More and more people are being diagnosed with high blood pressure and started on treatment. This triggers the cynic in a lot of us (myself included) and we wonder who’s behind this and what they are getting out of it…

Here are a couple of statements that we come across a lot:

“Blood pressure goes up naturally as you get older. So blood pressure targets should increase with age as well.”

“Blood pressure targets keep being lowered so the drug companies can sell more drugs. This is designed to turn healthy people into patients.”

There is truth in both of these statements, but you won’t be surprised to hear that they bear further examination. Let’s look at the first statement here and I’ll write another post about the second one.
“Blood pressure goes up naturally as you get older. So blood pressure targets should increase with age as well.”

There is no denying that, on average, blood pressure increases with age. Especially the systolic (higher) number which is the pressure in your blood vessels when your heart beats. This is probably due to the walls of the vessels becoming less elastic over time so when the heart pumps they can’t stretch as much, so the pressure increases instead. So far, so good.

In the past, doctors would therefore increase someone’s target blood pressure as they got older, to compensate for this natural change. But sadly, something else that naturally increases as we get older is heart attacks and strokes.


So, although blood pressure goes up naturally with age, so does the death rate from the things associated with high blood pressure. And even if you are older, we know that lowering your blood pressure will bring a reduction in your chance of having a heart attack or a stroke. This is why we now have targets for blood pressure which don’t pay so much attention to your age.


BUT (there’s always a but…) this is a balancing act. As we get older, that loss of elasticity in our blood vessels means that we also won’t manage with as low a blood pressure as when we were younger. If we lower it too far, people may feel faint and fall which is certainly a bad thing. The current UK guidance therefore does suggest a higher target for people who are 80 or older.

The second BUT… is that these are ‘targets’ for lowering blood pressure. They’re just something to aim for. Most authorities accept that many people will not be able to reach the targets, e.g. due to medication side effects or the drugs simply not being good enough. It’s important not to see this as a failure though. Even a small reduction in blood pressure brings significant benefit, whether or not you hit the target. To give one example, a drop of just 5mmHg in diastolic blood pressure has been shown to reduce your chance of having a stroke by a third. And that doesn’t matter whether you’ve hit the target. That’s no reason to stop at just a 5mmHg drop though as the benefit keeps increasing as you get closer to the target.

So, in summary, the targets may be more difficult to reach as we get older, but the benefits largely remain. Our preferred approach is therefore to aim for the target regardless of age, but remember all the benefits you still get if, like a lot people, you can’t quite get there!

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