High Blood Pressure

High blood pressure (HBP) is common among senior citizens in the United States and is a serious condition that can significantly increase the probability of having coronary heart disease, a heart attack, stroke, kidney failure, and other health problems and risks. In literal terms, "blood pressure" is the force of blood pushing against arterial walls while the heart pumps out blood. A large force over a long period of time is called HBP and it can cause extensive damage to the body. It is very important that senior citizens understand what their blood pressure means and how they can effectively prevent and, if necessary, treat HBP. People who participate in the elder care of senior citizens should also be familiar with HBP and how they can encourage behaviors that facilitate healthy blood movement. 

Overview

In the United States, about one in three adults have HBP. By itself, HBP has no apparent symptoms; it could be damaging the heart, blood vessels, kidneys, and other parts of the body for years without any obvious signs. Because of this, knowing your blood pressure is important regardless of how you physically feel. That way, you can take the necessary steps if your pressure is too high. Senior citizens and those involved in their elder care should monitor blood pressure regardless of what range it is in. If it is normal, you should work to keep it in that range. If it is high, you should seek treatment to minimize and prevent damage to your body. 

Blood Pressure Numbers

The numbers that make up the pressure reading include systolic pressure, which is the pressure when the heart is pumping blood, and diastolic pressure, which is the pressure when the heart is resting between beats. Often, your blood pressure will be written and stated as systolic over diastolic. For example, you might see 120/80 mmHg, which someone would say aloud as "120 over 80."

The following table presents normal numbers for adults and shows you which numbers place you at a greater risk for health problems. BP may fluctuate, but if your numbers are consistently above normal, you are at risk for developing high blood pressure.

*These ranges apply to adults without short-term serious illnesses, which could temporarily change blood pressure.

Levels above 120/80 mmHg raise your risk, which continues to rise as the numbers increase. "Prehypertension" implies that you are prone to developing high BP if steps are not taken to prevent it. If you have been treating HBP and your numbers have been in the normal range, your BP is under control, but you still have the condition. Therefore, it is important to continue the treatment to maintain normal levels even if you attain a healthy blood pressure at some point.

Causes

High blood pressure is common in senior citizens because blood pressure tends to rise with age unless you take steps to prevent or control it. For this reason, it is important that senior citizens and those involved in their elder care monitor blood pressure to ensure that it remain in or return to the normal range.

There are certain medical problems that may raise blood pressure levels, such as chronic kidney disease, thyroid disease, and sleep apnea. Some medicines may also raise blood pressure. These include medications for asthma (corticosteroids) and even over-the-counter cold-relief products.

Some women experience a raise in blood pressure if they use birth control pills, become pregnant, or use hormone replacement therapy. For women going through menopause, taking hormones to reduce symptoms can cause a small rise in systolic blood pressure. If you already have HBP and would like to begin taking hormones, you should discuss the risks and benefits with your physician. If you decide to follow through with taking hormones, it is important to find out how to control your blood pressure and how often you should get it checked to prevent more serious health problems.

Risk Factors

Many risk factors for HBP exist, including certain traits, conditions, and habits. The major risk factors for HBP are described below.

Age

Since blood pressure rises with age, senior citizens have a higher risk of developing HBP. In the United States, over half of the senior citizens have HBP. The most common form of HBP in senior citizens is isolated systolic hypertension (ISH), which is defined as having high systolic pressure (top number) only. About two-thirds of senior citizens with HBP have ISH. Although many senior citizens have HBP, it is not necessarily a normal part of aging. There are many ways to stay healthy and maintain blood pressure at a normal level as we age.

Race and Ethnicity

Anyone of any background can develop HBP, but it is more prevalent in African American adults than it is in Caucasian or Hispanic American adults. In relation to these groups, African Americans: 

• Tend to get HBP earlier in life
• Often have more severe HBP
• Are more likely to be aware that they have HBP and to get treatment
• Are less likely than Caucasians and about as likely as Hispanic Americans to achieve target control levels with HBP treatment
• Have higher rates than Caucasians of premature death from HBP-related complications, such as coronary heart disease, stroke, and kidney failure

HBP risks vary among different groups of Hispanic American adults. For instance, Puerto Rican American adults have higher rates of HBP-related death than all other Hispanic groups and Caucasians. But, Cuban Americans have lower rates than Caucasians.

