What Is the Best Blood Pressure for Older People?

Añadido: 2026-06-04

[00:00:00]So, the best blood pressure for somebody over the age of 60 is not necessarily a number that you'll find printed in a leaflet or a guideline. It is a number that belongs to you and only you. And in this video, I want to explain why that matters more as you age than at almost any other point in your life. So, I spent years working as a doctor watching two kinds of patients come through the doors with problems with their blood pressure. The first kind had let theirs run too high for too long and we've been seeing things like strokes and heart attacks and kidney failure as well. The second one though surprises people. This group of patients come in confused having fallen, having cracked their head on the bathroom floor and their blood pressure wasn't high at all. It was too low often because we'd pushed it there with medication.

[00:00:54]So both groups of these patients become harmed, one by neglect and one by overcorrection. And that tension sits right at the heart of everything I'm about to tell you in this video. If you're new here, then welcome to the channel. I'm Dr. Alex. I've worked in emergency medicine for 10 years, and now I'm sharing literally everything I know with you to help you live longer and prevent the things that we see in emergency medicine all the time. And if you learned something from this video today, then please support what I'm doing here by clicking the like button, the thumbs up button, and subscribing to the channel as well. It's the only thing I'll ever ask of you, and honestly, I appreciate it more than I can tell you.

[00:01:37]So, thank you so much. So, let me start with something that gets missed all the time. So, your blood pressure is just literally a snapshot of the pressure inside your arteries at that time, but it says nothing about the arteries themselves. So two people can both read at 120 over 70 and inside one of them their vessels are soft and elastic and delivering blood beautifully to the brain. But inside the other person the vessels are stiff and calcified and narrow because of decades of wear and tear and neglect. And that same pressure is barely pushing enough blood uphill to the brain when they stand up. And that's why people get dizzy. And that is the part that changes with age. Arterial stiffness increases as we get older. And a stiff system behaves completely differently from a young flexible system. So the same reading carries a different meaning depending on whose body it's sitting in. So when I'm assessing an older patient, I'm not really treating the number. I'm trying to understand what the number is doing to their brain and their kidneys and their ability to stay on their feet and not have a fall. Now, there's a reason why people fixate on getting blood pressure as low as possible, and it comes from some genuinely important research, so it's worth going through them quite carefully. So, the first one is the Sprint trial, and I'll put a link in the description below if you want to read about that in a bit more detail.

[00:03:13]Well, this was published in around 2015, and it took more than 9,000 adults aged over 50 and split them into two different groups. One group aimed for a blood pressure below 120. The other aimed for their systolic pressure below 140, so below 120 and below 140. And the lower group did better on the things that we care most about. We're talking about fewer heart attacks, fewer strokes, fewer cardiovascular deaths. So on the surface that looks like a completely closed case and you know if you watch these videos regularly then you'll know that I say that a lower blood pressure is better for you. That is absolutely correct. But you have to read who was actually in that trial. The sprint trial deliberately excluded people with diabetes, people who'd already had a stroke, people with dementia or advanced kidney disease or significant frailty. So what it really demonstrated was that aggressive lowering helps robust, relatively healthy older people. It never claimed to speak for the frail 85year-old on six medications. And that distinction gets lost almost every time this trial is quoted, which is why really if you're not elderly and you're fit and healthy, it's true that the lower the better.

[00:04:35]Mine sits around 110 105 over 75 on a good day. That's where I want it to be.

[00:04:42]Now, a few years later in 2021, the step trial, which came out of China, ran a similar design with adults aged 60 to 80 and landed in roughly the same place.

[00:04:54]And the finding was this. So the group that was pushed down towards 120 had fewer heart attacks and fewer strokes, but they also more importantly had more episodes of dizziness, more strain on the kidneys and more people feeling faint or unsteady. So you gain protection against the big cardiovascular events, but at the same time, if you're elderly, you raise the chance of these troubling side effects.

