Hypertension, or high blood pressure, is defined by the force of blood against artery walls being consistently too high. In adults, a reading of 130/80 mmHg or higher is generally considered hypertension. The prevalence of this condition increases significantly with age, affecting a majority of adults aged 65 and older. This age group is often characterized by isolated systolic hypertension (ISH), where the systolic pressure is elevated (130 mmHg or higher) while the diastolic pressure remains normal (below 80 mmHg). Uncontrolled hypertension is a leading risk factor for cardiovascular disease, making its management in older adults a major public health concern.
Unique Physiological Causes in Aging
The primary driver of hypertension in older adults is the progressive stiffening and loss of elasticity in the large conduit arteries, such as the aorta. This process, known as arteriosclerosis, reduces the arteries’ ability to buffer the forceful surge of blood from the heart’s contraction. When the arteries cannot expand efficiently, the systolic pressure rises dramatically, resulting in isolated systolic hypertension. This increased arterial stiffness is a direct consequence of age-related changes, including the proliferation of collagen and the loss of elastin fibers within the vascular walls.
Changes in the kidney’s function and neurohormonal systems also contribute to elevated blood pressure. Older adults often develop increased salt sensitivity due to a decline in the activity of sodium-handling pumps in the kidney. This decreased ability to regulate sodium leads to greater fluid retention and increased blood volume, which raises overall blood pressure.
The renin-angiotensin-aldosterone system (RAAS), a hormonal pathway that regulates blood pressure and fluid balance, becomes dysregulated with age. Overactivation of the RAAS promotes vasoconstriction and can lead to fibrosis, or scarring, within the blood vessels and the heart. This imbalance exacerbates the stiffening of arteries and contributes to sustained hypertension.
Serious Complications of Untreated High Blood Pressure
Sustained, uncontrolled blood pressure exerts excessive stress on the cardiovascular system, leading to severe health consequences. Progressive damage to artery walls significantly increases the risk of both heart attack and stroke. High blood pressure forces the heart to work harder against increased resistance, eventually leading to the thickening of the heart muscle and the development of heart failure.
The small blood vessels within the kidneys are particularly susceptible to damage from chronic hypertension. Over time, this damage impairs the kidneys’ filtering capacity, accelerating the progression of chronic kidney disease. Impaired kidney function can further complicate blood pressure control and medication management, creating a challenging cycle.
Hypertension is a major modifiable risk factor for cognitive decline and dementia. The constant high pressure damages the cerebral microvasculature, restricting blood flow to areas of the brain responsible for memory and executive function. This damage can manifest as vascular dementia or contribute to the pathology of Alzheimer’s disease. Untreated hypertension is strongly associated with an accelerated rate of cognitive decline in older individuals.
Essential Lifestyle Adjustments for Control
Effective blood pressure management begins with specific, sustainable lifestyle modifications. These changes can significantly enhance the effects of medication or, in some cases, delay the need for it. The Dietary Approaches to Stop Hypertension (DASH) eating plan is highly recommended, focusing on a diet rich in fruits, vegetables, and whole grains. This plan emphasizes foods high in potassium, calcium, and magnesium, while limiting saturated fats and added sugars.
Reducing dietary sodium intake is a particularly effective strategy for lowering blood pressure. While a standard goal is to limit sodium to 2,300 milligrams per day, a reduction to 1,500 milligrams daily can offer greater blood pressure reduction. Since processed foods are major sources of sodium, reading nutrition labels and using salt-free seasonings are practical adjustments.
Regular physical activity is beneficial, but older adults should choose low-impact exercises that also focus on balance and flexibility to minimize the risk of falls. Activities such as brisk walking, swimming, or tai chi are excellent options for improving cardiovascular health and reducing blood pressure. Additionally, maintaining a healthy body weight and limiting alcohol consumption, typically to no more than one drink per day for women and two for men, support overall management efforts.
Medical Treatment and Ongoing Monitoring
When lifestyle adjustments alone are insufficient, medical therapy is necessary to reach target blood pressure goals. Common medications include thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and calcium channel blockers. The choice of medication is individualized based on co-existing health conditions, such as diabetes or chronic kidney disease.
Healthcare providers typically follow a “start low, go slow” approach when initiating medication in older adults to minimize the risk of adverse effects like dizziness or orthostatic hypotension. This gradual titration helps the body adjust and allows for careful monitoring of side effects. The goal blood pressure is often individualized, balancing the benefits of risk reduction against the potential for treatment-related harm, particularly in frail patients.
For many non-frail older adults, the target for systolic blood pressure is often below 130 mmHg, though targets may be less stringent for the very elderly or those with significant frailty. Ongoing monitoring is necessary, including regular follow-up appointments and consistent at-home blood pressure checks. Home monitoring provides the medical team with accurate data reflective of daily life, facilitating timely adjustments to the treatment plan.