proper Techniques for Measurement
- Ensure the blood pressure device is functioning correctly.
- Make sure the arm is supported (i.e., resting on a desk or table).
- Use the correct cuff size.
Step 3: Proper Measurements
- Use both arms for measurement and use the arm that gives you the higher measurement reading.
- Take two measurements, with 1-2 minutes rest break in between.
Step 4: Proper Documentation
- Record the systolic and diastolic blood pressure reading.
- Note the time of your most recent blood pressure medication taken before the measurement.
- Average the two readings and this represents an accurate measurement.
High blood pressure is quite common among older adults. How common?
- In the United States, it has an estimated 76% prevalence among older adults aged 65 to 74 years of age.
- In the United States, it has an estimated 82% prevalence among older adults aged greater than 75 years of age.
These are high numbers, but don’t freak out. Blood pressure becomes more difficult to manage as we age for a couple of different reasons.
- Both systolic and diastolic blood pressure steadily change as we age, particularly in the fifth or sixth decade of our lives. The systolic blood pressure tends to gradually increase as the diastolic blood pressure tends to decrease.
- Naturally, as we age, our large arteries become more stiff, plaque builds up in our arteries (occurs from time of birth), and our risk for an incident of heart disease gradually becomes higher.
It may seem like an inevitable destiny that older adults will develop high blood pressure given how high the prevalence is in the United States, but don’t lose hope just yet. Through thoughtful attention to your diet, activity levels, and medications (if taking any), your blood pressure can be well controlled.
Relationship Between Blood Pressure and Heart Disease
Blood pressure and heart diseases go hand in hand. If you manage your blood pressure within the normal range, your chance for heart disease can be quite low. High blood pressure left unmanaged for years at a time will dramatically increase your risk for heart disease.
You want to protect the walls of your arteries for a healthy heart. With uncontrolled high blood pressure, the walls of your arteries begin to lose their strength and can malfunction as the stress and pressure becomes overwhelming. Over years of stress on the heart, common heart diseases that can occur include:
- Abnormal heart beats
- Narrowing of the arteries
- Heart attack
- Heart failure
- Heart muscle disease
- Blood vessel disease
What does the research suggest about blood pressure and heart disease? Several research studies have been conducted, with some studies involving over 10,000 older adults. These studies looked at the relationship between blood pressure and heart disease. The numbers showed that lowering blood pressure in older adults with high blood pressure:
- Reduced a severe heart disease from occurring by 29 percent.
- Decreased the chance for a person passing away from heart disease by 33 percent.
- Prevented heart failure by 37 percent.
- Reduced the risk for developing any heart disease up to 50 percent.
- Among older adults that had hypertension, when systolic blood pressure was lowered by 20 mm Hg, the risk for stroke decreased by 33 percent among those aged 80-89 years and 62 percent in those aged 50 to 59 percent.
Blood Pressure Management in Older Adults
The big question, “Does managing blood pressure differ from older adults compared to those under the age of 65 years?” The short answer is ‘no’. Research studies have shown that lowering blood pressure among community dwelling older adults that had high blood pressure resulted with no bad reactions or health threatening events.
Overall, the conclusion is that blood pressure management among healthy older adults should not differ from other adults. A comprehensive research study concluded:
- Lowering blood pressure among frail older adults is one of the few things that have shown to effectively reduce severe complications.
- In community-dwelling older adults, even those aged greater than 80 years, treatment for lowering blood pressure should not differ from those younger than age 65 years.
- No research study has ever shown any harm or less benefit when lowering blood pressure among older adults when compared to younger adults.
If there’s anything that’s different among older adults when managing blood pressure, it’s a term known as ‘orthostatic hypotension’. This term refers to a dramatic drop in blood pressure when changing positions such as from sitting to standing or vice versa. It’s the experience when we stand up too quickly and we feel a tad bit dizzy or lightheaded. Among older adults, this may pose a risk for falling or losing your balance that can lead to an injury. How concerned should you be about this?
Orthostatic hypotension usually only occurs when a person undergoes ‘intensive blood pressure lowering’ protocols. In other words, the person has been provided with medications to lower their blood pressures in a very fast fashion – usually only done in hospitals or medical emergencies.
One group of older adults that do find themselves having difficulty with blood pressure management include those that have multiple pre-existing disabilities, take multiple medications, or have advanced memory difficulties. Older adults that find themselves in these categories fortunately have someone to care for them or live in nursing homes or assisted living facilities. Luckily, blood pressure and medication monitoring are often facilitated by well trained staff members within nursing homes and assisted living facilities.