[00:05:23]The lower target helps your heart and your brain in one way while putting them at risk in another way. And the whole challenge is basically weighing those two against each other for each individual person. That is what medicine is all about. Everything should be personalized. Now the second part in all of this, the side effects, this is where my experience in emergency medicine comes in because I've seen exactly what it costs. We see falls in the A&E multiple times a day. And anybody that works in A&E will know what I'm talking about here. When you drive blood pressure too low in an older person, the brain is the first organ to complain because it's the highest organ in the body and we've got gravity to deal with.

[00:06:08]Your brain needs a certain pressure to stay profused, especially when somebody stands up quickly where your blood pressure doesn't have, you know, enough time to squeeze its arteries and then push that blood up to the brain. So, if you drop below that threshold, then you get things like lightadedness and the blackouts or the buckling of the knees and, you know, the flashing lights in the eyes because there's not enough blood going to the brain. And in an older body, a fall is not a minor event.

[00:06:39]A hip fracture at the age of 80 carries a one-year mortality that rivals many cancers. Striking your head on the floor or the toilet or a hard sink when you're taking a medication that thins your blood like warerin or possibly aspirin or certainly things like riveroxaban can mean that you have a bleed on your brain that no surgeon can fix in time. It could be a death sentence. And the reason this happens is that your arteries are not just fixed pipes like a garden hose, which is to be fair the analogy that I often use to explain it.

[00:07:13]I use that analogy to make, you know, the concept of blood pressure really easy to explain. But they are living active vessels that squeeze and constrict and relax to push blood where it's needed and to hold your pressure up when you stand. And that responsiveness starts to fail as we get older. So when we chase an aggressive target in the wrong patient, we trade a statistical reduction in stroke risk for a very real increase in falls risk. And falls steal something that these research studies don't measure well. They steal independence. The person stops trusting their own legs. They stop going out.

[00:07:53]They stop moving. And this deconditioning that follows accelerates absolutely everything else. That is the quiet way that overt treatment leads to frailty. And this brings up a really practical question, which is how do you actually know if this is happening to you? Well, the reassuring thing is that your body is surprisingly good at telling you when its pressure has been pushed past what it can handle. The problem is that these signals get dismissed as just getting old. So pay attention if you feel severe lightadedness when you stand up. The kind where you have to grab the counter or the arm of the chair. Pay attention to dizziness in the morning to persistent brain fog to a fatigue that medication changes seem to track with.

[00:08:40]So if your doctor increases your ramipril or amloopene if you suddenly become a bit more dizzy then that's something to pay attention to. And then other things like feeling unsteady on your feet or cramping or the sense that you might pass out or home readings when your pressure keeps dipping below 100 systolic. Any one of these is really worth a conversation with your doctor about whether you're being lowered too far. Lower pressure is only a victory if you feel well at that pressure. The moment it costs you your steadiness, well obviously that equation has then flipped. So with all of that in mind, let me give you the way that I actually think about all of this in practice because it's more useful than just a single threshold. So the first question is how robust are you? If you're between 60 and 79, say, and you walk regularly, you live independently, your thinking is really sharp, your kidneys are fine, you're not stacked up on multiple medications, then a target around 130 over 80 is reasonable, and you may even tolerate lower than that with real cardiovascular benefits. Your physiology should be able to absorb the aggressive approach that the sprint trial that I mentioned earlier was actually studying.

[00:09:57]The second scenario is the same age band but a different body. So if you carry several chronic conditions or you're on four or more medications, your kidney function is borderline and you get dizzy now and then, then obviously chasing 120 isn't brave, it's reckless. So somewhere closer to 140 over 90 protects you from the strokes, you know, to some degree without tipping you into the falls risk as well. And once you pass the age of 80, the whole calculation shifts again.

[00:10:30]Here, you know, most doctors are generally comfortable with a systolic pressure somewhere in the region of 130 to 150, preferably over 140, guided far more by how you feel, than by hitting a precise figure. If you happen to sit lower than that and you feel genuinely well with no dizziness and no falls and you stay well hydrated all the time, then that's fine and that will probably help you. But the target follows your symptoms, not the other way around. Now, obviously, we've got to be clear about something here. This is a framework for thinking. This is not a prescription.

