High blood pressure is common. Left untreated, it contributes to stroke, coronary heart disease and heart failure. We therefore recommend you should get your blood pressure checked regularly. Diagnosis is quite easy and there are effective medicines to treat it.

Unfortunately, though, these can occasionally lower blood pressure too far. For younger patients, the consequence of this is that they feel faint at times, but it usually corrects quickly. Reducing the dose stops any recurrence, and this is no reason to miss out on potentially life-prolonging treatment.

But it’s not so straightforward for the elderly. They are not able to compensate so quickly for a drop in blood pressure, and the resulting unsteadiness can cause them to fall and potentially injure themselves. In addition, a critical pressure must be maintained to ensure sufficient blood flow to their brain. This is the reason it takes longer to stabilise an elderly patient on blood pressure lowering medication.

Studies show there are benefits for treating blood pressure in the elderly – but there are some nagging doubts. How do you ensure the right people are treated, especially given that there are general practice incentives in the NHS for doing so?

A recent commentary and a scientific review have raised questions about balancing the risks against the advantages of lowering blood pressure in the elderly. Dr Spence, writing in the British Medical Journal*, asks whether too many elderly patients are being put at unnecessary risk by an enthusiasm for meeting a numerical target rather than assessing all aspects of the patient. If a person is frail, ill with another condition and likely to die soon, what’s the point of ineffective treatment that carries a risk? On the other hand, someone in more robust health might benefit significantly from life-prolonging blood pressure treatment.

Many people would go along with this idea, but it’s difficult to know how to make an assessment of a patient’s frailty. It cannot simply be a matter of age. There are 80-year-olds who are active – sometimes more active than younger people – and others whose quality of life is impaired.

Recent research** has provided some help in assessing frailty through a straightforward test of walking speed. The researchers measured walking speed in 2340 patients with high blood pressure aged over 75 years. After ruling out other factors that might have interfered with walking speed, they divided the patients into those that walked faster than 0.8 meters/second (about 75 feet in 30 seconds) and those that were slower than this. Over a seven-year follow-up period, there were 24 deaths per thousand person years in the fast walkers but 70 deaths per thousand person years in the slow walkers. This suggests a way to pick out the fitter people who are more likely to benefit from life-prolonging preventive treatment.

These observations don’t fully answer every question about treating elderly people with high blood pressure and there may be other more pertinent measurements. But they do make a start in differentiating people who are frailer and therefore less likely to derive benefit from treatment.

If you are elderly and are diagnosed with high blood pressure, make sure you discuss fully all the pros and cons of treatment with your doctor before coming to an informed decision about the best option for you personally.


Link to the British Medical Journal commentary: http://www.bmj.com/content/345/bmj.e5923

Link to the research paper: http://dx.doi.org/10.1001/archinternmed.2012.2555



“Oh, there’s no point in me stopping smoking at my age. I’ve been smoking since I was 14, so all the damage’s done.”

This is a common excuse used by older people, and many doctors have gone along with it and not pressed the point. But how valid an excuse is it?

Smoking causes a lot of deaths and illness. It has been estimated that if there’s no reduction in smoking it will result in over a billion deaths in the 21st century. The World Health Organization blames it for 12% of male deaths and 6% of female deaths worldwide.

Many studies have shown that stopping smoking reduces this risk, with the benefits increasing the longer a person remains a non-smoker. But these studies have mostly been based on middle-aged people.

Now a recent study* has looked at evidence for smokers older than 60, bringing together the data from 17 studies in seven countries. It showed that, even up to the age of 80, stopping smoking was effective in reducing deaths.

This study firmly shows that older people should be encouraged to stop smoking if they can. Many 60- and 70-year-olds are likely to live to much older ages, with plenty of time to experience the benefits of giving up.

The study also shows how important it is for us all – younger people, older people and the medical profession – to be cautious about coming to erroneous conclusions about the health of older people without the information to back them up.

*Link to study

Professor Brian Kirby, author of How to Live to 110: Your comprehensive guide to a healthy life


The Commission for Improving Dignity in Care today published a draft report that highlights the importance of respecting the dignity of old people.

They are right. It is all too easy to make assumptions about older people, or to talk down to them.

This was brought home to me a long time ago by some young medical students in a hospital ward where I worked. One of the students tried to engage a patient – an old, rather deaf man – in conversation.

“Now then, dad, what did you used to do for a living?” he casually shouted in the old man’s ear.

“I, laddie, was a Professor of Medicine,” came the stern – and unexpected – reply.

It turned out the old man in front of them had been perhaps the foremost medical professor of his generation, and the author of a textbook almost every medical student owned in those days.

“Have you got my book?” he asked. “Well, bring it in and I’ll sign it for you.”

The next day, the six students each proudly possessed a signed copy of the professor’s book. And each book was inscribed with a note hoping the owner would remember for the rest of his professional life that the old were once young, productive members of  society. After that lesson, I’m sure they did.

It’s easy to fall into bad habits, but it is up to everyone to do our bit to preserve the dignity of older people.

And perhaps it wouldn’t be so bad to extend this to younger people too!

(To see and comment on the Commission for Improving Dignity in Care’s draft report, click here.)


Professor Brian Kirby, author of How to Live to 110: Your comprehensive guide to a healthy life.


© 2012 How to Live to 110 Suffusion theme by Sayontan Sinha