If a family member cares for you, have a discussion about not continuing to walk and get up if suddenly feeling dizzy. Best advice is to sit back down, wait for the dizziness to resolve, then get up and try it once more only when the dizziness has disappeared.
Best Ways to Lower Blood Pressure Without Medication
Let’s debunk the myths and understand the facts of maintaining a healthy blood pressure. Taking secondhand advice for managing blood pressure shouldn’t be taken lightly. Heart attacks or strokes have long lasting disabilities that can compromise your health, particularly for older adults.
Non-medication means to maintain healthy blood pressure readings are all lifestyle choices. This creates a double edge sword dilemma. It’s wonderful because you have complete control within your own hands to do all of the things that you need to do in order to develop healthy blood pressure. The other sharp end of the sword is that developing the skills to maintain healthy blood pressure takes effort and is often the harder thing to do. Ask yourself if it’s worth it and your answer should always be – “yes, even if it’s the harder thing to do because my life is on the line”.
Six proven methods that have shown to have effective results in research studies include:
- Weight Loss: Aim for your ideal body weight but it’s recommended to lose at least 2.2 pounds in older adults who are overweight. You can expect about a one mm Hg decrease in systolic blood pressure for every 2.2 pounds reduction in body weight. This should be achieved through both the amount of calories consumed and exercise. Because developing a new lifestyle routine takes time to adjust, behavior change is the most challenging aspect of weight loss. Many older adults in research studies that have experienced weight loss experienced a drop of up to five mm Hg alone with weight loss.
- Healthy Diet: The most popular diet recommended to maintain a healthy blood pressure is known as ‘Dietary Approaches to Stop Hypertension’ or DASH. DASH has been the most effective diet for lowering of blood pressure because it comprises a diet high in fruits, vegetables, and low-fat dairy products. In older adults that had high blood pressure, the DASH diet alone reduced systolic blood pressure up to 11 mm Hg.
- Reduced Intake of Salt: Out of the six, this one hits home as the most difficult for many of us. Salt flavors our food and ultimately makes us happier with our meals. Fortunately, people can develop salt-sensitivity, such that over a prolonged period of time with a low salt-diet, your palate will become more sensitive to low amounts of salt in your food. Learn to be judicious with how much salt you put in your food, begin reading food labels, choose “no added sodium added” food products, and have thoughtful consideration when eating out. Just reducing salt intake by 25% (approximately 1000 mg per day) alone for older adults with high blood pressure can reduce systolic blood pressure by six mm Hg.
- A Potassium High Diet: A high potassium diet overlaps a bit with the DASH diet. Potassium has an inverse relationship with blood pressure and hypertension. In other words, if you have adequate potassium in your diet, your blood pressure tends to drop. In addition to lowering your blood pressure, adequate intake of potassium decreases your chance for a stroke as well. If it’s difficult to maintain a high potassium diet, ask your doctor for potassium pill supplements. Four to five servings of fruits and vegetables will provide you with the appropriate amount of potassium for your daily needs. Consider these as part of your diet – bananas, oranges, cantaloupe, spinach, broccoli, sweet potatoes, and cucumbers.
- Physical Activity: Exercise is often dreaded if not already part of your routine. You may find yourself asking “What type of exercise is healthy for an older adult to do?” Aerobic (endurance), resistance training (lifting weights), and static isometrics (long periods of contracting your muscles), are the best exercises effective for lowering blood pressure. For older adults with high blood pressure, exercise alone can decrease your systolic blood pressure up to eight mm Hg. Finding yourself on a time crunch with your busy schedule? High intensity and interval exercises have shown to effectively decrease your blood pressure.
- A recent high intensity research study was completed looking at a cycling exercise class lasting only 15 minutes, four to five times per week, and for a duration of six weeks. Older adults in the study showed a reduced systolic blood pressure by an average of nine mm Hg.
- Here was the layout of the exercise: ‘Two-minute’ warm up, five ‘one-minute’ intervals of cycling at 90 percent of your maximum effort with resistance, 90 seconds of cycling without resistance, and a final three and a half minute recovery cool down phase.
- Alcohol Moderation: For those of us that enjoy alcoholic beverages, moderation is key. If you consume more than 3 standard drinks per day (approximately 36 ounces of beer, 15 ounces of wine, or four and a half ounces of distilled spirits), consider decreasing your daily drinks. Older adults that went from consuming greater than six drinks per day to 3 drinks per day decreased their systolic blood pressure by five and a half mm Hg.
