A new study, published in the Journal of the American Geriatrics Society, has suggested that older people may need different recommendations to maintain healthy blood pressure.

More than half of the Americans aged 60 and above have high blood pressure (hypertension) and it is important to maintain one’s blood pressure to prevent life-threatening events, such as heart attack, stroke, or kidney disease.

According to the American College of Cardiology (ACC) and American Heart Association (AHA) guidelines, people who are 65 or above should not have a systolic blood pressure of more than 130 mmHg.

Many older people develop health issues by the time they reach 85. According to the U.S. Department of Commerce estimation, at least 10 percent of Americans will be 85 or older by 2050.

And the new study, which was conducted on more than 1,160 participants, has recommended blood pressure guidelines for individuals who are 85 or above.

Researchers looked at the participants who had experienced heart attacks, strokes, changes in kidney function, cognitive decline, quality of life reduction, and who had died. They found that around 27 percent of them had a history of heart disease, while the majority of them had three or more medical conditions.

The average age of the participants was 84. More than half of them were taking five or more medications for their health issues.

The researchers found that the participants had a systolic blood pressure of approximately 142 mmHg.

Dividing the participants into two groups, the researchers wanted to determine whether aggressively controlling the blood pressure would help lower the risk of strokes, heart attacks, cognitive decline, or death.

One group received “intensive” treatment to bring down their systolic blood pressure under 120 mmHg, while the other group received assistance to keep their blood pressure under 140 mmHg.

The group that achieved systolic levels to 120 mmHg or less had a lower risk of cardiac events and cognitive impairment; however, they had significant changes in their kidney function, some requiring hospitalization due to kidney damage.

The development of dementia in both groups was about the same. The study suggests that reducing the risk of heart disease or cognitive decline may well outweigh the risk of changes in kidney function.

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High blood pressure is the strength or force of the blood that is pushing against artery walls. When the pressure is too high, the heart works double-time. After a while, high blood pressure can weaken the blood vessels, kidneys, heart, and other organs in your body.

It is sometimes called the silent killer because of the absence of symptoms, as well as the serious health risks it causes. Some of the health risks associated with high blood pressure are kidney disease, heart failure, heart attack, stroke, peripheral artery disease, or vision loss. If the blood pressure becomes too high, a hypertensive crisis may happen and can be life-threatening.

Hypertensive Crisis Symptoms

Having a nosebleed is a hypertensive crisis symptom that must not be taken lightly. In a statement posted on their website, the American Heart Association said that high blood pressure does not normally cause nosebleeds or headaches. The strongest indication you are already experiencing a hypertensive crisis is when blood pressure shoots to as high as 180/12mmHg or more.

If your blood pressure is abnormally high and you are starting to suffer from headaches or having a nosebleed, the AHA recommends waiting for at least five minutes and retesting. When severe headaches or nosebleeds occur, and you are not feeling well, you should immediately get in touch with your doctor as these could be symptoms of other medical conditions.

Being Aware of the Condition

High blood pressure is dangerous in the sense that most of those who have it are not even aware of it. According to health organizations, almost one-third of the population in the UK suffers from high blood pressure, yet they do not know they already have it.

One surefire way to know if you are suffering from high blood pressure is to undergo regular checkups. If your blood pressure is unusually high, try to observe if you start feeling symptoms like fatigue, chest pain, vision problems, irregular heartbeat, and pounding in the neck, chest, or ears. Seeing blood in the urine and difficulty breathing are also indications of high blood pressure.

Lower Blood Pressure Readings

High blood pressure is caused by many factors. One of the biggest factors, however, is lifestyle choices. You can successfully manage your blood pressure by opting for a healthy lifestyle. Doing so could prevent, delay, or minimize the need for blood pressure control medication.

Perform physical activities for at least 150 minutes each week. Divide it into chunks of 30 minutes per day. This can reduce blood pressure readings by around five to eight mmHg.

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Hereditary and relatively common, researchers have long thought polycystic kidney disease (PKD) was progressive and irreversible, condemning people with the condition to a long, slow, and often painful decline as fluid filled cysts develop in the kidneys, grow, and eventually rob the organs of their function.

Once their kidneys fail, PKD patients often require dialysis several times a week or must undergo a kidney transplant. To make matters worse, a host of other PKD-related conditions and complications add to the patients’ health burden, including high blood pressure, vascular problems, and cysts in the liver. And that doesn’t take into account the medical costs and the reduced quality of life.

Progress toward finding a cure has been sluggish, with only one drug proven to slow—but not stop—the progression of PKD. But now, a solution may be no farther than the end of your fork.

