Blood pressure for the “old old” (those over 85)

 A journal called Clinical Interventions in Aging, includes an article titled “Appropriate blood pressure for the ‘old-old- (85 years and older).” The author states, “treating hypertension in patients over the age of 85 years, ie, the “old-old,” presents a challenge that is different from that encountered when treating any other age group.” Some in the medical field believe that, for this group (my cohort) the target should be less than 140/80, a target that this author says, “encourages aggressive treatment simply to meet a specific metric.” “Aggressive treatment,” of course, means medications. Besides, this author says, “a study from the University of Leiden in the Netherlands has reported that high blood pressure is “associated with resilience to physical and cognitive decline.”

In the Leiden study, researchers followed 572 85-year-olds for 3.2 years, measuring their blood pressure, their activities of daily living (ADL), and their cognitive scores using the standard Mini-Mental State Examination (MMSE). Their conclusion: “At age 85, higher systolic blood pressure was associated with lower ADL disability scores and higher MMSE scores”—a good thing. Researchers from Oxford, in studying the Leiden data concluded: “lower systolic blood pressure in the oldest-old taking antihypertensives was associated with higher mortality and faster decline in cognitive function.”

In 2003 Dr. Claudia Kawas, a neurologist and professor at UC Irvine, came across previously ignored health records of more than a thousand residents of a retirement community in California. The records consisted of lengthy surveys, taken in 1981, about the residents’ health and lifestyles.  In studying the records, her team found that 1,900 of the original survey takers were still alive and in their 90’s or older. The researchers tested about 1,600 of this still-alive group for a variety of health indicators. Among other things, their findings revealed that having high blood pressure reduced their chances of dementia.

One difficulty with all of this is that I couldn’t find how the researchers defined high blood pressure. Here’s the standard definition: Normal is 120/80; pre-hypertension is 120-139/80-89; stage 1 hypertension is 140-159/90/99; stage two hypertension is 160/100. The article in the New England Journal of Medicine ends with the following: "My final point is that a study from the University of Leiden in the Netherlands has reported that a systolic blood pressure of 180 mmHG is associated with resilience to physical and cognitive decline in patients with pre-existing disability." He doesn't say which "pre-existing disability."

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My adventure with blood pressure meds

Prior to my two knee replacement surgeries, I’d never taken medications to reduce my blood pressure. I didn’t worry about it. The few times I’d had my blood pressure taken in a doctor’s office it was always high—the “white coat effect.” When I take my blood pressure at home, it hovers somewhere in the 125-145 range—sometimes lower, sometimes higher. As I feared, at my pre-surgery appointment, my blood pressure was 190 over something, a number that alarmed the medical personnel and led them to require my local doctor—whom I hadn’t seen in 20 years—to give the go-ahead for my surgery.

At my doctor’s office, as I predicted, my blood pressure was also very high. I needed some kind of intervention that would make it possible for me to have the surgery. My doc prescribed a medicine that combines lisinopril and hydrochlorothiazide. Lisinopril relaxes the blood vessels; hydrochlorothiazide, a diuretic, reduces blood volume. I started taking that medicine—what I call the “combo” drug.

One morning prior to my surgery, I felt a little light-headed and took my blood pressure. It was 87 over something. Whoa! Normal is supposedly 120 (systolic) over 80 (diastolic). (Systolic is the highest arterial pressure just after the heart contracts; diastolic is the minimum pressure during relaxation.) Thinking that the combo drug was overkill, I asked the doc to give me a prescription for just the diuretic, which he did (12.5 mg dose).  

Returning to my doctor’s office, my blood pressure was low enough that he gave the go-ahead for the surgery. To make sure my blood pressure was reasonable prior to my surgery, I took the combo drug for two days before going in, but in between surgeries I took just the diuretic. Prior to the second surgery, I took the combo drug again, just to make sure they didn’t kick me out. After that, I continued taking just the diuretic.

Three weeks after my second knee replacement, I quit taking any blood pressure drug. Since then, I’ve been taking my blood pressure twice a day. As before my surgery, it has stayed mostly in the 125-145 range. That seems OK to me. I relayed this information to my local doctor and he agreed.

It seems to me that an old person shouldn’t be expected to have the same blood pressure as a young person. I’ve started researching this. It appears that nobody really knows what the target should be for  for people my age (85). Some say 150/80. Some say more, some say less. I’ll say more about this next week.

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“Time restricted feeding”

Most of us associate the term “circadian rhythm” with the internal clocks that regulate when we go to sleep and wake up. In fact, your whole body operates on an internal clock. For example, during the day, your pancreas increases its production of insulin, which controls blood sugar levels, then slows it down at night. Similarly, your gut’s “clock” regulates the daily ebb and flow of enzymes, the absorption of nutrients and the removal of waste. Even the bacteria that comprise your gut microbiome operate on a daily rhythm. It turns out that daily rhythms are programmed in our DNA, such that in every organ, thousands of genes switch on and off at roughly the same time every day.

According to a growing body of research, our bodies do best when our eating patterns align with our circadian rhythms. Satchin Panda, a professor at the Salk Institute and an expert on circadian rhythms, argues that people improve their metabolic health when they eat their meals in a daily 8- to 10-hour window, taking their first bite of food in the morning and their last bite early in the evening. Researchers also recommend that you eat a big breakfast and small dinner. That’s because your blood sugar control is best in the morning and at its worst in the evening. You also burn more calories and digest food more efficiently in the morning.

Except for the big breakfast, this “time restricted feeding,” as it’s called, is easy for me. But what about people, such as night owls, whose circadian rhythm seems to be different? I think the researchers have more work to do.

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Asbestos in baby powder

 I’m watching a show about the cosmetics industry called Not So Pretty. The first episode deals with asbestos in cosmetics. Because asbestos occurs in the same geologic formations in which talc is mined, it often turns up in cosmetics. Also in baby powder. I never bought baby powder because I could never figure out what you were supposed to do with it. Apparently, lots of people use it liberally.

Johnson & Johnson, the maker of baby powder, is featured in the first episode of the show. Some women who had used the powder for years began to die of mesothelioma, a lung cancer, and also ovarian cancer (apparently some women use the powder on their privates). In autopsies, researchers discovered asbestos in the lungs of those who’d died of mesothelioma. As reported in one scientific journal, “Through many applications of this particular brand of talcum powder, the deceased inhaled asbestos fibers, which then accumulated in her lungs and likely caused or contributed to her  mesothelioma as well as other women with the same scenario.… In recent years, more than 10 women developed mesothelioma and their only source of asbestos exposure was the use of one brand of talcum powder.” In the  image below, the straight rod is asbestos. 

Lawsuits ensued. Despite proof to the contrary, Johnson&Johnson steadfastly maintained that their baby powder contained no asbestos. In fact, in-house documents as early as the 1970s revealed that company executives were aware of asbestos liabilities. Beginning in 1971, tests from different labs found asbestos in the baby powder, but Johnsons & Johnsons never reported the findings to the FDA. What’s more, they didn’t remove their product from U.S. markets until 2019. The product is still sold in other countries.

Johnson&Johnson is not a nice company, vaccines or no vaccines.

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