From Streit S et al. Ann Fam Med 1 March 2019 and reported by Sarfaroj Khan UK Clinical Digest 13 March 2019
In my GP career treatment of blood pressure for the general population has become more intensive as time has gone on. This hasn’t always resulted in better long term outcomes overall. Indeed, the target systolic blood pressure, the upper measurement, has been moved from 130 to 140 in the last few years because of this.
A Dutch study of over a thousand patients over the age of 75 showed that those with a systolic blood pressure under 130 showed more cognitive decline than those with a blood pressure over 150 when they had mental functioning tests a year later.
Those with higher blood pressures had no loss of daily functioning or quality of life.
As aggressive blood pressure control in those with diabetes is standard treatment, it is worth knowing this. Perhaps further studies in this subgroup of patients would be worth doing. I have seen reports of impaired kidney function when blood pressure levels are “optimal” but low too.
Another study regarding blood pressure management reported in the British Journal of Sports Medicine indicates that blood pressure reduction of almost 9mm Hg in hypertensive patients when regular structured exercise is undertaken. This is of a degree similar to most anti-hypertensive medications. (Reported in BMJ 5 Jan 2019)
Diabetes Diet 
maybe it is a dumb question but what are the health issues that result in Blood Pressure that is too low? OK, I know the one sure outcome of BP 0/0, but I am thinking more like 90/60 or 70/50. Low numbers must surely have long term health impacts, just as too high is an issue.
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High blood pressure long term can cause strokes and cardiac failure in particular. It can also accelerate ischaemic kidney damage and ischaemic heart disease. On the other hand, it if is too low it can cause cognitive decline and poor kidney function. On the short term low blood pressure can cause fainting and falls. If you fall you can break bones and have head injuries. There seems to be a sweet spot for blood pressure but that spot looks like it is 130 if you are under 40, 140 systolic if you are older than this or a bit more, probably 150 if you are over 70.
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There was a time when hypertension was regarded as 100 + your age. I saw a recent but more complex formula but can’t recall where.
IMO controlling insulin is the key to controlling the CAUSE rather than just treating the symptom with drugs. However the latter is more financially viable- tell people to eat the most profitable diet, then when that makes them ill prescribe the most profitable drugs, Oh and blame salt.
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Chris, I’ve had to go back to the 100 plus your age with some patients as “good enough” due to the side effects they have with drugs.
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