What Is a Normal Blood Pressure Reading for a 70 Year Old Woman?

Are you caring for an older person with hypertension, also known as loftier blood pressure? Or does your parent take medication to lower blood pressure?

If so, yous are probably wondering simply what is the correct blood force per unit area (BP) for your older relative, specially given the 2015 publication of the Systolic Blood Pressure Intervention Trial (abbreviated as "Dart") research results.

[Looking for information related to the November 2017 new high blood pressure guidelines? Encounter here: New Loftier Blood Pressure level Guidelines Again: What the Cardiology Hypertension Guidelines Mean for Older Adults.]

The Dart study offset made headlines in September 2015, in part because the findings seemed to contradict the expert hypertension guidelines released in December 2013, which for the first time had proposed a college goal BP ( a systolic BP of less than 150mm mercury) for most adults anile threescore or older.

In detail, SPRINT randomly assigned participants — all of whom were aged l or older, and were at high risk for cardiovascular events — to take their systolic blood pressure level (that's the meridian number) treated to a goal of either 140, or 120. Considering the study found that people randomized to a goal of 120 were experiencing meliorate health outcomes, the written report was ended early on.

For those of us who specialize in optimizing the health of older adults, this is apparently an important inquiry development that could alter our medical recommendations for certain seniors.

Merely what about for yous, or for your older relative? Do the SPRINT results hateful you should talk to the doctor nigh irresolute your BP medications?

Perchance aye, but quite possibly no. In this article, I'll assistance you better understand the SPRINT study and results, also as the side-furnishings and special considerations for seniors at chance for falls. This way, yous'll better empathize how SPRINT'south findings might inform the BP goals that you lot and your doctors choose to pursue.

Here'south what this post will cover regarding the SPRINT study:

• Who was included and excluded from Sprint, and what the research intervention involved, including the blazon of BP medications that were used nearly oft
• What the actual likelihood of benefits and harms was inside Sprint, and what you might expect if yous are similar to the SPRINT participants
• Why you probably demand to make a alter in how your claret pressure is measured earlier considering a SPRINT-fashion systolic BP goal of 120.
• What this means for new blood force per unit area guidelines

[Note: This original version of this post explained why I supported the December 2013 claret pressure guidelines suggesting a higher BP treatment goal for most older adults. You lot tin still notice that content in the bottom role of the mail service, forth with a link to a handy cheatsheet I developed to assistance family caregivers check an older person for worrisome BP, or risky drops in BP when standing. Also, in January 2017 the American Higher of Physicians and American University of Family Practice issued joint hypertension guidelines endorsing a higher BP handling goal for nearly older adults.]

Who was — and wasn't — studied in the Dart claret pressure trial

Practise the study results apply to you or your older relative? This is one of the ii most of import questions to enquire yourself, when you hear heady news almost clinical research. (The other question to ask is "What's the "number needed-to-treat," which corresponds to your odds of actually benefiting; more than on that below.)

Why? Because a well-done medical report tells us what health outcomes happened when we applied a certain intervention to a certain group of people. If you aren't similar the people who were studied, then there's a higher take chances you won't experience the benefits that study participants did.

So who was in Dart? Here are the criteria the researchers used to define the report group, and enroll participants.

What the SPRINT participants were like:

• Aged 50 or older, systolic blood pressure level of 130-180mm mercury, and at "increased risk of cardiovascular events."
• At increased gamble for cardiovascular disease, which was divers by meeting one of the following conditions:
  • Aged 75 or older. Yeah, that in of itself puts people at take a chance.
  • A 10-year risk of cardiovascular disease of xv% or greater on the basis of the Framingham risk score. You lot can check your own Framingham risk score here; you'll need to know your total cholesterol, HDL cholesterol, and systolic blood force per unit area.
  • Chronic kidney disease, defined by an estimated glomerular filtration rate (eGFR) of 20-60.
  • Clinical or subclinical cardiovascular disease other than stroke . This means things similar a history of heart assault, bypass surgery, peripheral avenue disease, carotid artery stenting or surgery, or whatever testing considered "positive" for cardiovascular disease. For a total list of criteria, meet the published written report's supplemental materials here.