Overweight or Obesity

If you are overweight or obese, you are at a higher risk for developing HBP. Being overweight is defined as having extra body weight from muscle, bone, fat, and/or water; obesity is defined as having a high amount of extra body fat.

Gender

More adult men than women have HBP, yet younger women aged 18-59 are more likely than men to be aware of and seek treatment for BP. Women over 60 have the same likelihood as men of being aware of and seeking treatment for HBP, but among the group of women over 60 who are being treated, control of blood pressure is lower than it is in men of the same age group.

Unhealthy Lifestyle Habits

Certain lifestyle habits can be risk factors for HBP. Senior citizens and their caregivers should minimize and discourage the following unhealthy behaviors:

• Consuming too much sodium in salty foods or drinks
• Drinking an excess of alcohol
• Insufficient potassium intake
• Insufficient exercise or physical activity
• Smoking

Other Risk Factors

A history of HBP in your family may increase your susceptibility to developing HBP. Long periods of stress may also contribute to your risk.

Signs and Symptoms

In general, high blood pressure by itself is not accompanied by any noticeable symptoms. Infrequently, you may experience headaches if you have HBP. It is possible to have HBP for years without realizing it. This does not mean that it is not doing harm to your body at this time; on the contrary, HBP can damage the heart, kidneys, blood vessels, and other parts of your body without your knowledge.

Often, people learn that they have HBP only after they experience a heart attack or stroke or develop coronary heart disease. Having your blood pressure checked regularly and knowing your numbers is very important in preventing damage as well as more serious health problems. Maintaining a normal blood pressure or working to lower a high blood pressure can significantly lower your risk of developing more serious health problems.

Complications 

Over time, high blood pressure can cause:

• Enlarging or weakening of the heart, which can lead to heart failure - a condition in which the heart is unable to pump enough blood throughout the body
• The formation of aneurysms-abnormal bulges or "ballooning" in the arterial wall-in blood vessels (Aneurysms commonly form in the in the main artery that transfers blood from the heart to the body; arteries in the brain, legs, and intestines; and the artery that leads to the spleen)
• Narrowing of blood vessels in the kidneys, which may cause kidney failure
• Narrowing of arteries throughout the body (especially in the heart, brain, kidneys, and legs), which limits blood flow and may lead to a heart attack, stroke, kidney failure, or amputation of part of the leg
• Bursting or bleeding of blood vessels in the eyes, possibly leading to blindness or changes in vision

Treatment

Treatments for HBP include lifestyle changes and medication. The goal for treatment is to attain and maintain a blood pressure below 140/90 mmHg.

Lifestyle Changes

One way senior citizens can control blood pressure levels is to develop healthy habits, including:

• Eating a healthy diet
• Getting enough exercise
• Maintaining a healthy body weight
• Quitting smoking
• Managing and learning to deal with stress

A combination of these measures works better than any one habit alone. It can be hard to change your lifestyle, but if you take it slowly and change one thing at a time, changing your habits can be more manageable. Those involved in senior citizen elder care should encourage and help facilitate these healthy changes. 

Sometimes it is possible to control blood pressure levels with lifestyle changes alone, but some senior citizens may need to take prescribed medicine on top of maintaining the lifestyle changes they have adopted to help lower blood pressure. The goal for people with HBP is to control blood pressure as much as possible, so it is important to keep up a healthy lifestyle even after beginning to take medication.

Follow a Healthy Eating Plan

Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have HBP. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and lower in sodium (salt). 

This eating plan is low in fat and cholesterol. It also features fat-free or low-fat milk and dairy products, fish, poultry, and nuts. The DASH eating plan suggests less red meat (even lean red meat), sweets, added sugars, and sugar-containing beverages. The plan is rich in nutrients, protein, and fiber. 

To help control HBP, you should limit the amount of salt that you eat. This means choosing low-salt and "no added salt" foods and seasonings for the table and when cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item. You should eat no more than about 1 teaspoon of salt a day. 

