It won’t take long to see why this latest study grabbed my attention. Because it deals with something that I have suspected, and warned about, for quite some time.
And that’s the fact that older people with low blood pressure—particularly the frail ones—are more likely to die from any cause.
Yet, this is the very same age group that gets medicated to death. (Quite literally, it seems.) So, let’s take a closer look at these findings…
How low should you go?
This research appeared recently in the journal Age and Ageing. The team behind this study found that high blood pressure increased risk of cardiovascular incidents, just as you might expect.
But that’s not all. They also found that elderly patients over the age of 85—and patients up to a decade younger who were particularly frail—were less likely to die if their systolic blood pressure (the top number) was over 150 mmHg.
And this isn’t the first trial to point to the potential dangers of low blood pressure in this population—though conclusions up to now have been conflicting, at best. That’s one reason why international recommendations for optimal blood pressure in this group reach as high as 150/90 mmHg.
But if we’re to believe this latest study, even that may not be high enough.
Increasing age had a bigger impact on all-cause mortality than increasing frailty did. (Which makes sense, as older people are naturally going to die more often than their younger peers.)
High systolic blood pressure, on the other hand, had no ties with elevated mortality—even in adults over the age of 85, those who were severely frail, and those with systolic blood pressure greater than 180 mmHg.
In fact, among this population, risk of dying appeared to drop as systolic blood pressure rose. Death risk plummeted anywhere from six percent for adults with systolic blood pressure between 150 and 159 mmHg, to 16 percent among the severely frail.
And ultimately, blood pressure below 130/80 mmHg was linked with a higher risk of death from any cause among all subjects older than 75, regardless of frailty.
Patients are people, not numbers
The conclusion here is pretty clear: Lower blood pressure might protect the hearts of younger patients. But among the older and frail? It’s pointless at best, and potentially lethal at worst.
And that should worry all of us. Because as I’ve warned here before, blood pressure guidelines are focusing on tighter and tighter targets. That means more hypertension diagnoses, and more drug prescriptions.
The problem, of course, being that—just as with blood sugar among the elderly population—the risks of low blood pressure far outweigh the benefits.
That’s exactly why I hate all of these guidelines. If licensed physicians don’t follow them, they set themselves up for malpractice suits—and yet the standards completely ignore the nuanced big picture.
Now, don’t get me wrong. We know that high blood pressure increases your risk of heart attack, heart failure, and stroke at any age. And it’s also the most common chronic illness among older adults, affecting some 75 percent of people over 80.
But how high is too high… and how low is too low? These are the judgment calls that doctors need to be making on a case-by-case basis.
Guidelines are just that—guidelines. In other words, do NOT allow your doctor to treat you as a number. Every medical decision you make together should be tailored to your needs and your history.
That’s the definition of individualized medicine—and it’s the only way I treat my patients. Because at the end of the day, it’s not just common sense. It’s plain good medicine, pure and simple.
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“Low Blood Pressure Increased Mortality Risk in Older Adults.” Medscape Medical News, 03/09/2020. (medscape.com/viewarticle/926422)