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Diseases

High blood pressure in older adults — can lowering it too much be harmful?

Sources: 8 · Article: 11 670 characters

Jerzy Jaśkowski claims that lowering blood pressure in older people to 140/80 was said to cause impaired consciousness and worsen dementia.

  • He recommends not aiming to lower blood pressure rapidly in older adults.
  • According to him, treatment should depend on age: the upper limit for blood pressure is 100 plus age, and the lower limit should not exceed 90 mm Hg.

What the authors write

Jerzy Jaśkowski

In older people with high blood pressure, the aim should not be to lower it rapidly.

„Therefore, the aim should not be to lower blood pressure rapidly in older people with high blood pressure. Normal blood pressure ranges depend on the patient's age. The optimal blood pressure of 120/80 mm Hg, introduced in the 1970s, was normal for young people.”Nie należy więc dążyć u osób starszych z nadciśnieniem do jego gwałtownego obniżania. Normy prawidłowego ciśnienia zależą od wieku chorego, czyli wprowadzane w latach 70 ubiegłego wieku jako optymalne ciśnienie 120/80 mm Hg było prawidłowe dla młodych ludzi.
Podstawy fizyczne hemodynamiki cz. 2
Jerzy Jaśkowski

Lowering blood pressure to 140/80 in older people was said to cause impaired consciousness and worsen dementia.

„However, this caused serious disturbances in patients' consciousness and worsened the condition known as dementia. Recently, the age-plus-100 value has been adopted again for older people. It is more important to keep the lower limit at no more than 90 mm Hg. Neither the aorta nor other large arteries have blood vessels that nourish them.”Powodowało to jednak poważne zaburzenia w świadomości chorych i nasilenia zjawiska zwanego demencją. Ostatnio powrócono do wartości wiek plus sto dla osób starszych. Większe znaczenie ma utrzymywanie dolnej granicy nieprzekraczającej 90 mm Hg. Zarówno aorta, jak i inne duże tętnice nie posiadają naczyń odżywczych.
Podstawy fizyczne hemodynamiki cz. 2
Jerzy Jaśkowski

Blood pressure should be adjusted according to age, and the stated upper limit is 100 plus age.

„Normal blood pressure ranges depend on the patient's age. The optimal blood pressure of 120/80 mm Hg, introduced in the 1970s, was normal for young people. For older people, the accepted values set the upper limit at 100 plus age, so, for example, a 60-year-old can have a blood pressure of 160/80.”Normy prawidłowego ciśnienia zależą od wieku chorego, czyli wprowadzane w latach 70 ubiegłego wieku jako optymalne ciśnienie 120/80 mm Hg było prawidłowe dla młodych ludzi. Dla osób starszych przyjęto wartości, że górna granica wynosi 100 plus wiek, czyli np. 60-latek może mieć ciśnienie 160/80.
Podstawy fizyczne hemodynamiki cz. 2
Jerzy Jaśkowski

Jerzy Jaśkowski points out that it is important to keep the lower blood pressure number at no more than 90 mm Hg.

„It is more important to keep the lower limit at no more than 90 mm Hg. Neither the aorta nor other large arteries have blood vessels that nourish them. High diastolic pressure causes the artery walls to become progressively thicker. This, in turn, makes it harder to supply nutrients to the cells of the arteries.”Większe znaczenie ma utrzymywanie dolnej granicy nieprzekraczającej 90 mm Hg. Zarówno aorta, jak i inne duże tętnice nie posiadają naczyń odżywczych. Wysokie ciśnienie rozkurczowe powoduje systematyczny wzrost grubości ścianek tętnic. Ten fakt z kolei powoduje trudności w odżywianiu komórek tętnic.
Podstawy fizyczne hemodynamiki cz. 2
Jerzy Jaśkowski

Treatment for high blood pressure should depend on age.

„However, treatment depends very much on age. In young people, an increased heart rate is most often related to nervousness, so it is enough to give them herbs: lemon balm, valerian, or hops. Such herbal teas can be drunk three times a day.”Leczenie jednak jest zdecydowanie zależne od wieku. U osób młodych przyspieszenie pracy serca ma najczęściej podtekst nerwowy, wystarczy więc podawać zioła: melisę, kozłek lekarski, czyli popularną walerianę lub chmiel. Takie herbatki można pić trzy razy dziennie.
Podstawy fizyczne hemodynamiki cz. 2

Research from PubMed · Europe PMC

We selected 4 studies with the best, positive results. This is a selection, not a full review of all research.

Total number of studies on this topic in PubMed: 991.

Among people aged 60–80, more intensive treatment reduced the rate of the primary cardiovascular outcome compared with standard treatment.

Aim of the study: The appropriate target for systolic blood pressure to reduce cardiovascular risk in older patients with hypertension remains unclear.

