Lots of leeway for optimal blood pressure

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May 23, 2019 - 9:42 AM

Dear Dr. Roach: My husband is 75. I am 68. Our family doctor says that our blood pressure average is fine at 140/80 with no medicine. We thought it should be 120/70, but he says the limit is higher for seniors in order to decrease falls. This is pretty confusing. Do you think it’s OK? — S.M.

Answer: The best goal for blood pressure has been the subject of controversy. For the overall population, a level of 120/80, slightly less than the average blood pressure in the U.S. and Canada, is associated with a lower risk of heart disease, stroke and death than a blood pressure of 140/80. But the difference is pretty small. A blood pressure of 160/90 has a significantly higher risk, and at blood pressures above 160 systolic (that’s the first or “top” number), the risk for stroke and heart disease rises steeply.

A recent trial (the SPRINT trial) showed that among older people with high blood pressure who had increased risk for heart attack, a systolic blood pressure goal of 120 was better at reducing risk than a blood pressure goal of 140. Both groups had a diastolic (the second or “bottom” number) goal of less than 90. However, the goal among people at lower risk is not as clear.

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