Hypertension in the Elderly: How to Manage High Blood Pressure

As we age, our blood vessels naturally lose some of their elasticity. In younger individuals, arteries expand and contract easily as blood flows, helping to keep blood pressure in a healthy range. But in seniors, the arteries become stiffer. This makes it harder for blood to flow smoothly and increases systolic blood pressure (the top number in a blood pressure reading).

Other contributing factors include:

• Changes in the baroreceptors – These are tiny stretch sensors in our arteries that detect changes in blood pressure and send signals to the brain. With age, they may not work as effectively, making it harder for the body to adjust to sudden changes. This can lead to wide fluctuations in blood pressure and heart rate.
• Cumulative stress over a lifetime – Decades of emotional stress, poor sleep, and unhealthy habits can all add up, affecting heard and vessel health.
• Chronic illnesses – Conditions such as diabetes, kidney disease, and heart failure often appear alongside hypertension. These not only make the condition more common but can also complicate treatment.

This combination means that high blood pressure is not just more likely in seniors, it can also be more stubborn and harder to manage.

Treating hypertension in older adults is often more complex than in younger people. This is because:

• Multiple medical conditions – Seniors often have more than one chronic illness, which means medications must be chosen carefully to avoid harmful interactions.
• Medication restrictions – Certain blood pressure medications are unsuitable for people with specific health issues. For example, if someone has kidney failure, certain types of diuretics or ACE inhibitors may not be safe.
• Limited options – If a senior cannot tolerate one category of medication and other prove ineffective, there may be fewer safe alternatives left to try.

All these factors mean doctors must a strike a delicate balance between lowering blood pressure enough to reduce risk, but not as much as that it causes other problems.

While medication is often necessary, lifestyle changes can greatly enhance results. In fact, for some seniors, small adjustments can make a significant difference. Here are four strategies that doctors frequently recommend:

1. Maintain a Healthy Weight

Excess weight forces the heart to work harder, which can push blood pressure higher. Even a modest weight loss, just 5-10% of body weight, can improve how well blood pressure medication works.

2. Reduce Salt Intake

Sodium is one of the biggest dietary drivers of high blood pressure. Many seniors consume more salt than they realise, especially from processed and pre-packaged foods.

Cut back on:

• Salty snacks (chips, crackers, salted nuts)
• Soy sauce, fish sauce, and other high-sodium condiments
• Canned soups and instant noodles

Instead, season food with herbs, lemon juice, or vinegar for flavour without the extra sodium.

3. Stay Physically Active

Exercise improves circulation, keeps blood vessels flexible, and helps maintain a healthy weight. The goal is not intense workouts, but regular, safe movement.

Gentle, senior-friendly activities include:

• Walking
• Light aerobics
• Stretching or chair exercises
• Tai chi for balance and relaxation

4. Manage Stress

Chronic stress triggers the release of hormones that raise blood pressure. For seniors, common stressors include caring for grandchildren, managing household responsibilities, or relationship tensions.

To reduce stress:

• Communicate openly with family about needs and limitations
• Take part in hobbies or social activities that bring joy
• Prioritise rest and aim for 7-8 hours of sleep each night

When managing blood pressure in seniors, it’s not just about lowering the numbers, it’s also about avoiding complications.

Orthostatic Hypotension

This is a sudden drop in blood pressure when moving quickly from lying down or sitting to standing. It can cause dizziness (or vertigo), lightheadedness, or even falls, which in turn may lead to fractures or head injuries.

To minimise the risk:

• Stand up slowly and pause for a few seconds before walking.
• Avoid overly aggressive blood pressure lowering.
• Tell your doctor about any dizziness so medications can be adjusted.

Electrolyte Imbalance

Some blood pressure medications such as Thiazide and Loop diuretics, can lower sodium or potassium levels. This can cause weakness, irregular heartbeat, fainting, or confusion.

Seniors with irregular appetites or those who depend on others for meals are especially vulnerable. Regular blood tests can help monitor electrolyte levels and prevent complications.

Medication Compliance Challenges

For seniors with dementia or memory issues, medication routines can become tricky. They may forget to take their medicine, or accidentally take it twice.. or thrice.

Helpful solutions include:

• Using a clearly labelled pill organiser
• Having a caregiver manage the medications
• Daily supervision at a senior daycare or nursing home