Results: Of the 9624 patients screened for eligibility, 8511 were enrolled in the trial; 4243 were randomly assigned to the intensive-treatment group and 4268 to the standard-treatment group. At 1 year of follow-up, the mean systolic blood pressure was 127.5 mm Hg in the intensive-treatment group and 135.3 mm Hg in the standard-treatment group. During a median follow-up period of 3.34 years, primary-outcome events occurred in 147 patients (3.5%) in the intensive-treatment group, as compared with 196 patients (4.6%) in the standard-treatment group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.92; P = 0.007).

Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension. · N Engl J Med 2021
Money for the studygovernment, public institutions · Chinese Academy of Medical Sciences, National Natural Science Foundation of China, Beijing Outstanding Young Scientist Program
Do the authors have ties to companies?not stated
Did a manufacturer help with the study?unknown
Type of studystudy with random allocation to groups (RCT)
Participants8 511

“Not stated” does not mean nobody paid — the database does not always record it.

Among people aged 75 years or older, an intensive blood pressure target was associated with a lower rate of cardiovascular events and deaths.

Aim of the study: To evaluate the effects of intensive (<120 mm Hg) compared with standard (<140 mm Hg) SBP targets in persons aged 75 years or older with hypertension but without diabetes.

Results: Among 2636 participants (mean age, 79.9 years; 37.9% women), 2510 (95.2%) provided complete follow-up data. At a median follow-up of 3.14 years, there was a significantly lower rate of the primary composite outcome (102 events in the intensive treatment group vs 148 events in the standard treatment group; hazard ratio [HR], 0.66 [95% CI, 0.51-0.85]) and all-cause mortality (73 deaths vs 107 deaths, respectively; HR, 0.67 [95% CI, 0.49-0.91]). The overall rate of serious adverse events was not different between treatment groups (48.4% in the intensive treatment group vs 48.3% in the standard treatment group; HR, 0.99 [95% CI, 0.89-1.11]).

Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial. · JAMA 2016
Money for the studygovernment, public institutions · NCATS NIH HHS, NCRR NIH HHS, NHLBI NIH HHS
Do the authors have ties to companies?not stated
Did a manufacturer help with the study?unknown
Type of studystudy with random allocation to groups (RCT)
Participants2 636

“Not stated” does not mean nobody paid — the database does not always record it.

A review of studies in people aged 65 years or older found fewer serious cardiovascular events with more intensive blood pressure lowering, without a significant increase in serious adverse events.

Aim of the study: The 2014 Eighth Joint National Committee panel recommended a therapeutic target of systolic blood pressure (BP) <150 mm Hg in patients ≥60 years of age, a departure from prior recommendation of <140 mm Hg. This study assessed the efficacy and safety of intensive BP-lowering strategies in older (age ≥65 years) hypertensive patients.

Results: We identified 4 high-quality trials involving 10,857 older hypertensive patients with a mean follow-up of 3.1 years. Intensive BP lowering was associated with a 29% reduction in MACE (RR: 0.71; 95% CI: 0.60 to 0.84), 33% in cardiovascular mortality (RR: 0.67; 95% CI: 0.45 to 0.98), and 37% in heart failure (RR: 0.63; 95% CI: 0.43 to 0.99) compared with standard BP lowering. Rates of myocardial infarction and stroke did not differ between the 2 groups. There was no significant difference in the incidence of serious adverse events (RR: 1.02; 95% CI: 0.94 to 1.09) or renal failure (RR: 1.81; 95% CI: 0.86 to 3.80) between the 2 groups. The fixed effects model yielded largely similar results, except for an increase in the risk of renal failure (RR: 2.03; 95% CI: 1.30 to 3.18) with intensive BP-lowering therapy. In older hypertensive patients, intensive BP control (systolic BP <140 mm Hg) decreased MACE, including cardiovascular mortality and heart failure.

Outcomes of Intensive Blood Pressure Lowering in Older Hypertensive Patients. · J Am Coll Cardiol 2017
Money for the studynot stated
Do the authors have ties to companies?not stated
Did a manufacturer help with the study?unknown
Type of studycombined analysis of many studies (meta-analysis)

“Not stated” does not mean nobody paid — the database does not always record it.

In people with chronic kidney disease, an intensive blood pressure target was associated with lower mortality, although some adverse events were more common.

Aim of the study: The appropriate target for BP in patients with CKD and hypertension remains uncertain. We report prespecified subgroup analyses of outcomes in participants with baseline CKD in the Systolic Blood Pressure Intervention Trial.

Results: The prespecified main kidney outcome, defined as the composite of ≥50% decrease in eGFR from baseline or ESRD, occurred in 15 intensive group and 16 standard group participants (HR, 0.90; 95% CI, 0.44 to 1.83). After the initial 6 months, the intensive group had a slightly higher rate of change in eGFR (-0.47 versus -0.32 ml/min per 1.73 m2 per year; P<0.03). The overall rate of serious adverse events did not differ between treatment groups, although some specific adverse events occurred more often in the intensive group. Thus, among patients with CKD and hypertension without diabetes, targeting an SBP<120 mm Hg compared with <140 mm Hg reduced rates of major cardiovascular events and all-cause death without evidence of effect modifications by CKD or deleterious effect on the main kidney outcome.

Effects of Intensive BP Control in CKD. · J Am Soc Nephrol 2017
Money for the studynot stated
Do the authors have ties to companies?not stated
Did a manufacturer help with the study?unknown
Type of studystudy with random allocation to groups (RCT)

“Not stated” does not mean nobody paid — the database does not always record it.

Perspectives and opinion materials

The content below presents the authors’ opinions, interpretations and hypotheses. It is not treated as equal to scientific studies and systematic reviews.

Orthomolecular Medicine News Service Opinion material
„Such conditions include the following: Brain disorders, including Parkinson's disease and Alzheimer's disease, stroke, and depression [149-152] Autism [153] ADHD (Attention Deficit Hyperactivity Disorder) [154] Hypertension (high blood pressure) [155-158] Coronary artery disease (atherosclerosis) and acute myocardial infarction [159-162] Improved clinical outcome post-coronary bypass and post-coronary angioplasty [163,164] Atrial fibrillation [165] Asthma [166,167] Obesity [168] Fibromyalgia [169] Diabetes (improved glucose and lipid profile) [170] Multiorgan failure when genetically deficient [171] Improvement in chronic kidney disease [172]…”Such conditions include the following: Brain disorders, including Parkinson's disease and Alzheimer's disease, stroke, and depression [149-152] Autism [153] ADHD (Attention Deficit Hyperactivity Disorder) [154] Hypertension (high blood pressure) [155-158] Coronary artery disease (atherosclerosis) and acute myocardial infarction [159-162] Improved clinical outcome post-coronary bypass and post-coronary angioplasty [163,164] Atrial fibrillation [165] Asthma [166,167] Obesity [168] Fibromyalgia [169] Diabetes (improved glucose and lipid profile) [170] Multiorgan failure when genetically deficient [171] Improvement in chronic kidney disease [172]…
Heart Failure or Therapy Failure? Toxins Cause Cardiomyopathy
Orthomolecular Medicine News Service Opinion material
„Male participants were 50 years or older, female participants were 55 years or older. Participants were permitted to take up to 600 IU/d vitamin D3 (800 IU/d if over 70 years). The trial ran a median of 5.3 years. Mean baseline 25-hydroxyvitamin D [25(OH)D] concentrations for those who provided values were over 30 ng/ml (75 nmol/l). The article was published in the New England Journal of Medicine, which mandated that only the principle outcome for each supplement could be presented in the abstract. For the entire group, neither vitamin D3 nor omega-3 fatty acids reduced the risk of cancer or CVD.”Male participants were 50 years or older, female participants were 55 years or older. Participants were permitted to take up to 600 IU/d vitamin D3 (800 IU/d if over 70 years). The trial ran a median of 5.3 years. Mean baseline 25-hydroxyvitamin D [25(OH)D] concentrations for those who provided values were over 30 ng/ml (75 nmol/l). The article was published in the New England Journal of Medicine, which mandated that only the principle outcome for each supplement could be presented in the abstract. For the entire group, neither vitamin D3 nor omega-3 fatty acids reduced the risk of cancer or CVD.
Top Advances in the Understanding of Vitamin D on Human Health in 2019
Orthomolecular Medicine News Service Opinion material
„Or they may have been older people who got dehydrated, which is also very common among men who are active outside during the summer. Among the most important factors in kidney stones is dehydration, especially among the elderly.[13] Summarizing: Ascorbate in low or high doses generally does not cause significant increase in urinary oxalate.[2-6] Ascorbate tends to prevent formation of calcium oxalate kidney stones.[3,4] Risk factors for kidney stones include a history of hypertension, obesity, chronic dehydration, poor diet, and a low dietary intake of magnesium.”Or they may have been older people who got dehydrated, which is also very common among men who are active outside during the summer. Among the most important factors in kidney stones is dehydration, especially among the elderly.[13] Summarizing: Ascorbate in low or high doses generally does not cause significant increase in urinary oxalate.[2-6] Ascorbate tends to prevent formation of calcium oxalate kidney stones.[3,4] Risk factors for kidney stones include a history of hypertension, obesity, chronic dehydration, poor diet, and a low dietary intake of magnesium.
What Really Causes Kidney Stones (And Why Vitamin C Does Not)

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