It'due south equally important to consider who was excluded from Sprint. You may have already heard that SPRINT didn't cover people with diabetes or stroke, but the exclusion listing is much longer than that. (See the study appendix for the full detailed listing.)

What the Sprint participants were not like: Older persons with whatsoever of the post-obit diagnoses, conditions, or circumstances were not eligible for the study:

• Diabetes
• Past stroke
• Clinical diagnosis of dementia, and/or being on dementia medication
• People residing in a nursing domicile. (Assisted-living was ok.)
• Substance abuse (active or within the past 12 months)
• Symptomatic eye failure within the past 6 months or left ventricular ejection fraction (by any method) < 35%
• Polycystic kidney disease or eGFR < 20
• "Significant history of poor compliance with medications or attendance at dispensary visits."

Every bit you can see, quite a lot of mutual diagnoses and circumstances were grounds for exclusion from the Sprint written report.

Ultimately, 9361 people were enrolled between November 2010 and March 2013. The boilerplate historic period was 68, and 28% of participants were anile 75 or older.

Surprisingly to me, the average systolic blood pressure at baseline was 140, which struck me as better BP control than average older adults. And but 34% of participants had a systolic blood pressure level higher than 145 at the start of the study. (For comparison, the CDC reports that only 52% of people with hypertension take it adequately controlled.)

On boilerplate, at the start of the study participants were taking ii claret pressure level medications.

What did the Sprint intervention involve?

Dart participants were randomly assigned to be treated to a systolic BP goal of either 140, or 120.

Participants were seen once a month for the first iii months, and then every 3 months subsequently that.

To care for blood pressure, Sprint provided all the major classes of BP medication for free, and also allowed clinicians to apply other BP medications if they saw fit. Here are the primary classes of medication used; I've organized them roughly past how commonly they were used (per table S2 of the appendix).

Blood Pressure Medications Used in Dart:

• Angiotensin converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (ARBs), e.g. lisinopril, losartan
• Diuretics, e.grand. chlorthalidone, hydrochlorothiazide, furosemide, spironolactone
• Calcium-channel blockers, east.chiliad. diltiazem, amlodipine
• Beta-blockers (encouraged for those with coronary artery illness), due east.g. metoprolol, atenolol
• Alpha-one blockers,e.g. doxazosin
• Directly vasodilators,eastward.1000. hydralazine, minoxidil
• Alpha-two agonists,e.grand. clonidine

Those last 3 classes of BP medication were used in 10% of people or less, which makes sense equally none of them are recommended as first-line medication choices for hypertension, centre conditions, or kidney disease.

What about non-drug methods to manage high claret pressure?

In the scholarly publication, the Dart investigators say that "Lifestyle modification was encouraged as role of the management strategy," just they don't provide more specifics on what modifications were encouraged or how. So it's hard to know how whatsoever not-drug methods — diet, practise, salt reduction, stress reduction — might have factored into this written report.

Benefits and Harms Observed in Sprint

Sprint randomly divided participants into an intensive-handling group, which aimed for systolic BP less than 120, and a standard-treatment group, which aimed for systolic BP less than 140.

After i year, the average systolic BP amongst the intensive-handling group was 121, compared to 136 among the standard-handling group. The intensive group required an boilerplate of 2.8 medications to reach their lower BP goal; the standard group required an boilerplate of 1.eight medications.

The follow-upwardly period averaged near three years.

Benefits of intensive BP treatment:

During follow-up, 1.65% per twelvemonth of people in the intensive-treatment group and 2.19% per year of people in the standard-treatment experienced a significant cardiovascular "issue upshot": a heart attack, a stroke, acute decompensated heart failure, or death from cardiovascular causes.

The study authors calculated that "The numbers needed to treat to foreclose a main effect event, decease from any cause, and death from cardiovascular causes during the median 3.26 years of the trial were 61, 90, and 172, respectively."

In other words, if yous are similar the report participants, and if yous decide to switch from a systolic BP goal of 140 to a goal of 120, over a few years you'll have:

• A one in 61 (1.6%) risk of avoiding a cardiovascular event
• A 1 in 90 run a risk (one.one%) take a chance of avoiding expiry from any cause
• A i in 172 take a chance (0.6%) chance of fugitive expiry from cardiovascular causes

(For more on the wonderfully useful statistic the Number Needed to Treat, run across this informative NYT article and also the website www.thennt.com.)

