What Your Target Should Actually Look Like
There’s no single perfect target for everyone over 60. If you’re generally active and tolerating your medication well without symptoms, aiming for a systolic blood pressure below 140 makes sense, and sometimes closer to 130 is a reasonable, well-supported target. But if treatment is making you feel dizzy, weak, foggy, or unsteady, or you’re experiencing any falls, or your blood pressure drops noticeably when you stand up, that conversation changes completely. At that point, your symptoms are telling you something the number on the cuff isn’t — and your symptoms should take priority. For some patients, staying in the 140s systolic rather than pushing into the 130s is the right call specifically to avoid orthostatic hypotension and falls
A Simple At-Home Test for Orthostatic Hypotension
Take your blood pressure while sitting down and record the number. Wait two minutes, then stand up and take your blood pressure again within one minute of standing. If your systolic (top) number drops by more than 20 points, or your diastolic (bottom) number drops by more than 10 points, and you feel any lightheadedness, that indicates orthostatic hypotension. Bring that specific finding to your doctor.
High Blood Pressure Still Matters
None of this means untreated high blood pressure is safe to ignore — it silently damages blood vessels over years and genuinely increases the risk of stroke, heart attack, heart failure, and kidney disease. The point is weighing that risk in balance with your actual symptoms, especially if orthostatic hypotension is present. Blood pressure management in older adults is a balancing act between reducing long-term cardiovascular risk and avoiding the more immediate risk of falls from overly aggressive treatment.
