What Happens to Blood Pressure as We Age

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Age is a known risk factor for hypertension (high blood pressure), and, as people get older, their blood pressure tends to rise. Many of these changes are typical and, in some ways, expected. For this reason, doctors will regularly monitor your blood pressure readings and adjust treatment as needed to mitigate the risk of cardiovascular disease.​

African American doctor checking senior man's blood pressure
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Monitoring Blood Pressure

Your blood pressure is measured using a device called a sphygmomanometer, which historically evaluated circulating blood pressure based on the height of a column of mercury in a thermometer-like tube. For this reason, blood pressure is still described in millimeters of mercury (mm Hg), even though current monitors are either digital or do not contain mercury.

Blood pressure readings are described with an upper and lower value:

  • Systolic blood pressure is the upper value that measures the pressure at the maximum part of your heartbeat when the heart chambers contract to push blood through the vessels.
  • Diastolic blood pressure is the lower value that measures the pressure in your blood vessels between heartbeats, at the point where the chambers are refilling with blood.

The reading described in values referred to systolic over diastolic. A systolic value of 120 mm Hg and a diastolic value of 80 mm Hg is reported as 120/80 mm Hg and described as "120 over 80."

According to the current guidelines, a normal blood pressure reading is a systolic value of less than 120 and a diastolic value of less than 80.

Hypertension is now generally defined as a systolic pressure of 130 or higher or a diastolic pressure of 80 or higher. Previously it was 140/90.

On the flip side, hypotension (low blood pressure) is generally diagnosed if your blood pressure is lower than 90/60.

Typical Changes With Age

Both systolic and diastolic blood pressure are important when it comes to diagnosing and monitoring hypertension. But they can change in different ways as you age.

Specifically, the systolic blood pressure will tend to rise as you get older, while the diastolic blood pressure tends to fall. This is true for people with pre-existing high blood pressure as well as those with no prior history of hypertension.

For those with pre-existing hypertension, these changes can occur even if the blood pressure is well controlled with antihypertensive drugs.

Older people diagnosed with high blood pressure often have isolated systolic hypertension. This is a type of high blood pressure where only the systolic blood pressure is elevated above 129 (while the diastolic blood pressure remains under 90).

Isolated systolic hypertension is commonly noted in people with atherosclerosis (hardening of the arteries) and heart valve problems, both of which tend to occur in older adults.

Hypotension and Age

Hypotension is also common in many older adults, particularly a form called orthostatic hypotension where you feel light-headed or dizzy whenever you rise from a chair or a prone position.

The diagnosis of orthostatic hypotension (a.k.a. postural hypotension) requires a decrease in systolic pressure of 20 a decrease in diastolic pressure of 10 within three minutes of rising from a seated or lying position.

Orthostatic hypotension is common in adults 65 and over and tends to increase with advancing age. It is associated with cardiovascular disease, particularly carotid stenosis (narrowing of the carotid arteries in the neck).

In addition, receptors called baroreceptors (which regulate blood pressure whenever a person changes positions or is doing physical activities) become less sensitive with age. In severe cases, orthostatic hypotension can lead to syncope (fainting) and injury from falls.

Treatment

If you are being treated for high blood pressure, your doctor may need to adjust your treatment with advancing age. This includes keeping your blood pressure low enough to reduce the risk of heart disease but high enough to prevent orthostatic hypotension.

Current guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) recommends a blood pressure target of under 130/80 for adults 65 and over with stable heart disease.

By contrast, the ACC/AHA guidelines advise against a systolic pressure under 130 and a diastolic pressure under 65 in people over 80. In this group of adults, observational studies have found an association between low systolic and diastolic pressure and an increased risk of cardiovascular disease.

A Word From Verywell

The reasons why blood pressure increases with age are still poorly understood but are a topic of intense research. While a certain level of elevation is unavoidable as you age, you can minimize the risk by following the same lifestyle recommendations as younger people, including a low-fat diet, appropriate routine exercise, and adherence to daily medications.

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