“It’s surprisingly effective—much more effective than any drug treatment that we’ve tested,” says Thomas Weimbs, a biochemist at the University of California, Santa Barbara, whose work focuses primarily on the molecular mechanisms underlying polycystic kidney disease and related renal diseases.

KETOSIS TO FIGHT POLYCYSTIC KIDNEY DISEASE

In previous studies, the research team found that reducing food intake in mouse models slowed the growth of polycystic kidneys; but at the time, they did not know why. In the new paper, the scientists identified the specific metabolic process responsible for slowing the progress of the disease.

The best part? It’s a process many of us already know well.

“There’s a way of avoiding the development of the cysts through dietary interventions that lead to ketosis,” Weimbs says.

You read that right: Ketosis, the underlying metabolic state of popular diets such as the ketogenic diet, and, to a lesser extent, time-restricted feeding (a form of intermittent fasting), has been shown in the Weimbs group’s studies to stall and even reverse PKD.

“The cysts appear to be largely glucose-dependent,” Weimbs explains. In people with the predisposition toward PKD, the continuous supply of sugar in the high-carbohydrate, high-sugar diets of modern culture serve to feed the growth and development of the fluid-filled sacs.

“Ketosis is a natural response to fasting,” Weimbs says. “When we fast, our carbohydrate reserves are very quickly used up. In order to not die, our bodies switch over to a different energy source and that comes from our fat reserves.”

The body, he continues, breaks down the fat reserves into fatty acids and ketones which then take the place of glucose in providing energy to the body. The researchers found that the presence of ketones in the blood stream in particular inhibits the growth of the kidney cysts. And with a steady supply, ketones actually acted to reverse the condition in their animal studies.

The problem with typical Western diets is that we almost never go into ketosis: we eat high-carb, high-sugar foods almost continuously throughout the day, securing for ourselves a continuous supply of glucose. In the ketogenic diet, the body’s typical “go-to” source of energy—glucose—is taken away as ketogenic dieters focus on non-carbohydrate foods, eventually forcing their bodies to mimic the fasting response. Time-restricted feeders, meanwhile, reach that state by limiting the window of time they eat to a small part of the day, leaving the remaining 16-20 hours of their day for the body to use up the carbs and sugars and switch over into ketosis.

EATING KETONES

Ketones are actually a class of three different naturally occurring molecules, says Weimbs. Of particular interest and effectiveness is one called BHB (beta hydroxybutyrate), which has been shown “to affect numerous signaling pathways that are implicated in PKD,” according to the study. The team found that by just feeding that ketone to rats with PKD, they were able to create the beneficial effects of ketosis, no special diet restriction needed.

“Which makes this really amazing,” Weimbs says. “On top of a normal high-carb diet, which they can eat all day long, if we give them BHB, they’re fine.” After five weeks of treatment with BHB in the drinking water, rat polycystic kidneys were “nearly indistinguishable” from normal ones.

In fact, the result surprised the researchers so much they thought they’d made a mistake. “I was so surprised by the effect of BHB treatment that I had to go and double-check all the genotypes of the animals to make sure they had PKD to start with,” says lead author Jacob Torres, a postdoctoral researcher. “The effect was really unlike anything I had encountered before.

“The impact of this research has huge implications on the field of PKD,” Torres continues. It provides a framework, he says, for understanding the pathology of PKD from a metabolic viewpoint and adds another disease to the list that a ketogenic diet can treat.

“Our discovery also has implications for understanding cellular metabolism at a fundamental level as we learn more about what has gone wrong in our disease models. I am really looking forward to the future of research in this field as we explore this new space and uncover even more about what is really going on in PKD.”

KETONE SUPPLEMENT

It’s quite possible to reach ketosis just by avoiding carbs or by fasting for a period of time. “It’s a very natural way to have your own body produce BHB,” Weimbs says. “So something like a time-restricted diet is feasible.”

But the key to success with diet-related issues is consistency. Ask virtually any dieter and they’ll tell you that staying on track is the difficult part.

For those with polycystic kidneys who could use an assist with ketosis, whether or not they need to lose weight or wish to change their diets, the Weimbs lab is developing a dietary supplement to add BHB to their regular intake. This patent-pending nutritional supplement would be similar to commercially available ketone products being offered as energy boosters, but formulated specifically for supporting kidney health.

“We want to make sure we don’t put anything harmful into the bodies of people with potentially compromised kidney function,” Weimbs says. “And some of the ketone products already out there are high in potassium and other ingredients that could be detrimental.”

