Hi ,

After my last email on early treatment of newly diagnosed high blood pressure, I received a thoughtful response from a physician. Thank you, Dr. R!

He reminded me that while guidelines often focus on the 140/90 mm Hg threshold, this isn’t appropriate for everyone. For example, in an 80-year-old with poor balance or a history of falls, aggressively lowering blood pressure to 120/70 mm Hg may increase the risk of falls and serious injury.

This is why individualized care matters.

In my last email, I forgot to mention that the study I referenced (Barrett et al., Hypertension, 2025) involved much younger adults—the average age was 56.0 ± 14.8 years. That age group doesn’t represent many of our older or frailer patients.

🩺 A Call for Individualized Care

When considering whether and how to treat high blood pressure in older adults, a 2019 review in Circulation Research suggests that rather than using age as the main guide, we should tailor treatment based on function and independence. Here’s a simple way to think about it:

• What is this person’s functional status?
• Are they at risk of falls or postural hypotension?
• Are they independent in daily activities?
• Would treatment improve or worsen their quality of life?

🚶‍♀️ Functional Status–Based Treatment Profiles

1. Preserved Function Profile

These are older adults who are physically active, mentally sharp, and fully independent. Their blood pressure can usually be managed using the same approach as younger adults between 65 and 75.

2. Some Loss of Function, Still Independent in Daily Tasks

These people may move more slowly or feel a bit more tired, but they can still manage everyday tasks like dressing, bathing, and eating independently.

A more detailed health review can help decide whether starting or adjusting medication is a good idea.

3. Significant Loss of Function and Daily Independence

These people often need help with daily activities and may have memory problems or other serious health issues.

In these cases, the focus may shift to comfort and safety. It may be better to reduce or stop some medications rather than add more.

🔄 What Is Orthostatic Hypotension—and Why Does It Matter?

Orthostatic hypotension is when your blood pressure drops significantly when you stand up. It’s defined as a drop of at least 20 mm Hg in systolic pressure or 10 mm Hg in diastolic pressure within three minutes of standing.

This can lead to dizziness, lightheadedness, or even fainting. It’s especially important in older adults who are on blood pressure medication.

Many clinics don’t routinely check for it, but you can easily do it yourself at home.

👉 How To Test For Orthostatic Hypotension

If you notice a significant drop, it’s worth discussing with your healthcare provider.

🌿 It’s Not Always About More Medications

While medications are necessary to control blood pressure, better blood pressure doesn’t always require more pills. Several effective strategies can help naturally improve blood pressure:

• Getting better sleep, especially the deeper stages of sleep
• Low-carbohydrate food
• Adjust salt intake with guidance—some people are more salt-sensitive than others.
• Review your current medications—are any raising your BP or causing side effects? Some cold and flu over-the-counter medications and pain medications can increase BP.
• Isometric exercises such as wall sits or handgrip training
• Adding key nutrients like magnesium and omega-3 fatty acids, CoQ10
• Maintaining healthy vitamin D levels

When used together, these strategies can support blood pressure control and overall vascular health, often reducing the need for additional medications.

Final Thoughts

Good medicine isn’t just about following protocols and treating numbers—it is about providing individualized care. What matters most is safety, functional independence, quality of life, and what truly matters to the person.

Best regards,

Shabnam

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Reference

Benetos, Athanase, Mirko Petrovic, and Timo Strandberg. "Hypertension management in older and frail older patients." Circulation research 124.7 (2019): 1045-1060.

In case you missed the previous email, here are both emails on one page.

Dr. Shabnam Das Kar, MD

Functional Medicine Doctor

Tiny Habits Coach

Email: info@drkarmd.com