You also should try to limit alcoholic drinks. Too much alcohol will raise your blood pressure. Men should have no more than two alcoholic drinks a day. Women should have no more than one alcoholic drink a day. 

Do Enough Physical Activity 

Regular physical activity can lower HBP and also reduce your risk for other health problems. Senior citizens often feel anxious about beginning an exercise routine. It is helpful to check with your doctor about how much and what kinds of activity are safe for you. Unless your doctor tells you otherwise, try to get at least 30 minutes of moderate-intensity activity on most or all days of the week. You can do it all at once or break it up into shorter periods of at least 10 minutes each. 

Moderate-intensity activities include brisk walking, dancing, bowling, riding a bike, working in a garden, and cleaning the house. If your doctor agrees, you also may want to do more intense activities, such as jogging, swimming, and playing sports. Those involved in the elder care of senior citizens should help facilitate and encourage appropriate physical activity for the senior. 

Maintain a Healthy Weight

Staying at a healthy weight can help control blood pressure and also reduce your risk for other health problems. If you are overweight or obese, aim to reduce your weight by 7 to 10 percent during your first year of treatment. This amount of weight loss can lower your risk for health problems related to HBP.  After the first year, you may have to continue to lose weight so you can lower your body mass index (BMI) to less than 25. 

BMI measures your weight in relation to your height and gives an estimate of your total body fat. A BMI between 25 and 29 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for keeping blood pressure under control. 

Quit Smoking 

Smoking can damage your blood vessels and raise your risk for HBP. It can also worsen health problems related to HBP. Smoking is bad for everyone, especially those who have HBP.

If you smoke or use tobacco, quit. Talk to your doctor about programs and products that can help you quit. 

Managing Stress 

Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.  Physical activity helps some people cope with stress. Other people listen to music or focus on something calm or peaceful to reduce stress. Some people pray, learn yoga, or mediate. 

Medication

It is very important to take all the blood pressure medications your physician prescribes. Know the names and doses of all your medications, and ask your doctor or pharmacist questions if you have any. Order refills of your prescriptions before they run out, and take your medicines just as they were prescribed (do not skip days or take more or less than the suggested dose). If you experience side effects, talk to your doctor about them. There may be a better medication or dosage for you. Trust your doctor-it is not a good idea to stop taking medications without consulting with a health-care professional.

Prevention

If you have normal blood pressure, you can make changes or maintain healthy habits to prevent high blood pressure. These habits include:

• Eating a healthy diet, which includes limiting sodium and alcohol intake
• Losing weight if you are overweight or obese
• Getting enough exercise or physical activity
• Quitting smoking
• Managing and learning to deal with stress

These steps, whether done individually or collectively, can help reduce the risk of developing HBP. To be most effective in delaying or preventing HBP, following most or all of the steps is suggested.

If you have high blood pressure, you can still make changes to prevent more serious effects of HBP. The healthy habits listed above, along with medication, can improve your quality of life. It is important to closely follow the treatment plan suggested by your physician-this will delay or prevent serious health problems including kidney disease, coronary heart disease, and stroke.

Living with High Blood Pressure

A diagnosis of HBP means that you will have to treat and control it for life-even if treatment successfully lowers your blood pressure, you still have the condition. Making lifestyle changes, taking medicines as prescribed, and getting ongoing medical care will become a part of your life.

Although treatment helps to control blood pressure, it is not a cure. Stopping treatment will raise your blood pressure again, which raises your risk for other health problems. Working toward a healthy future means closely following your treatment plan and working with your health-care team to gain lifelong control of your blood pressure.

Ongoing Care

See your doctor for checkups or tests as often as he or she recommends. Your treatment plan as prescribed by your doctor may change over time, and regular checkups allow you and your doctor to know whether your blood pressure is rising so that your treatment plan can be quickly altered as necessary. During checkups, you can ask your doctor or health care team any questions you have about your lifestyle or medicine treatments.

Keeping track of your blood pressure is vital. Have your blood pressure checked on the schedule your doctor advises. You may want to learn how to check your blood pressure at home. Your doctor can help you with this. Each time you check your own blood pressure, you should write down your numbers and the date.