Harms of Intensive BP Treatment

The Sprint investigators were careful to track side-effects and complications. They found that serious adverse events occurred in 38.3% of the intensive-treatment group and in 37.1% of  the standard-treatment group.

Adverse events included problems like hypotension (depression blood pressure), syncope (passing out), electrolyte problems, declines in kidney part, and injurious falls. Most problems afflicted 1-7% of participants, with the exception of orthostatic hypotension — which ways BP dropping with continuing — which afflicted 16-18% of participants. (Continuing BP was checked at baseline, 1, 6, and 12 months and yearly thereafter.)

Although many side-effects were a little more common in the intensively-treated group, injurious falls were equally common in both treatment groups, and affected 7.1% of participants.

This finding is actually consistent with what was reported in a 2014 study of serious falls (e.chiliad. bone-breaking falls) in older people with high blood pressure. In that study, the researchers classified people as being on no BP medication, moderate-intensity BP treatment, or high-intensity BP treatment. Moderate- and loftier-intensity treatment was linked to a near equivalent run a risk of falling over iii years (virtually 8.5%), whereas 7.1% of seniors on no BP medication had a bad fall.

How Blood Pressure level Was Measured in Dart

Blood pressure was measured a very careful way that is quite different from the way patients normally have BP measured by their doctors. Here's what they did in Dart:

• Had people sit downward and rest for five minutes before checking BP
• Checked BP three times consecutively, using an automated BP monitor (Omron 907)
• Used the average of those iii BP measurements to appraise the person'south BP and determine whether medications should be adjusted up or down.

Obviously, this is not the experience that almost people have in the doctor'south office, and likely led to lower BP measurements than those taken nether usual circumstances.

If you are similar to a SPRINT participant and are thinking of aiming for a lower BP goal, be sure to asking that your BP is checked in a similar way. In truth, information technology's a much sounder basis for changing a patient's medications, simply it's not usual care at this time.

Does Sprint hateful New Claret Pressure Guidelines?

[Note: In Jan 2017 the American College of Physicians and American Academy of Family Practice issued joint hypertension guidelines endorsing a higher BP handling goal for most older adults. These guidelines business relationship for the Sprint trial results.]

Briefly, no. Or in any example, not still. That's in office considering guidelines are the result of some skillful group going through a very careful process of show review and synthesis. So information technology will take a while before any reputable group tin can synthesize SPRINT into the existing medical evidence, and finalize guidelines to be released to clinicians and the public.

Now, that doesn't hateful that some doctors won't exist attempting to get patients to a lower blood pressure goal right abroad. Merely information technology's not articulate that this should be done for nearly patients, and at a minimum, people should know that if they are like the SPRINT participants — which they probably aren't — aiming for the lower BP goal likely gives them a 0.five%-one.v% risk of avoiding a bad health effect. (Whereas they will take a very high per centum chance of having to have more than medication every twenty-four hours.)

In fact, I thought information technology was quite funny that the NYT headline reporting on SPRINT proclaimed "Information on Benefits of Lower Blood Pressure Brings Clarity for Doctors and Patients," considering many doctors take gone on the tape with a more nuanced assessment. The NYT itself published a sensible commentary by a well-regarded cardiologist, Dr. Harlan Krumholz, which I would highly recommend: "iii Things to Know About the Sprint Claret Pressure Trial."

As Dr. Krumholz points out, most people who currently take high blood pressure would non have qualified for SPRINT. Information technology's especially notable that people with diabetes were excluded; that was in role because a similar well-done study called Accordance found that intensively treating the blood pressure of people with diabetes did non reduce mortality.

(An added little twist to consider: Withal another research group has studied clinical trials that end early, and found that studies that end early usually report bigger effects than studies that don't cease early. See this JAMA commodity.)

Personally, I concur with Dr. Krumholz's conclusions:

• These results should not exist considered a mandate for people to run out and go treated then their blood pressures are below 120.
• The potential benefits of lowering claret pressure level must be weighed against the harms.
• Nosotros need more information near the residuum of risks and benefits for each person and then that the selection can exist personalized.

