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I have found that the offices that use the electronic cuffs, my mom's blood pressure is always high but if they use the old fashion manual cuff and stethoscope it is in her normal range. I now insist that is the only way for them to take it. My mom is diabetic, CHF, and stage 3 renal disease.
Thank you Dr. Kernisan. I guess a cardiologist may treat a 60's something differently than an older patient. Many people don't realize high blood pressure can make heart walls thicker causing things like congestive heart failure, and kidney problems later in life. Prevention, is best! Low sodium diets are huge in helping reduce high blood pressures, sometimes reducing need for medications.
It's important to know the patient's baseline, resting BP and look for sudden changes, too high can be a blockage and too low can be a hemorrhage. Be aware that the difference between the two numbers should be 30 to 60 points. If it is only 20, say 110/90, the heart is not pumping efficiently.
Hi norestforweary, Good questions. The guidelines recommend a goal of 140/90 for people with diabetes or chronic kidney disease, regardless of age. They don't seem to specify anything for coronary artery disease, but diabetes is often considered a "coronary artery disease equivalent." You can read about the guidelines in Harvard's newsletter here: https://www.health.harvard.edu/blog/new-guidelines-published-for-managing-high-blood-pressure-201312186953 Or you can try combing through the guideline statement in JAMA (free, but long) website: jama.jamanetwork/article.aspx?articleid=1791497
I don't know about specific recs for aortic stenosis and left ventricular hypertrophy...in general I think ideal BP would depend on how bad the conditions are, and whether the heart seems to pump better when BP is lowered to certain levels. This is something that is somewhat testable for a particular patient, by following symptoms, BP, and possibly echocardiograms. For a "youngish" person in their 60s, it might be worth doing.
But I think the point of recent research is that lower is not always better. I was drilled to treat to BP less than 130/80 for diabetes and kidney disease in med school, and finally the medical establishment is admitting that overall there is not good evidence that this results in better outcomes than getting people below 140.
For older people who are frail, the downsides of tight BP control can be substantial. I think it's less likely to be harmful in people in their 60s however; most are medically "middle-aged" and not as vulnerable as the patients I take care of.
The upper limits of blood pressure have been raised for person's over 65 and they are 149/89 with no blood pressure medication needed. There is still debate over this among doctors. It was changed Feb. 19th, and I remember arguing with hospital staff/doctors not to give my husband any hypertension med because he was just anxious being in the hospital. After he came home his B/P went back to his normal for the following three weeks I checked it twice a day.
Interesting article Dr. Kernisan. Taking bp at home can reduce the number of elevated readings at medical facilities due to "white coat syndrome". Low sodium diets are also encouraged to bring down BP numbers. Are the parameters lower than 150/90 for 60 somethings with known cardiac disease such as aortic stenosis, left ventricular hypertrophy or previously diagnosed coronary artery disease? Thanks!
The new recommended target for BP treatment in people aged 60+ is 150/90.
This is controversial among some experts but generally applauded by those of us in geriatrics.
Also, a recently published study found that people aged 70+ on blood pressure medication had more serious falls (fractures, dislocations).
Significant hypertension should certainly be treated, but in my own experience many older adults are taking more medication than they probably need. I do a lot of scaling back the BP meds, as do the other geriatricians I know. Hope this info helps!
Rather than worry about a number (assuming you're within a reasonable range, anyway) I'd look out for marked changes in an individual.
On the other hand, if there is a sudden change, your first thought should be "check it again, please" - hurried readings, wonky cuffs, there are dozens of reasons why b.p. readings can be plain wrong.
The second thought should be a reluctance to tinker unless there's anything else wrong. If you've got a pre-1930 model puttering along happily, don't fiddle with it unless you have to. But good doctors will be adopting this attitude anyway.
I don't know if they are available in your area, but I strongly suggest anyone over the age of 65 see a doctor who is board certified in geriatric medicine. Note: Board Certified. Any doctor can claim they take care of the elderly, however are they board certified?
