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(As you get older, the mechanism that increases blood pressure automatically when you get out of bed or a chair can become less responsive, making you prone to falls.

This is a condition called orthostatic hypotension.) If your office numbers are indeed high, ask your doctor about a home blood pressure monitor.

That can deprive the heart of oxygen, causing it to enlarge, and can rob the brain of blood. Weintraub, associate professor of medicine and director of the Center for the Prevention of Cardiovascular Disease at New York University Langone Medical Center.

In someone with a wide pulse pressure, getting systolic pressure down without driving diastolic pressure too low can become a real balancing act. "You can't go any further in those individuals or you may see unwanted consequences of low diastolic blood pressure." Doctors also have to be cautious about treating people who are hypertensive but have transient low blood pressure when they stand.

These easy-to-use devices allow you to test your own blood pressure at various times during the day, which can help your doctor rule out both white coat hypertension and masked hypertension.

In some cases, doctors recommend ambulatory blood pressure testing, using a device that automatically takes readings of blood pressure over a 24-hour period.

Experts caution against using beta blockers, such as Inderal or Toprol XL, in older people because they may slow already sluggish heart rates. » Beta blockers also tend to worsen wide pulse pressure.

Combining ACE (angiotensin-converting enzyme) inhibitors, such as Lotensin or Vasotec, and ARBs (angiotensin-receptor blockers), such as Diovan or Benicar, is also risky in most older patients — research shows the combination increases the risk of kidney failure and death.

"I'd treat a very healthy 80-year-old as I would any [middle-aged] hypertensive."When people develop high blood pressure in middle age, the problem is typically elevated diastolic pressure, which is indicated by the lower number," says Izzo.Ideally, the goal is to bring the numbers down close to a normal reading of 120/80.Once you hit age 60, though, it's the upper number — the systolic pressure — that can really climb, causing concern.Systolic hypertension occurs when the arteries close to the heart begin to stiffen, making them less responsive to blood flow."Blood pressure changes every second of the day," says Dr.Sharon Brangman, a professor of medicine at the State University of New York at Buffalo and president of the American Geriatric Society. Doctors have long been familiar with the phenomenon of "white coat hypertension" — the tendency for some people's blood pressure to shoot up when it's tested in a doctor's office. Blood pressure readings may be perfectly normal at the doctor's office and elevated as soon as the person gets home, a condition called "masked hypertension." Next: How do you know if you really have high blood pressure?Some older people are being given blood pressure drugs that may be dangerous for them. "On the wrong dosages of medication, older people are at risk of fainting and falling," says Dr. Logan, a hypertension expert at Mount Sinai Hospital in Toronto."And when a frail older person falls, it can be devastating." What can you do to ensure that your blood pressure is being treated appropriately? As it deflates, your doctor's eyebrow lifts slightly. While a blood pressure reading of 120/80 is considered to be the norm for most adults, an expert panel convened by the American College of Cardiology (ACC) and the American Heart Association (AHA) recommends the following measurements for older people: Age 65 to 79: 140/90 or less Age 80 : 140/90 to 145/90 But as you age, the story those numbers tell about your health can be very different from the one they conveyed when you were a decade or two younger. The older you are, the greater the likelihood that your numbers will climb into the danger zone, commonly thought to be a systolic pressure (the upper number) of 140 or higher, or a diastolic pressure (the lower number) of 90 or more.

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