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why high blood pressure in the elderly may be a good thing


Elderly High Blood Pressure

“A person’s physiology is ever-changing at the structural, functional, and molecular levels as they age, and every major organ system experiences physiologic change with time. The changes to the nervous system result mostly in cognitive impairments and the cardiovascular system result in higher blood pressures with lower cardiac output.  These aging-related changes in the cardiovascular system primarily start with changes in connective tissues. Connective tissue stiffens within the arteries, veins, and myocardium, causing them to become less compliant.

This stiffening is secondary to a cessation of elastin production in the 4th decade of life.  Also, collagen turnover is a slow process, and both elastin and collagen proteins accumulate free radical damage over time.  As elastin is damaged, it is then replaced with less flexible collagen protein.  Arterial stiffening leads to systolic hypertension….” From the July 2015 issue of Anesthesiology Clinics (Physiology Considerations in the Geriatric Patient)

“In aging there is a progressive increase in cardiac volume due to an increased peripheral resistance. The myocardium and conducting system are subject to fibrosis, the valves calcify, the coronary arteries lose their elasticity, diminish in calibre and become atherosclerotic.  Other vessel walls undergo a similar structural deterioration, becoming progressively less compliant.  Diminished arterial elasticity leads to a progressive increase in blood pressure, especially the systolic component.”
From the March 1985 issue of the Canadian Journal of Anesthesia (Systemic Changes in the Elderly Patient and their Anaesthetic Implications)

Researchers from Switzerland and the Netherlands recently teamed up to bring us a study titled Lower Blood Pressure During Antihypertensive Treatment is Associated with Higher All-Cause Mortality and Accelerated Cognitive Decline in the Oldest-Old-Data from the Leiden 85-Plus Study that was published in the issue of Age & Aging that came out just a few days ago.  In this study researchers looked at over 500 patients that were 85 years or older; some of them on high blood pressure medications (anti-hypertensives) and some of them not.  Below is a direct quote from the authors.

“Participants taking antihypertensives showed an association between accelerated cognitive decline and lower blood pressure; decline in cognition was more rapid in those with lower hand grip strength. In participants not prescribed antihypertensive treatment, no significant associations were seen between blood pressure and either mortality or cognitive decline.”

Although this is fairly simple and straightforward, allow me to break it down for you.  In patients over 85 who had been on anti-hypertensives for at least a year, their minds were more likely to go south and they were more likely to die than those not on the drugs.  How much more likely?  Try 29% on for size.  The hand strength test was simply testing for frailty.  The more frail the person, the worse their cognitive decline — if they were on blood pressure medication.

This phenomenon is why I have heard MY BROTHER complain about the absurdity of doctors putting their elderly patients on BP meds.  It also reminds me of studies on HIGH BLOOD PRESSURE and salt intake.  Despite doctor’s incessant warnings not to consume salt, some of the biggest studies ever done on the subject indicate that those consuming the least amount of salt have the highest mortality rates (HERE are my salt posts).  Lest you think these author’s findings are an aberration, pay attention to some cherry-picked tidbits from their conclusions concerning SBP (Systolic Blood Pressure — the first number of your blood pressure reading).

“Our findings are in line with other studies showing the same associations of low SBP and increased mortality. For cognition, age seems to modify the associations; in studies with patients aged  over 60 there was either no association between BP and cognitive decline or an association of higher SBP with a lower risk of dementia. At age 85 years and older, low SBP predicts the onset of dementia and is associated with worse cognitive function….

These findings could explain the accelerated cognitive decline we found in our patients with low SBP under antihypertensive treatment. Our results are also in line with Mosello et al.’s findings where 172 patients with an average age of 79 years, taking antihypertensive therapy, and with a diagnosis of dementia or mild cognitive impairment of outpatient memory clinics were followed-up for a median of 9 months. Our results confirm and extend these findings by showing similar associations in a population-based cohort over a longer observation period of 5 years.”

What’s going on here?  Everyone knows that high blood pressure leads to all sorts of health problems, including strokes.  While this is true, particularly in the “non-elderly” population, in the geriatric crowd you must remember that blood pressure naturally goes up with age — it has to.  As I showed you at the top of the page, this is because all tissues, blood vessels included, get stiffer and less elastic as we get older.  Increased blood pressure allows this stiffness to be overcome so that blood can actually perfuse THE FIBROTIC TISSUES, brain included. 

Furthermore, if your BP really is too high, in most cases there are far better ways to lower it than drugs, many of which can be found HERE.  Oh, don’t forget to spread the wealth on FACEBOOK if you appreciated this post.


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