In addition, the supplement in development is combined with another nutrient the researchers have recently shown to inhibit cyst formation in PKD by a completely different mechanism from BHB, thereby approaching the problem from two directions. While not a drug—and therefore less expensive and essentially free of serious side effects—the supplement is nevertheless intended for use by those under medical supervision. Members of the Weimbs team are planning to conduct a clinical trial to test their supplement mixture in people with PKD. Assuming all goes well, they are planning to launch a company to make it available.

“We’re really excited that we can actually provide a supplement that potentially could help many more people than dietary intervention alone,” Weimbs says.

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A hypertension specialist with Penn Medicine, she is thrilled with any talk of encouraging people to measure their own blood pressure. In too many studies to count, physicians have shown that keeping blood pressure under control is associated with a longer, healthier life.

But measuring it with a video selfie? Or with sensors built into your running shoes or sports watch?

While those innovations have been in the news lately, they are not yet ready for action, says Cohen, an assistant professor at the University of Pennsylvania’s Perelman School of Medicine.

The only kinds of automated devices that have been validated for measuring blood pressure outside a health-care setting involve the use of cuffs on the upper arm or, in a few cases, the wrist. And even some of those have not met international validation standards.

“People need to be empowered to check their blood pressure at home, but they have to understand that it has to be done right,” Cohen said.

In fairness, the scientists whose study of video selfies was published this month agree that more research is needed—as they tested the technique only in people with normal blood pressure, and not in anyone with extremely dark or fair skin. Briefly, the method is based on the principle that some ambient light is absorbed through the skin by hemoglobin, a protein in blood. An estimate of blood flow can be made based on the residual light that is reflected back to the smartphone camera.

The running-shoe sensor is still in development, according to a patent application from Under Armour Inc., described by the Baltimore Business Journal. Still, some sports watches advertised as measuring blood pressure already are on the market.

None of these “wearables” have been validated, Cohen said.

“Validated” means that the device has been tested in an independent, peer-reviewed study of at least 85 people, and that the measurements are similar to those taken with the high-quality, manually operated blood-pressure monitors generally used in a hospital or doctor’s office.

Cohen, who also specializes in kidney disease, is part of national and international efforts to compile lists of validated blood-pressure monitors for use in the home.

Such devices are sorely needed because measurements taken in the doctor’s office, while generally accurate, do not tell the whole story for two kinds of patients:

Some people suffer from “white-coat hypertension,” meaning their blood-pressure measurements are elevated in the doctor’s office, perhaps due to anxiety. If their blood pressure returns to normal ranges outside the office, such patients might assume that there is little reason for concern. But in older people who are not on blood-pressure medication, higher blood-pressure readings in the doctor’s office are associated with an increased risk of eventually developing high blood pressure all the time, Cohen said.

Other people suffer from the opposite phenomenon: higher readings at home than in the hospital or doctor’s office, called “masked” hypertension. The reasons for this condition are not always clear, but it could mean that the person feels relaxed when seated or lying down at the doctor’s office, yet suffers from high blood pressure when engaged in everyday activities at home.

In July, Medicare coverage of home-based blood-pressure monitors was expanded for both types of patients. The government said it would start covering these “ambulatory” devices for people with masked hypertension, who were not previously covered. The decision also expanded the number of patients with white-coat hypertension who are eligible for the devices, lowering the blood-pressure threshold from 140 over 90 to 130 over 80, as measured in a doctor’s office.

The home-based devices measure blood pressure all day and night, with readings typically taken at 15- or 30-minute intervals.

The latest research suggests this round-the-clock collection of data can save lives. Elevated measurements over 24 hours and at nighttime both are associated with a higher risk of mortality, according to a study this month in the Journal of the American Medical Association.

Yet even when people are aware they have high blood pressure, they often do not take steps to keep it under control, according to a recent study led by Temple University researchers.

The authors analyzed prescription refills for more than 370,000 patients under 65 who were prescribed medicines to lower blood pressure, such as ACE inhibitors. Within 275 days, 23.5% had discontinued use of the drugs, the study found.

Several factors might explain why people stop taking the meds, said lead author Gabriel Tajeu, an assistant professor of health services administration and policy at Temple.

“Hypertension is largely an asymptomatic disease,” he said. “You don’t necessarily feel better when you take your antihypertensive medication. In some cases, you feel worse. For younger populations, there’s literature that suggests they don’t want to admit they have a chronic disease that they have to manage for the rest of their lives.”

Blood pressure also can be brought under control in many cases with a healthy diet and aerobic exercise, but it takes consistent effort.

Failure to address the problem can lead to grave consequences such as heart failure, a stroke, or an aneurysm. Broadly speaking, high blood pressure is a sign that the heart is being overworked, straining to pump blood through vessels that are narrowed or stiff.

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