What is the recommended blood pressure range in older people and why there is often confusion

For decades it was repeated that 120/80 mmHg was the “ideal” blood pressure for everyone. However, in people over 65 years of age, this reference can be misleading and even risky.

Based on what Thomas Weber explained, this article clarifies why the classic value is not always the most appropriate in old age and which is the range that offers the best results.

Why the “120/80” Isn’t Always Ideal After 65

Over the years, the arteries lose elasticity. Instead of behaving like flexible conduits, they become more rigid, something comparable to old pipes. This stiffness changes the way blood circulates and how it reaches vital organs.

In older adults, the brain and kidneys need a slightly higher perfusion pressure to receive sufficient blood flow. If the pressure is reduced too much trying to reach 120/80, not enough blood may reach these organs.

The risks of too low blood pressure in old age

Maintaining very low figures in older people can cause relevant adverse effects:

• Dizziness and feeling unsteady
• Falls, with increased risk of hip fractures
• Fainting when standing up
• Cognitive impairment due to reduced cerebral blood supply

These problems are not uncommon and explain why many specialists today prioritize security and functionality over a “perfect” manual number.

What range shows the best prognosis based on the evidence

A large study published in JAMA Internal Medicine looked at outcomes in older adults and found something key:

Older people with blood pressure between 130 and 145 mmHg (systolic) had a better overall prognosis than those with lower numbers.

This does not mean that higher values are desirable for everyone, but that forcing pressures that are too low in old age does not always bring benefits and can increase risks.

Why there’s so much confusion about ideal pressure

The confusion arises because:

1. General guidelines are usually intended for adults of all ages.
2. Many health messages do not differentiate between young and old people.
3. It is assumed that “lower is always better”, when in old age the context changes.

Each older person has a different medical history, and the optimal blood pressure should be assessed on an individual basis.

The Schelllong test: a simple tool to do at home

Dr. Weber recommends a simple test to detect dangerous pressure drops when standing up, known as the Schelllong test:

1. Measure the pressure lying down, after 5 minutes of rest.
2. Stand up.
3. Remeasure the pressure at one minute and 3 minutes.

If the pressure drops sharply or dizziness appears, it may be orthostatic hypotension, a common condition in older adults that requires medical evaluation.

A more realistic look at blood pressure in old age

In older people, it’s not about chasing a perfect number, but about maintaining a pressure that:

• Ensure good cerebral and kidney irrigation
• Reduce the risk of falls
• Preserve autonomy and quality of life

For this reason, it is now considered that a moderately higher range may be safer and more beneficial than the classic 120/80 in many older adults.

Important: This information is for guidance only and does not replace medical consultation. Any adjustment of medication or pressure targets should always be made with a healthcare professional.

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