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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