Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries. It is measured using two numbers: systolic pressure, the higher number representing pressure during a heartbeat, and diastolic pressure, the lower number representing pressure when the heart rests between beats. Determining a “normal” blood pressure for an 85-year-old is complex because guidelines change significantly with advanced age and depend heavily on an individual’s overall health status. Management in the very elderly shifts from aggressive lowering to a careful balance of risks.
How Aging Changes Blood Pressure
The physical mechanics of the cardiovascular system naturally change with age, directly affecting blood pressure readings. The primary change is the progressive stiffening of the major arteries, known as arteriosclerosis. This loss of elasticity means the blood vessels are less able to expand to accommodate the surge of blood during a heart contraction.
This decreased flexibility causes the systolic blood pressure (the top number) to increase steadily throughout life. Conversely, the diastolic blood pressure (the bottom number) tends to increase until about age 50 or 60 and then often begins to decrease. The resulting wide gap between the two numbers is known as an increased pulse pressure, which is common in advanced age.
Current Blood Pressure Targets for 85-Year-Olds
The appropriate blood pressure target for an 85-year-old is highly individualized and depends on their overall health. For generally healthy, non-frail individuals, some guidelines suggest a systolic blood pressure (SBP) goal of less than 130 mmHg, similar to younger adults. This intensive goal is considered for those who are active and expected to tolerate medication well.
For many individuals in this age group, especially those who are frail, have multiple chronic conditions, or have a history of falls, a less stringent target is preferred to prioritize safety. A common, more lenient SBP target for the very elderly is in the range of 140 to 150 mmHg. Treating blood pressure below this range may not provide additional benefit and can increase the risk of adverse events.
Diastolic blood pressure (DBP) targets are usually less of a concern, though keeping it above 60 mmHg is advised to ensure proper blood flow to the heart muscle. Clinical judgment is paramount, and the goal is to lower high blood pressure enough to reduce the risk of stroke and heart attack without causing side effects like dizziness. Establishing a personalized and safe treatment plan requires a shared decision-making approach between the patient and physician.
Understanding Hypotension Risks in Advanced Age
While the focus is often on high blood pressure, low blood pressure, or hypotension, presents a distinct and significant danger for the very elderly. Hypotension is generally defined as a reading below 90/60 mmHg, but a sudden drop from a person’s usual range can be problematic even if the reading is technically higher. Aggressive treatment of hypertension can inadvertently lead to this dangerous state.
A common manifestation is orthostatic hypotension, a rapid drop in blood pressure upon standing up from a seated or lying position. This occurs because the body’s baroreceptors, which regulate blood pressure quickly, become less responsive with age. The resulting lightheadedness or dizziness can lead to syncope (fainting) and is a major contributing factor to falls.
Severely low blood pressure can also reduce blood flow to the brain and other organs, potentially causing confusion, cognitive decline, or a state of shock. For the 85-year-old, the risk of harm from an aggressive drop in blood pressure often outweighs the theoretical benefit of achieving a very low target. Medications for other conditions, such as those for prostate issues or depression, can also contribute to hypotension, necessitating careful medication review.
Monitoring and When to Consult a Doctor
Effective management of blood pressure requires consistent and accurate monitoring, often at home, using a validated automatic cuff. Measurements should be taken while seated quietly with the back supported and feet flat on the floor, after resting for a few minutes. It is recommended to take two readings, morning and evening, discarding the first reading for better accuracy.
Home monitoring is particularly useful for detecting orthostatic hypotension. This involves measuring blood pressure while seated and then immediately after standing up to look for a significant drop. Consult a medical professional if readings are consistently outside the personalized target range.
Immediate consultation is necessary for symptoms like persistent lightheadedness, dizziness, fainting, or any sudden, unexplained change in cognitive function or balance. A doctor should also be consulted if there is a sudden and sustained jump in blood pressure, which could indicate a developing problem.