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Posted on 03/22/2026 5:51:24 PM PDT by SeekAndFind
For years, turning 65 with a blood pressure reading above 130 meant one thing: medication.
A new analysis of the 2025 American Heart Association guidelines shows that this practice is changing, finding that roughly 10 percent of older adults previously flagged for treatment may no longer meet the criteria, a move experts say prevents overtreatment, but one that carries its own risks.
The 2025 guidelines marked a significant departure from the 2017 AHA guidelines, which recommended treatment for all adults over 65 with blood pressure at or above 130/80 mmHg.
The updated 2025 guidelines replace that blanket approach with one that weighs a patient’s 10-year cardiovascular disease (CVD) risk, offering what experts describe as a more personalized lens on heart health.
Under the new framework, immediate medication is no longer recommended based only on age and blood pressure levels, but also with consideration of the individual’s other cardiovascular risk factors. This translates to around 1 in 10 Americans over the age of 65 with early hypertension who would no longer being recommended medication.
More than 70 million Americans are currently taking medication to lower their blood pressure and reduce their risk of heart attack and stroke. However, these drugs can sometimes cause side effects like dizziness, fatigue, and kidney problems, making the question of who truly needs treatment a consequential one.
Researchers analyzed data from 2,200 adults aged 65 to 79 with high blood pressure. They compared two groups: one that received treatment based on the 2017 guidelines, and another based on the current ones, which are guided by each person’s overall health risk profile.
They found that around 1 in 10 Americans over the age of 65 with Stage 1 hypertension would no longer be recommended medication, provided that they are otherwise healthy with no other cardiovascular risk factors.
Stage 1 hypertension is defined by blood pressure readings of 130 to 139 mmHg systolic or 80 to 89 mmHg diastolic.
The study also found that about 40 percent of older adults with high blood pressure could benefit from treatment that considers their overall health risks, not just their blood pressure numbers. This risk-guided approach could prevent overmedication of patients and thereby shield more patients from the potential side effects of blood pressure medication, while still reducing cardiovascular disease risk.
“The art now is to match the intensity of treatment to both global cardiovascular risk and the patient’s blood pressure, rather than chasing a number at all costs and treating all older patients with a ‘one size fits all’ approach,” Dr. Carolyn Lam, senior consultant cardiologist at the National Heart Center of Singapore and co-founder of AI medtech platform Us2.ai, told The Epoch Times.
In older adults, the concerns with over-aggressive blood pressure lowering include dizziness, falls, fractures, and acute kidney injury, especially in those who are frail or have chronic kidney disease, Lam noted.
The risk-guided approach, she explained, concentrates intensive treatment where the absolute benefit is greatest—typically in patients with diabetes, kidney disease, or multiple cardiometabolic risks—while avoiding unnecessary polypharmacy in lower-risk patients.
“Done well, this can reduce heart attacks, strokes, and heart failure, yet also help preserve independence and quality of life in later years,” Lam said.
“Many of these people are fragile,” he pointed out, and have blood pressure that goes up and down in a way that can be difficult to predict.
“Some of them have periods where their blood pressures go very low on their own, and then the blood pressure medication is quite difficult to use because you’re trying to abolish the high values, but you don’t want them to be exposed to low [blood pressure] values,” he said.
However, Kowey also warned that the report may have the unintended consequence of reducing treatment for those who really need it.
“I have a big problem with this,” he said. “It’s very analogous to what we’ve done with statins and LDL.”
He compared the new model for prescribing antihypertensive drugs to the risk models applied from previous guidelines on statin prescription statins and LDLs, which reduced the number of Americans that would once be candidates for statin medication by up to 40 percent.
Because the new risk model requires considering all relevant risk factors for treating high blood pressure, Kowey said a primary care doctor who is not savvy enough or doesn’t have enough time to do all the risk assessments is likely to get the wrong message.
“Which is, ‘well, I don’t have to treat this guy or this lady,’ and I think that could be a big trap,” he warned.
Kowey emphasized that he would very much not want primary care doctors to be, in the 10 minutes that they have spent with a patient, “sitting there wringing their hands about whether they should treat a blood pressure of 160 over 100 because of the risk factor issue.”
He concluded that the big challenge isn’t getting people off medications—“The big challenge here is finding all the people out there that need to be treated and giving them something that works, and that they can tolerate.”
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Now 106/73
“94/67”
Impressive, but rather low. Do you get dizzy? Does BP drop precipitously when you stand up?
/
I’m thinking that zer0 is too low.
One blood test back, some one of those xDLs was listed at <30 as apparently the test protocol can’t resolve values below 30. Who knew?
I have not done any research other than reading that the Brain uses cholesterol as a primary metabolic fuel. I’m thus sure that zer0 is BAD.
I’m going to have to get into it.
I’m now on Repatha in addition to max Statin. That’s when the <30 showed up. [The latest reading was 50, but I had skipped the Repatha for 2 weeks [4 total] as I didn’t bring along a second dose to cover the event of be being far away for an additional 2 weeks].
In any event, I did find a paper that found that the level of Statin dosage [I don’t think the study included NO Statin] while also on Repatha made essentially no difference, so I have been splitting the Statin pills.
Maybe MAHA can tell us?
I SPENT 51.5 HOURS IN HOSPITAL WITH VERTIGO.
WAS PRESCRIBED LISINOPRIL—ONCE DAILY-—AND NOW I SEE THAT IT CAUSES DIZZINESS????????
ITCHY THROAT HAS NOW FOLLOWED....
AM STOPPING IT.
“ How much cholesterol in the blood going to the brain is necessary for superior brain function?”
Good question. I know a woman who is raising small children on a vegan diet
That’s not advisable
I agree with some other posters.
You need to provide detailed info on just WTF you are talking about.
Look up LifeWave X39 patches.
Those machines never read as accurately as a well trained physician with a sphygnomanometer. Of course you can’t find a an actual by God well trained GP with a geiger couneter.
That’s probably not the medication for you.
But some meds that effect most people one way. can have nearly the opposite effect on certain individuals.
If it did not help you with your vertigo, it’s not a benefit to you.
It’s ridiculous that someone keeps lowering the numbers on BP, thus ensuring that more people are diagnosed as *hypertensive* thus “needing” BP meds which are supposed to be lifetime medications.
There are natural ways of dealing with *high* BP in many cases, enough to help enough to be able to stay off the meds.
I just went into get an anual checkup that included a blood analysis and urine sample. This time the number or parameters were about three times the number I have seen in past year.
everything was good except by vitamin d levels were too high. (I’ve been taking way too much vitamin d.) the fix is easy there and summer is coming.
it also showed my co2 levels were too high. i’m not sure how to solve for that. well I have a pretty good idea. I need to get more exercise of the kind that forces me to breath hard.
My psa was high but its always been high. I have bph. I had a mildly the least invasive procedure you can do for that last fall. It has greatly relieved my condition. I sleep well at night. hmm. I do wear a cpap. so I don’tlose oxygen at night.
From the NIH:
“The human brain is the most cholesterol-rich organ, containing approximately 20%–25% of the body’s total cholesterol. While the brain represents only about 2% of total body weight, it contains roughly 20%-25% of all body cholesterol. Nearly all (about 70%-80%) of this cholesterol is located in the myelin sheath, which insulates nerve fibers.”
Hm...seems like it is quite important, no?
The point is somewhat not one of accuracy. It’s getting your home device verified as measuring what the doctor’s office device measures.
If you are then seeing much lower numbers at home, regardless of what they are those are the numbers that you should insist be used. A nurse will watch as you verify your device matching their device so there won’t be any question from the doctor about that and most devices now for at home retain memory. So you can cycle back through memory to the dock and add to his confidence even further
When I told my doc I was concerned about my BP (I’m on Hydrochlorothyazide) because it was always in the 130s and 140s, she said it was fine for older folks.
Thanks.
I certainly think so.
Interesting.
It’s apparently not just a fuel for the brain, but an integral part of same.
The whole HDL/LDL medical management seems to be more than a bit simplistic.
Somebody must be doing more sophisticated studies.
I just went into get an anual checkup that included a blood analysis and urine sample. This time the number or parameters were about three times the number I have seen in past year.
everything was good except by vitamin d levels were too high. (I’ve been taking way too much vitamin d.) the fix is easy there and summer is coming.
it also showed my co2 levels were too high. i’m not sure how to solve for that. well I have a pretty good idea. I need to get more exercise of the kind that forces me to breath hard.
My psa was high but its always been high. I have bph. I had a mildly the least invasive procedure you can do for that last fall. It has greatly relieved my condition. I sleep well at night. hmm. I do wear a cpap. so I don’tlose oxygen at night.
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