What really matters when the life underwriter sees blood pressure differing significantly in people over (versus under) age 65?
The answer is not widely known.
In fact, those who are astute in assessing BP risk have noticed that some mid-life “rules” completely invert in these older persons.
For example, diastolic BP (DBP) is the driver of mortality risk under age 45. Later in life, however, just the opposite is true. Of the 3 BP variables measurable during a routine examination, diastolic finishes dead last (at least when elevated).
In assessing risk in this population, systolic BP (SBP) and pulse pressure (PP) carry the day. Pulse pressure is the difference between the systolic and diastolic readings. For example, if the BP is 140/80, then the PP is 60.
As we age, SBP inches upward while DBP diastolic readings slowly decline, widening the pulse pressure. When the PP gets too wide (prevalent rule of thumb being > 70), it reflects insidious arterial stiffening and bodes unfavorably for both mortality and morbidity.
Older age hypertensive individuals present most often with so-called “isolated systolic hypertension.” ISH is present when SBP is >140 but DBP remains normal. Thus, ISH will often correlate with high PP as this gap widens.
ISH confers extra mortality. The degree of that mortality depends on how high both the systolic BP and pulse pressure get–before they are (hopefully) treated, that is.
In truth, the efficacy of the many widely-used BP drugs is more or less the same. Physicians choose the drug (actually, drugs, since most people with high blood pressure are treated with two drugs, not just one) which in their experience is the best fit for the patient’s circumstances.
As regards perscriptions for geriatric hypertension, 2 points stand out from a life underwriting perspective: