A lower blood pressure goal after 60 may offer better heart protection

Keeping the top blood pressure reading under 130 may help lower the risk of major cardiovascular events in some adults age 60 and older, according to a research review. The findings question the assumption that simply turning a certain age means a higher treatment target is automatically better.

High blood pressure puts extra pressure on blood vessels and raises the chances of serious heart and circulation problems. Choosing an appropriate treatment target may help older adults safeguard their health without exposing them to the problems that can come with overly aggressive treatment.

The encouraging takeaway is that older adults may still benefit from good blood pressure control. At the same time, the review does not point to a single ideal number for everyone, since the best target depends on health conditions, how well treatment is tolerated and other individual factors.

Researchers at the Second Affiliated Hospital of Chongqing Medical University published the analysis in Cardiovascular Innovations and Applications. They pooled evidence from six randomized trials of older adults with high blood pressure, drawing on studies identified through January 2022.

The analysis compared people whose achieved systolic blood pressure was below 130, between 130 and 139, or at least 140. Systolic pressure is the higher number in a blood pressure reading and reflects the pressure when the heart contracts.

Participants in the below-130 group had a lower chance of major cardiovascular events than those whose systolic pressure was 140 or higher. This combined measure brings together several serious outcomes to show the overall pattern of cardiovascular benefit.

Accurate blood pressure measurement is also important when deciding on and evaluating any target.

The estimated odds were notably lower, but the uncertainty around that estimate was wide. It is also important not to confuse a combined outcome with proof that every individual condition improved by the same amount or with the same level of certainty.

In particular, the analysis did not find statistically significant differences for each separate outcome, including individual cardiovascular events and deaths. For that reason, it would be inaccurate to say the review definitively proved that a lower target prevents every kind of heart problem or lengthens life for everyone.

The researchers used a statistical approach that combines direct comparisons with indirect evidence across trials. Differences in participants, medications and study designs can affect such comparisons, and the evidence was more limited for some groups, including the oldest adults.

A treatment goal is not the same as a command to reduce blood pressure as much as possible. Dizziness, fainting, falls, kidney problems and other treatment risks must be weighed when a clinician decides whether a specific target is suitable and tolerable.

For someone over 60, the next step is a conversation based on reliable blood pressure readings and overall health. The study supports considering tighter control when appropriate, while still allowing treatment to be adjusted for people whose circumstances make a more intensive goal less suitable.

If you are interested in this topic, please read articles about This food linked to better heart health and blood pressure in older adults, and The DASH diet is a simple way to lower high blood pressure.

For more information, please see articles about Salt and heart health: does less really mean more?, and What should know about high blood pressure drugs and their side effects.

Source: Second Affiliated Hospital of Chongqing Medical University.