High blood pressure in older adults

1. What is high blood pressure?

High blood pressure (also called hypertension) means the force of blood pushing against your artery walls is higher than it should be over time.

You usually cannot feel high blood pressure. Many people feel normal, even when their numbers are high. That is why it is sometimes called a “silent” problem.

If high blood pressure is not managed, it can increase the risk of:

• Heart attack
• Stroke
• Kidney problems
• Other heart and blood vessel diseases

2. Why high blood pressure matters more in older adults

High blood pressure can affect people of any age, but it often matters more in older adults because:

• Blood vessels can become stiffer with age
• Many older adults have other conditions like diabetes or kidney disease
• Many are taking several medications at the same time
• Older adults may be more sensitive if blood pressure drops too low

Because of this, your health-care provider may set a blood pressure goal that is right for your age and overall health, rather than aiming for the same numbers as a younger person.

3. How doctors usually treat high blood pressure

Your treatment is personalized. Health-care providers look at:

• Your blood pressure readings over time (not just one reading)
• Your age and overall health
• Other conditions (such as diabetes, heart disease, kidney disease)
• All the medications and supplements you already take

Treatment can include:

• Lifestyle changes, such as: eating patterns with more vegetables and fibre, reducing excess salt where possible, staying as active as is safely possible, not smoking, and moderating alcohol.
• Medications to lower blood pressure, sometimes more than one type

This website does not tell you which medication or dose is right for you. Only your doctor or nurse practitioner can make that decision.

4. Common types of blood pressure medicines in older adults

Health-care providers may choose from several types (or “families”) of blood pressure medications, such as:

• Diuretics (“water pills”) – help your body get rid of extra fluid and salt
• ACE inhibitors or ARBs – help relax blood vessels
• Calcium channel blockers – help relax and widen blood vessels
• Beta blockers – slow the heart and reduce its workload

Each type works differently and may have its own possible side effects, especially in older adults or people with kidney or heart problems.

If you are unsure what type of medicine you are taking, ask your pharmacist. You can bring all your pill bottles to the pharmacy and ask for a clear list.

5. Possible side effects older adults may notice

Not everyone has side effects. But older adults may be more sensitive, especially if blood pressure gets too low.

Call your doctor, nurse practitioner, or pharmacist if you notice:

• Feeling dizzy or light-headed, especially when standing up
• Feeling much more tired or weak than usual
• New or worse confusion or trouble thinking clearly
• Fainting or nearly fainting
• Swollen ankles, feet, or legs
• Very slow or unusually fast heartbeat

Do not stop your blood pressure medications on your own unless your health-care provider tells you to. Stopping suddenly can sometimes be dangerous.

6. Habits and lifestyle that may help

Many guidelines suggest that certain daily habits can help support blood pressure control along with medications. What is safe and realistic is different for each person, especially in older age.

Food and drink

• Eating more vegetables and fruits, prepared in ways that work for your teeth and digestion
• Choosing higher-fibre foods more often (for example, whole grains, beans, lentils)
• Reducing extra salt (sodium) where possible: tasting food before adding salt, using herbs and spices, limiting very salty processed foods
• Moderating alcohol, if you drink, according to your provider’s advice

Movement and activity

• Gentle activities such as walking, light stretching, or other movement you enjoy
• Short, frequent bouts of movement (for example, a few minutes several times a day)
• Balance and strength exercises if your provider says they are safe

Other habits

• Not smoking, or getting help to quit if you do smoke
• Managing stress in healthy ways (relaxation, social connection, hobbies)
• Getting regular sleep as best you can

7. When to call your doctor, nurse practitioner, or pharmacist (non-urgent)

Contact your health-care provider or pharmacist if:

• You feel more dizzy, light-headed, or tired than usual
• You have new swelling in your legs, ankles, or feet
• You notice new or worse confusion, or feel “off” in a way that worries you
• Your home blood pressure readings (if you check) are often much higher or lower than your target
• You are starting a new over-the-counter medicine, vitamin, or herbal product and are not sure if it is safe
• You are having trouble remembering to take your medications as prescribed

If your province has a nurse advice line or health information line, you may also call them for guidance.

8. When to call 911 or go to the emergency department

9. Questions to ask your doctor or nurse practitioner

You can print these questions and bring them to your next appointment:

• What blood pressure goal is right for someone my age and health?
• Are any of my medications more risky for me because I am older?
• Could my blood pressure medicines be increasing my risk of falls or dizziness?
• Should I be checking my blood pressure at home? If yes, how often and when?
• Are there foods, drinks, or over-the-counter products I should avoid?
• What kinds of physical activity are safe and realistic for me?
• How often should we review all of my medications together?