Taking Blood Pressure Medication – Why Some Choose Not To
Following instructions to take your prescribed medications should be a no brainer right? Or is it? If you’ve ever second guessed the effectiveness of the medications that you’ve been prescribed, you’re not alone. Doctors’ and researchers’ number one difficulty with blood pressure management are both aligned – why don’t people take their medications as prescribed when it has proven many times to fight against heart disease?
Although unfortunate, it remains common for people to revisit the hospital many times for health complications because they were not taught properly how to manage their medications. Admittedly, it’s tough. Especially when you’re dealing with over 3 different medications with instructions that seem to be twisting your arm rather than giving you simple instructions. Several people share their personal experiences in a research study looking at why they decided to stop taking their blood pressure medications. Many of these stories may resonate close to your own experiences.
- Beliefs and attitudes: Participants expressed fear about the long-term use of taking blood pressure medications and the possibility of being stuck with it forever. Many had negative feelings about the medications, such that they felt the medications were actually bad for the body. Information on the instructional pamphlets were also difficult to understand and not reader friendly.
- “I was afraid of the medication, because I was told that once I started to take it I would have to take it all my life.”
- “I don’t like them (medicines), they have lots of side effects, they can make you sick… I think that I might get worse instead of better.”
- “I read the whole leaflet but I don’t understand anything, and even the doctor doesn’t explain it.”
- Reasons for not taking medications: Many admitted that sometimes they simply forgot to take the prescribed medications, stopped taking the medication because they generally felt well, or wanted to simply experiment how they would feel if they stopped taking the prescribed medications. A few other participants expressed confidence in their own methods and remedies to treat high blood pressure.
- “My problem is that I forget to take my medication during the day when I don’t have it right beside me.”
- “I’ve stopped taking the tablets when I’ve felt like it, sometimes for a fortnight or three weeks just to see.”
- “If my blood pressure feels more controlled, I’ve reduced the dose myself.”
- “I’m really tired . . . I’ve been taking medication for thirty-one years now and I’m fed up so sometimes I say I’m just going to stop taking it for a while.”
- “I take lemons . . . that’s what helps me the most but the doctors don’t tell you that.”
- Encounters with doctors: The majority of the participants expressed negative experiences with their doctors when it came to becoming informed about blood pressure medications. Negative feelings shared included little time spent with the doctor, the doctor appearing busy or unconcerned, poor understanding of medical jargon used by the doctor, feelings of nervousness around the doctor, and rationales that were not explained as to why the medication is important.
- “There’s not really any conversation, you’re there explaining what’s wrong with you and he doesn’t even look at you, he’s just taking notes . . . He sends you away with a few words ‘here is your prescription’ and that’s it.”
- “Whenever I go to the doctor I would want to ask if I can go running or if it’s OK to ride a bicycle or not, but when I go into the surgery I don’t feel comfortable and I forget everything I wanted to ask.”
- “They’ve told me hundreds of times that I have to lose weight and I just don’t know how because they never explain how to do it.”
As a patient, it often seems the case that you’re the one to be blamed when following instructions incorrectly. Following and understanding everything that you’ve been instructed to do in order to maintain your health is not exactly easy when you’re stressed, worried about your health, meeting several different healthcare professionals, and given a ton of information pamphlets. A few recommendations to alleviate these difficulties:
- Before your visit, take a moment to sit and write down all questions or concerns in a notebook or within your phone. It helps to have a friend or another family member to brainstorm these questions too.
- Leave extra space between each question to take notes or even write down more questions during your encounter with the healthcare professionals.
- Make sure each and every single one of your questions or concerns have been answered properly to your understanding.
- Do not leave the visit under any means until you have fully understood all of the information regarding your medications, health recommendations, and educational handouts.
- Do not feel rushed even if the healthcare professional seems otherwise. Here are some examples you can use for starters:
- “Before I leave, I just want to make absolute sure that I understand this correctly.” Go on to explain what your understanding is regarding the materials that were discussed to the healthcare professional.
- “I didn’t understand this completely. Can you explain it to me again with less medical terms?”
- “If I have a question about something when I’m at home, who can I contact to make sure that I’m doing the right thing with my medications?”
In the back of your head, you were probably already aware of the changes that you needed to make in order to have a healthy blood pressure. It’s important to stick to the facts when it comes to managing your blood pressure as heart disease can be avoided through diligence, hard work, and consistent management of your lifestyle choices. If taking prescribed medications to manage your blood pressure, it’s extremely important that you do not miss your doses as it can lead to serious medical events such as a heart attack or a stroke. Stand your ground and make sure you understand everything when you encounter a healthcare professional because you’re worth it and your health is worth it.