In terms of my personal practice: I see a lot of older people who are worried about falls, and a well-washed study published in 2014 establish that blood pressure handling was associated with serious — as in, bone breaking — falls. (Read my coverage of this study here.)

I also find that many of my patients are struggling to manage multiple medications, and are at risk for interactions from their medications. For example, all the medications used in Sprint have side-effects to spotter out for, and many tin interact with other medications or chronic diseases.

There is indeed skilful scientific testify that for those older adults who have a systolic BP in the 160s or higher, getting them down to a systolic in the 140s does reduce the gamble of strokes and other serious cardiovascular diseases. (See hither and here.) So it's certainly important to identify serious hypertension in seniors, and treat it if possible.

Just given the relatively modest accented benefit of aiming for a systolic blood pressure level of 120, I expect that for nigh of my patients, aiming for a systolic BP in the 140s volition remain reasonable.

At present, you are likely still wondering what's the right claret pressure goal for your older relative. I can't tell you for sure for your particular state of affairs. Just here's more information on why to be conscientious about over-treating high blood pressure, and why I agreed with the December 2013 guidelines recommending a systolic BP goal of 150 for nigh seniors.

Why Seniors Should Lookout man Out for Over-Treatment of High Blood Pressure

In my experience, many older adults are taking more BP medication than they need, meaning they've reached a point at which the risks and burdens outweigh the benefits (compared with less ambitious treatment of loftier blood pressure level).

This can cause falls or dizziness due to orthostatic hypotension, and i of the about mutual medication changes I implement as a geriatrician is the cutting back of claret force per unit area medications. (For more than on orthostatic hypotension, see this article at HealthinAging.org, and also this FAQ I wrote about why elderly people get dizzy when standing up.)

If you lot want to read a longer article that I wrote on this topic, shortly afterwards the December 2013 high claret pressure guidelines were released, come across my post at AgingCare.com:

"What the New Blood Pressure Guidelines Mean for Caregivers"

Complimentary Cheatsheet: Get a handy cheatsheet to help you check on an older person'southward blood pressure treatment plan. Includes a PDF copy of my full AgingCare article and tips on what look out for. Click here.

AgingCare.com only publishes manufactures that won't exist published elsewhere on the web, so I can't post the whole thing hither. But here are the highlights related to the December 2013 BP guidelines:

• A higher target BP for adults aged threescore or older. The recommended goal BP is nowless than 150/90,instead of less than 140/90 (which was the target recommended in prior guidelines, published in 2003).

• A college target BP for people with diabetes and/or kidney disease. The recommended goal BP is now less than 140/90, instead of less than 130/80.

What does this hateful for yous, if you lot're caring for aging parents or other older persons? It ways you lot should check on how their BP has been doing.

If it's been much lower than the numbers above, yous should consider discussing the BP medications with your parent'southward doctor. This is especially important if you've had whatsoever concerns about falls or balance. For specific recommendations on how to brand sure your older loved i isn't getting too much blood force per unit area medication, read my full article at AgingCare.com. I also offer tips on checking BP in this mail service: Why I Love Habitation Claret Pressure Monitors.

Last but not least, I provide more guidance on figuring out hypertension handling here: 6 Steps to Amend High Claret Pressure Treatment for Older Adults.

Free Cheatsheet: Go a handy cheatsheet to help you cheque on an older person's blood pressure treatment plan. Includes a PDF copy of my full AgingCare article and tips on what look out for. Click here.

Related Articles:
New High Claret Force per unit area Guidelines Again: What the 2017 Cardiology Hypertension Guidelines Mean for Older Adults
New Blood Pressure Report: What to Know Well-nigh SPRINT-Senior & Other Research

[Note: In January 2017 the American College of Physicians and American Academy of Family unit Practice issued joint hypertension guidelines endorsing a college BP handling goal for most older adults. In November 2017 the American Eye Clan and American College of Cardiology issued new hypertension guidelines that do not suggest a loftier BP treatment goal for older adults. These guidelines account for the Dart trial results. I explain how to understand the two sets of guidlines in this article: New High Claret Pressure Guidelines Again: What the 2017 Cardiology Hypertension Guidelines Mean for Older Adults.]

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Source: https://betterhealthwhileaging.net/new-blood-pressure-guidelines-mean-older-adults/

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