Is Your Doctor’s Age Bias Making Your High Blood Pressure Worse?

The undertreatment of hypertension in older adults could have serious health consequences

Kimberly Hayes,

AARP

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Published October 10, 2024

man talking with his doctor with a blood pressure machine visible behind him

AARP (Source: Getty Images)

Older adults are more likely than younger people to have high blood pressure and suffer from serious health conditions that can be caused or worsened by hypertension, such as heart disease and stroke. But research suggests that high blood pressure in older patients often isn’t being treated as aggressively as it should be.

A Harvard study found that more than 70 percent of older Americans who need more intensive treatment for high blood pressure aren’t receiving it, and some health experts say they think age bias could play a role in those decisions. The assumption by doctors that high blood pressure is inevitable after a certain age, and concerns about side effects of lower blood pressures on older people, could be factors in this undertreatment.

“There’s a bias towards older people because doctors are concerned that they won’t do well on these lower blood pressures,” says Beverly Green, M.D., senior investigator for Kaiser Permanente Washington Health Research Institute. Doctors may have concerns about older patients becoming lightheaded, which could increase fall risk, and the effect on cognitive abilities, especially for someone already experiencing cognitive decline. But many of these concerns have been challenged by research, Green says, and it’s older people who actually benefit the most from the lower blood pressures.

Older people may not receive enough blood pressure medication

Hypertension becomes more common with age: The Centers for Disease Control and Prevention (CDC) says 74.5 percent of those over age 60 have high blood pressure, which is defined as a reading of 130/80 mm Hg. Yet a study published in Hypertension found that physicians were treating high blood pressure less aggressively in recent years, with fewer medications being prescribed overall. Lead author Brent Egan, M.D., vice president of the American Medical Association’s cardiovascular disease prevention group, says a fall in blood pressure diagnosis and treatment from 2015 to 2018 was primarily explained by a decline in the effectiveness of hypertension management plans.

“Fewer patients were being diagnosed with hypertension, fewer were being treated, and those being treated were more likely to report taking a single blood pressure medication when most patients require two or more blood pressure medications to control their hypertension,” Egan says.

Blood pressure goes up with age in part because blood vessels tend to stiffen and become less flexible, which may increase the pressure inside them. But even if this process is a normal part of aging, it’s not good for our health and longevity. “It actually increases our risk for stroke, in particular, heart failure and death,” Green says.

The role of ‘therapeutic inertia’ in blood pressure management

“We have safe, effective and inexpensive antihypertensive medication that can pretty much control blood pressure in 95 percent of people, regardless of age,” says Adam Bress, an associate professor of population health science at the Department of Veterans Affairs Salt Lake City Health Care System. “When someone’s blood pressure is not at goal and the medications are not changed, that’s what we call therapeutic inertia. That happens, believe it or not, in about 80 percent of doctors’ visits.”

Bress is a main author on another study published in Hypertension that found a strong association between older age and a greater likelihood of therapeutic inertia. And this association was present even if the patient was healthy and did not have impaired cognitive function. The conclusion was that doctors’ treatment decisions could be influenced by age alone, Bress says.

The national initiative Target: BP was created by the American Heart Association and the American Medical Association in response to the high prevalence of uncontrolled blood pressure. The goal is to help the medical community assess and treat people with high blood pressure, and to improve understanding of guidelines released by the American Heart Association and the American College of Cardiology in 2017 that lowered the diagnosis of hypertension from 140/90 mm Hg to 130/80 mm Hg.

According to Green’s research, there remains confusion among health care providers about what the blood pressure targets actually are for their patients. Compounding the struggle to manage hypertension more effectively is how overburdened primary care doctors are when treating older patients with multiple health problems.

“Doctors typically have 15 minutes to manage an average of nine chronic conditions with a patient who’s not thrilled about taking more medication,” Egan says. “I think when you look at that picture, the reason that more isn’t being done [to treat high blood pressure] becomes more apparent.”

How to talk with your doctor about blood pressure

For both patients and doctors, it’s vital not to ignore or minimize blood pressure concerns. If you find that every time you visit your doctor your blood pressure is 140/90, it may be time to discuss intensifying your medication therapy, Egan says.

Here are expert tips on how you can talk with your doctor about treating high blood pressure:

At your next appointment, let your doctor know that your blood pressure is not as well controlled as you would like, and that you are open to taking additional medication if appropriate. If the patient takes the initiative, the doctor may be more likely to prescribe the medication.
Monitoring and tracking blood pressure through electronic health records can help with blood pressure management. Ask about patient portals or other online options that could aid with communications between you and your doctor.
Ask your doctor about team-based approaches to high blood pressure management that could include pharmacists or specialists who may be able take more time with patients to discuss high blood pressure.
Report any side effects you experience from your blood pressure medications. Doctors can make adjustment to ensure you are able to stay on the proper type and dosage of medication.
Regularly monitor your blood pressure at home using a validated blood pressure monitoring device and bring your results to your visit. This empowers clinicians to make better decisions for treatment about hypertension.

“We shouldn’t be wasting time, because high blood pressure is a risk factor. Even if it doesn’t cause stroke or heart attack, it is causing damage in the body … to the heart, blood vessels and kidneys,” Egan says. “And that damage is sometimes difficult to reverse.”

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Kimberly Hayes is an editor-writer for AARP and has written on health and social justice issues for numerous organizations, including the National Organization for Women, the Robert Wood Johnson Foundation and the Lawyers’ Committee for Civil Rights. She previously served as editor of the Native American Report.