[00:11:08]And it is absolutely a decision that you make with your own doctor rather than just off the back of a video from me.

[00:11:15]And I say that because obviously I can't give personalized medical advice on a video. I don't know your medical history. I can't examine you. I can't listen to your heart and your lungs. So always discuss this with your own doctor who knows your medication list, who knows you, and who can examine you as well. But what I'd encourage is this.

[00:11:33]Before that conversation, measure your own blood pressure at home regularly for a week at the same time every single day and work out your average rather than trusting just one single reading. And write down any symptoms that you notice alongside it like dizziness or fatigue or unsteadiness on your feeds. And if you walk into your doctor's office with that information, then you turn a guess into a proper informed decision about your own body. The more information you can give your doctor, the better here.

[00:12:07]Now, some of you may be thinking, well, there is a point that Dr. Alex hasn't mentioned here. And once you see it, it changes how you think about this entire problem. The healthier your overall physiology, the more room you have to lower your pressure without paying the price.

[00:12:28]And here's the deeper truth about all of this. When you lower your blood pressure naturally through years of eating well and moving your body and building muscle, you're not just moving the number down. You are repairing the very system that produces that number in the first place. Your arteries become more elastic. your reflexes that hold your pressure steady get sharper. The whole machine just works better. So the lower number is a reflection of a healthier body. There is no cost attached to it.

[00:12:58]Now compare that to lowering the same 20 points with a tablet. So if I bring your pressure down with ramipril, the number on the screen looks identical, but nothing underneath has been repaired.

[00:13:12]I've simply overridden a system that is still struggling. And that override comes with a big price like dizziness and that tickly cough that people get with ramipril and the strain on your kidneys and the crash when you stand up.

[00:13:26]So the same destination which is a healthy blood pressure can be reached two completely different ways. One path leaves the body stronger and asks nothing in return. The other leaves the body unchanged and sends you a bill as well. Now, medication obviously has its place. I am not anti- medication. And for many people, it is essential and lifesaving. But if you have the years and the ability to earn that lower number rather than borrow it, that is always without fail, without exception, the safer way to arrive. A meta analysis in the journal Hypertension found that regular aerobic and resistance exercise can lower systolic pressure by several points on its own which sometimes means one fewer medication and one less source of side effects and the DASH eating pattern the DASH diet you know I'll put a research link in the description below built around veg and fruit and legumes and a deliberate shift away from excess sodium towards potassium richch foods has shown the same kind of reduction in control trials. Basically, what I'm trying to say here is that it's always better to try and lower your blood pressure naturally if you can. Which brings me to the single idea that I want you to take away from all of this. And that is that, you know, in medicine, we are treating a person. We're not treating just a reading on a blood pressure machine. But the vast majority of healthy people under the age of 60, the principle is fairly simple. The lower your blood pressure, the better, right down until the point where you start feeling lightaded. But most people don't get there because they're lowering it naturally. But as you get older, that simplicity starts to fall away a bit.

[00:15:15]And the only way to manage this well is to actually know your own numbers. Now, I measure my own blood pressure every single week in this studio in this chair at the same time every day. When I measure it, I know what my normal looks like. So the moment it starts drifting up or going down, you know, I notice immediately if you have no idea what your baseline is, then you are literally flying blind and every reading becomes a guess instead of a piece of information because your blood pressure fluctuates all the time. So you have to get an average over time. The guidelines that we learn in medicine give us categories and categories are useful starting points. But a category is not a treatment plan and a number on a screen is not a patient. The real work honestly is matching the target to the body that's in front of you. Watching how that body responds and then being willing to back off when it tells you to. So many elderly care doctors, geriatricians take off so many blood pressure tablets when they see a patient admitted into the hospital. Medications that should have been removed years ago. So if you get this right, then blood pressure management stops being a fight against a number and it becomes what it should be, which is one part of keeping you strong and clearheaded and on your own two feet for as long as possible. And that far more than just any single reading is what good blood pressure actually looks like after the age of