You might not need that blood pressure drug after all

I grew up in the Boston area and have been taking my family back to visit every summer for the past 25 years now. There’s a song associated with the area by the Kingston Trio about a man Charlie who rides the MTA (the old Metropolitan Transit Authority). He gets on the train to take a short hop to his destination, but loses his token and can’t get off. The song goes, “He may ride forever ‘neath the streets of Boston. He’s the man who never returned.”

Well, it turns out blood pressure drugs can be like that train, which is easy to get on, but impossible to get off.

Let me explain…

Blood pressure (BP) starts out low during childhood. In the 1970s, I was actually one of the first researchers to study BP changes in children, and the effects of stress. Then BP rises slowly until it reaches “normal” 120/80 in adulthood. Those nosebleeds that often occur during adolescence may result from normal increases in blood pressure before the thin blood vessels of the nose have adjusted.

When I was taught in medical school in the 1970s, it was also considered “normal” that blood pressure kept going up during adulthood too. It was considered that normal systolic blood pressure was your age plus 100. So at age 20, you were at the normal 120/80. By age 60, you were considered normal at 160 and so on. If you were fortunate to make it into your 70s or 80s, 170 or 180 were still normal.

But then, medicine got a lot more aggressive in treating blood pressure and prescribing drugs.

Of course, blood pressure fluctuates constantly. Today, doctors consider you as having high blood pressure if three readings under controlled circumstances are above 120 systolic and 80 diastolic.

The hidden benefits of “high” blood pressure

Blood pressure above 120/80 during young adulthood and middle age is a big risk factor for cardiovascular diseases. But based on recent studies, some data shows that 130/90 in older adults is just fine. Evidence does NOT link those levels in older adults with more heart attacks or strokes. And it also appears to lower the risk of dementia, as good blood circulation to the brain is important for brain health and cognitive function.

If your blood pressure is too low as you get older, it can cause other problems with light-headedness, fainting and circulation. Plus, it can also be much worse…

How low should you go?

A new study shows that when it comes to blood pressure drugs, you may be getting treated like “Charlie on the MTA.”

Researchers from University of Kent in the U.K. analyzed data for 11,167 patients over 70 years. Evidence linked low blood pressure with increased hospital admissions and higher death rates.

Plus, of the 1,899 patients who had low blood pressure, 66 percent of them still took blood pressure medications. Furthermore, of the patients with the lowest blood pressures (below 100 systolic), almost 70 percent still took blood pressure drugs. These drugs made their blood pressures too low to be healthy.

Why give a blood pressure drug to patients who already have low pressure?  Especially since low blood pressure increases the risk of hospitalization and death?

Amazingly, researchers found that once a patient started taking a blood pressure drug, doctors did not regularly review their status to adjust for changes associated with aging. That situation can quickly turn toxic, particularly when combined with other drugs typically given to older people.

Considering all the other factors, the researchers concluded that too many doctors inappropriately prescribe drugs to older patients with low blood pressure. And once a patient goes on a BP drug, they’re not likely to come off it. Even if blood pressure drops to low levels.

Clearly, many older people experience more harm than good from these drugs.

My advice?

Get your blood pressure regularly checked. While 120/80 is normal for middle-aged adults, recent studies show that BP up to 139 systolic can be safe as you get older since the brain and tissues need to maintain good circulation. If your blood pressure turns out to be too low, adjust your medications — or get off these drugs altogether. After all, the purpose of successful treatment should be to get people off drugs. Especially when the drug itself is the problem.


“Older people remain on blood pressure agents despite being hypotensive resulting in increased mortality and hospital admission,” Age and Ageing ( 6/30/2016