My mother lives in a city where there is a practice like this and all her doctors report to her geriatrician. Her health has improved dramatically because geriatricians don't dismiss the aches and pains older people may have that are often attributed to 'old age' by regular doctors.
This is a growing field I learned about fifteen years ago.
Yes... it gets confusing, especially (in our case) where the primary doctor doesn't communicate with the heart doctor... (the heart doctor says to 'listen' to the primary doctor... who is overloaded with patients)
Some people run higher than what is "normal". Some lower. My dad always had a low blood pressure and I had to always convey that any time he had his blood pressure taken. So a blood pressure of 120/80 which is within normal limits would not be normal for my dad.
If someone's BP varies from this "normal" it doesn't necessarily mean there's a problem. Medications can affect blood pressure as can diseases and ailments. If someone is in pain their blood pressure may increase or if someone is on diuretics they're blood pressure may be low.
Normal BP is 120/80. However, I recently read an article saying doctors now believe slightly higher numbers may be the real "normal" for an older person. By slightly higher they meant a max of 140/90. The medical community is not in agreement about this as of now.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
Good questions. The guidelines recommend a goal of 140/90 for people with diabetes or chronic kidney disease, regardless of age. They don't seem to specify anything for coronary artery disease, but diabetes is often considered a "coronary artery disease equivalent."
You can read about the guidelines in Harvard's newsletter here:
https://www.health.harvard.edu/blog/new-guidelines-published-for-managing-high-blood-pressure-201312186953
Or you can try combing through the guideline statement in JAMA (free, but long)
website: jama.jamanetwork/article.aspx?articleid=1791497
I don't know about specific recs for aortic stenosis and left ventricular hypertrophy...in general I think ideal BP would depend on how bad the conditions are, and whether the heart seems to pump better when BP is lowered to certain levels. This is something that is somewhat testable for a particular patient, by following symptoms, BP, and possibly echocardiograms. For a "youngish" person in their 60s, it might be worth doing.
But I think the point of recent research is that lower is not always better. I was drilled to treat to BP less than 130/80 for diabetes and kidney disease in med school, and finally the medical establishment is admitting that overall there is not good evidence that this results in better outcomes than getting people below 140.
For older people who are frail, the downsides of tight BP control can be substantial. I think it's less likely to be harmful in people in their 60s however; most are medically "middle-aged" and not as vulnerable as the patients I take care of.
https://www.agingcare.com/articles/what-new-blood-pressure-guidelines-mean-for-caregivers-164338.htm
The new recommended target for BP treatment in people aged 60+ is 150/90.
This is controversial among some experts but generally applauded by those of us in geriatrics.
Also, a recently published study found that people aged 70+ on blood pressure medication had more serious falls (fractures, dislocations).
Significant hypertension should certainly be treated, but in my own experience many older adults are taking more medication than they probably need. I do a lot of scaling back the BP meds, as do the other geriatricians I know. Hope this info helps!
On the other hand, if there is a sudden change, your first thought should be "check it again, please" - hurried readings, wonky cuffs, there are dozens of reasons why b.p. readings can be plain wrong.
The second thought should be a reluctance to tinker unless there's anything else wrong. If you've got a pre-1930 model puttering along happily, don't fiddle with it unless you have to. But good doctors will be adopting this attitude anyway.
My mother lives in a city where there is a practice like this and all her doctors report to her geriatrician. Her health has improved dramatically because geriatricians don't dismiss the aches and pains older people may have that are often attributed to 'old age' by regular doctors.
This is a growing field I learned about fifteen years ago.
http://en.wikipedia.org/wiki/Geriatrics
You can also Google Geriatric Medicine.
If someone's BP varies from this "normal" it doesn't necessarily mean there's a problem. Medications can affect blood pressure as can diseases and ailments. If someone is in pain their blood pressure may increase or if someone is on diuretics they're blood pressure may be low.
It just all depends.