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Why Measuring Blood Pressure Is Important For Elderly? Blood pressure, or sometimes referred to as arterial blood pressure, is the pressure exerted by circulating blood on the walls of blood vessels. Blood pressure is a measure of the pressure in the brachial artery, the major artery in the upper arm. A person’s blood pressure is expressed in terms of systolic pressure over diastolic pressure and is measured in millimeters of mercury (mmHg). 120/80 mmHg, for instance, is a typical blood pressure reading. The desired blood pressure range is between 90 and 120 for systolic pressure and between 60 and 80 for diastolic pressure. When a person’s blood pressure reading is persistently at or above 140/90 mmHg, he or she is said to have hypertension or more commonly known as high blood pressure. High blood pressure requires the heart to work harder than normal to circulate blood through the blood vessels. People with hypertension are at a higher risk of getting a number of medical disorders including stroke, heart disease (heart attack, heart failure, etc.), peripheral arterial disease and eye disease. Hypertension is also a cause of chronic kidney disease. However, one elevated blood pressure reading does not imply that hypertension does exist, especially for the elderly. It is necessary to record blood pressures on multiple occasions at rest before a diagnosis of hypertension can be confirmed. This is because the loss in elasticity and stiffening of arteries with ageing means an elevation in systolic blood pressure will be quite common with emotional stress, anxiety and physical exercise.
Furthermore, the so-called ‘white-coat hypertension’ and ‘pseudo-hypertension’ will induce labile systolic blood pressure elevation, too. Many elderly are prone to white-coat hypertension, also known as ‘white coat syndrome’, where measurements of blood pressure at clinic are high but measurements at elsewhere are normal. This is could be due to anxiety experienced by some people during clinic visit. In such situations, even multiple blood pressure readings at clinic are insufficient because readings taken at home provide a more accurate reflection of the blood pressure status. Pseudo-hypertension is not very common, and it is almost found in older patients. It is a condition where the systolic blood pressure is incorrectly elevated because of significant stiffening and hardening of the walls of the arteries. It happens to those who have thick or difficult-to-compress arteries. People with smaller arteries are also more likely to be affected as compared to those with larger arteries. This condition should be suspected when there are no symptoms and no evidence of damage to any organs, though the blood pressure is persistently high over time and not responding to medication. As illustrated above, some high blood pressure could be just normal. Therefore, a correct diagnosis is important for the elderly in avoiding overtreatment. To assess the effect of persistent hypertension, it is necessary to evaluate the impact of high blood pressure on the heart by using echocardiography. If the results show no changes in the heart, the person would probably have pseudo-hypertension even he or she is persistently hypertensive, not responsive to medication and yet not accompanied by symptoms. The current consensus among experts is that blood pressure in the elderly should be maintained at 140/90 mmHg or less. But for those with weak hearts, diabetes mellitus and chronic kidney disease, the blood pressure should not be more than 130/80 mmHg. Yet lower blood pressure might not be a good idea for certain groups of people. Several trials have shown that for the elderly and for those with underlying blockage of the heart arteries, lowering the blood pressure to 130/80 mmHg or less is linked to an increased incidence of death from heart disease. This is the so-called ‘J-curve effect’ where the benefits of blood pressure lowering turned to a detrimental effect when the blood pressure drops below a certain value. Hence, blood pressure should not be lower than 130/80 mmHg for elderly diabetics or octogenarians who face a higher risk of a postural drop in blood pressure on standing as a result of age-related decreased circulation to the organs.
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