High blood pressure- medication?

[HettyMeg]

My mum has been told she has blood pressure but has been given a choice in whether to try medication or "wait and see"... am I right in saying that it wouldn't just go down on its own and that she'd have to make big lifestyle changes without medication? She's in her 70s, no specific health conditions but overweight & doesn't exercise. Drinks daily and doesn't eat well. Worrying about her having a stroke.

Missed a key word - HIGH blood pressure, if not obvious....

How high do you know?

Yes, you're right OP. I would suggest taking the pills to minimise damage now, then trying to make the lifestyle changes. You can always stop the pills if it works.

I don’t think “wait and see” is really the alternative option, rather it should be wait and see if lifestyle changes will help lower her BP. But if you think she won’t be able to make large scale changes, then waiting is fairly pointless.

i was told to keep a bp diary for a fortnight before they would make the decision about whether to prescribe pills or not.

has she done that? does she have a bp machine to taje readings at home? what is the gp saying it’s at?

its supposed to be 120 over 80 or a little higher as we age.

i was told the first number should not be as high as 150 and the second should not be as high as 100. If it reaches that i will be given meds.

I wasn't sure how high it was but she's said today it's apparently 185/85. She says GP wants her to wait a month, testing 3 times a day. I don't know anything but what I've read online suggests this is a high level and so I'm confused as to why she's being advised to leave it a month?

Op is the 185 a typo or maybe she’s got it wrong? 185 is hypertentive crisis requiring immediate emergency medical attention, I’d be very surprised if a doctor said wait and see if they see a reading at this levels.

you’d expect to see systolic raise with age ( the top number) but 185 means she needs emergency medical care as is in crisis. Can you see her notes to check the reading?

Actually that sort of BP isn’t that uncommon as a presentation in the elderly and doesn’t always need a dramatic response. Presumably the OP’s DM’s GP is aware of the worrying signs that go with hypertension and has considered them in their response. You can do more harm than good dropping someone’s chronic hypertension too quickly.

In her 70s, overweight, no exercise, drinks daily, eats badly. If she’s been given the choice I’d go for the meds. Presumably the “wait and see with regular readings” is to see if she is really hypertensive or if it was a blip. Is she likely to change her lifestyle?

My dad was put on medication but decided he didn't want to take it. Had a TIA and then a massive stroke. It was really horrible, we thought he wasn't going to make it. Now he's housebound and miserable.

If she can't reduce it with changes to her lifestyle (I know it's not always that straightforward with older people, especially if there are other health issues) then I would urge her to take the meds. My dad wishes he had now. I think he thought a stroke would mean death and that he never imagined being left disabled.

We're all trying to make the best of it and cheer him up but he's very down.

At 185? I knew it increased with age, but 185 is usually considered crisis ar any age and not jist something uou wait and see. And she doesn’t need to have the bp brought down quickly they can manage medication in stages,

@Daisywhatsyouranswer no it depends on previous readings and if there are any other clinical markers of crisis. Certainly wouldn't be accepted for admission where I worked (I had a 240/150 BP refused for review/admission once....now I was shocked at that). It's manageable in the community. But as pp said you don't want to drop the elderly BP too quickly can cause more harm.

I'm in my 70s and take just one tablet per day to keep my blood pressure down. No side effects and I've been on them for years now. I would advise her to take them with blood pressure as high as that.

Just take the meds, don't wait and see. High BP is so common that everyone has it but no-one talks about it.

I was admitted with a BP of 204/110 in July. I had Pericarditis & Hyperlipidemia too. Now on 5mg each of Ramipril & Felodipine & still around 170/100. If I forget my meds for a day or two it's right back up to 200 again. I'd advise considering taking medication now.

Im nearing 60, mine is a problem at the moment. Doctor has started me on meds but say they take time to adjust the BP and may need medication adjusting. Im only marginally overweight BMI 27,( meno weight) exercise of 3 hrs classes a week, 15k steps a day and manual handling for cardio. Non smokers and moderate drinker.
Im averaging 150/85, peaking to 210/110. Yes, I've been ill.
High BP makes you feel rotten. In more elderly I imagine it would be horrible, particularly if unable to exercise.

It really isn't that uncommon (lots get picked up in anaesthetic preassessment) and it isn't always an emergency...it warrants thought, but not always immediate treatment. Unless I've got completely the wrong end of the stick it sounds like they've seen a doctor who's made an assessment of whether this looks like bog-standard hypertension or hypertension causing serious end organ dysfunction, hopefully had a think about how likely any of the more unusual causes of high BP might be, has offered medication or to monitor/make lifestyle changes and has organised FU....it's not like they've just said 'crack on it'll be fine & I'll see you if you have a stroke'. Realistically she'll probably end up on medication because, lets face it, most septuagenarians who are overweight and making poor dietary/alcohol choices just aren't going to embrace change, but it sounds like she's been offered both options and gone with the lifestyle route first. Older folk don't always behave quite as you'd expect starting anti-hypertensives & just every so often it can cause harm rather than benefit so every medication decision does need proper thought.

out of mild interest, the highest systolic BP I've seen was 315mmHg (not a typo)... that really was an emergency causing heart failure, kidney failure and the full works....target for the very long nightshift I spent with them was to keep it somewhere round about 180-200mmHg. Context is everything & hopefully the OP's DM's GP has the context (that none of us have) needed to make a sensible plan.

Mine developed from a reaction to LA - I kept a 7 day online reading diary it was sometimes around 174/100!

was on Ramipril but it stabilised- I’m 55 and not overweight but not very active- I would take the meds

But an element of it will be white coat syndrome so it's probably slightly lower (still high). Husbands was that when he went, he was given beta blockers as doctor thought from his description that it was more anxiety based, doctor didn't say it was a crisis. He's in his 50's. He is slim and exercises so not many lifestyle changes he can make, luckily it's gone down after a week on beta blockers so the dr's assessment was correct.

Update - it was a typo - should have been 158 over 85.

@HettyMegthat's good ! hopefully it can be managed to go np higher or even reduce a bit. @Greybeardy that is interesting info, thank you.

Ok I thought it might be, it does get higher with age as our arteries harden. Plus she may have been nervous having it taken, it probably is a watch and see op, don’t worry, x

I think a combo of meds and lifestyle
changes but it’s really hard as you age to lose weight. If she can cut back on food intake and increase exercise very gradually on a day to day basis it will really help. BP meds are often started at the lowest script anyway. From experience I would
suggest she gives it several months to see if there are any side effects.
High BP can lead to lots of quite serious health conditions, it’s not worth taking the risk.
Deffo worth investing in a home
BP testing machine and checking occasionally and keeping a log to see how effective the meds are.

I bet alongside the 'wait and see' approach the Dr also advised making lifestyle changes in that month to see if it might improve / be a one off high.

Weight loss may help, if she commits to that and actually does it. But unless she does, it’s unlikely to come down on its own.