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As an Obstetrician/Gynecologist/Cosmetic Surgeon, and Founding Member of the American Holistic Medical Association, a time came when I found myself in my internist's office for a routine physical. Having been shown into his office’s examining room, I was meditating while awaiting his arrival. When he arrived several minutes later, he took my blood pressure and pulse. Then he asked me if there was anything the matter. I responded, “No I feel fine. Why are you asking?” He said, “Well, your blood pressure is 70/40 and your pulse is 40.
It has been quite some time since that office visit. As I advanced in age I found it necessary to take medicine for hypertension. Hypertension is a very common condition as the body ages. The blood vessels, while very pliable in the young, become less so and harder and thicker as age progresses, resulting in the phrase ‘hardening of the arteries’. This results in many older patients needing medications for hypertension. Consequently, today I have been taking two medications for my increased blood pressure.
As a recreational tennis player after retired from medicine, I noticed a decline in energy. A friend of mine advised me to switch to pickleball, a very popular sport that is growing rapidly. The court is smaller than tennis so it was easier for me. However, I found I still had limited energy. My cardiologist is a good friend and, in an office visit, I mentioned that I felt my blood pressure was too low. To my surprise, he was in agreement. I told him that after playing pickleball my blood pressure would be as low as 100/50.
Like many aging Americans I have my own blood pressure spigmomanometer. I began monitoring more closely and decided to eliminate one of my medications. After a short time I had much more energy and could play for a longer period of time. My BP increased to 148/84, which by many of doctors today is too high. I play five days a week on a usual basis.
In medical school we were taught high blood pressure was above 150/90. In recent times Doctors say it should be below 130/80. However, at age 86 I find if my blood pressure is too low so is my enegy level. Consequently, I have come to the conclusion that as one ages the blood pressure should be maintained at a higher level, within reason.
I have seen blood pressure guidelines evolve over time, and it was my personal observation that energy levels decrease as age progresses when medication for hypertension is added. So I turned to the literature to see what evidence aligns with or challenges the idea that older adults might benefit from maintaining higher blood pressure "within reason," particularly regarding energy, vitality, or overall health outcomes. Historically, older guidelines, like those from the JNC 7 (2003), defined hypertension as 140/90 mmHg or higher, with a more relaxed target of 150/90 mmHg for those over 60. Medical training often reflected this, focusing on higher thresholds. But newer guidelines—like the 2017 ACC/AHA update—dropped the definition to 130/80 mmHg for all adults, aiming to reduce cardiovascular risk earlier. This shift sparked debate, especially for older adults where lower targets might not always align with functional well-being.
Studies Supporting Higher Blood Pressure in Older Age
Some research backs my hypothesis that higher blood pressure might be beneficial—or at least not harmful—for certain outcomes in advanced age, particularly past 85. A community-based study from 1998 in Leiden, Netherlands, followed 85-year-olds and found an inverse relationship between blood pressure and all-cause mortality. Those with systolic readings below 140 mmHg had higher mortality, while higher pressures (up to 160-180 mmHg) were linked to better survival, even after adjusting for health status. The authors suggested that low blood pressure might reflect frailty or poor cardiovascular reserve, reducing energy and vitality.
Another study, from Australia in 2011, looked at centenarians (mean age 97) and found that higher systolic pressures (around 140-160 mmHg) correlated with better cognitive function and physical capability. Those with pressures below 130/80 mmHg often showed more frailty and lower energy, hinting that a slightly elevated range might support perfusion to vital organs like the brain and muscles in extreme old age.
Studies Challenging This Idea
On the flip side, trials like SPRINT (2015) argue for tighter control, even in older adults. In a subgroup of participants over 75 targeting systolic pressure below 120 mmHg reduced cardiovascular events (e.g., heart attacks, strokes) by 34% compared to a 140 mmHg target. However, this came with trade-offs: more hypotension episodes and a slight dip in kidney function. Energy levels weren’t directly measured, but adverse events like fatigue were slightly higher in the intensive group. A 2021 analysis from China (ages 60-80) reinforced this, showing that systolic targets of 110-130 mmHg cut cardiovascular risk by 26% versus 130-150 mmHg, with no major energy-related downside reported. Still, this cohort topped out at 80.
Frailty and Energy Considerations
Having low energy with lower blood pressure finds some support in frailty-focused studies. A 2019 population-based study in Journal of Clinical Hypertension (ages 67-80) linked lower pressures (below 130/80 mmHg) to increased frailty markers—like slower walking speed and fatigue—in older adults. This suggests that pushing blood pressure too low might compromise systemic perfusion, especially in those over 85 where vascular stiffness and organ demands shift.
Conversely, the HYVET trial (2008) tested treatment in those over 80 (mean age 83.6) and found that reducing systolic pressure from 160 to 144 mmHg lowered stroke risk without clear harm to energy or vitality.
Reconciling the Evidence
The literature shows a tension: lower targets (120-130 mmHg) reduce cardiovascular risk but may increase frailty or fatigue in the very old, while higher pressures (140-160 mmHg) might preserve energy and function, though with potential long-term vascular trade-offs. The Leiden and Australian data lean toward the view for the oldest old, while SPRINT and HYVET prioritize risk reduction over functional outcomes like energy.
My conclusion—maintaining higher blood pressure "within reason” as one ages—seems to align with a personalized approach. If "within reason" means 140-150/90 mmHg, some evidence supports this for vitality in older age groups, but it’s not a one-size-fits-all. Factors like one’s comorbidities, frailty, and baseline health likely tip the scales.
In my opinion, quality of life is more important than living to 100 and feeling every bit of it.
