Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, board-certified in Anesthesiology, Pain Medicine, Interventional Pain Management, Addiction Medicine and Obesity Medicine. Dr. Padda is the owner of Communicare Elite. Last reviewed August 8, 2026. How we produce and review this content.
Read this first. High blood pressure is a serious condition and treating it prevents strokes and heart attacks. Nothing on this page is a reason to stop or reduce a blood pressure medication. Stopping antihypertensive medication without medical supervision can be dangerous. The point of this article is that treatment needs ongoing review — which is a reason to talk to a clinician, not to act alone.
Hypertension is one of the most common conditions in older adults; research has put the prevalence among Western populations over 60 at around 60 percent. It is so routine that the diagnosis, once made, often stops being questioned — and so does the prescription.
What the study found
A study published in Age and Ageing analyzed more than 11,000 patients over the age of 70 and found that a substantial number — over 1,200 of them — were taking antihypertensive medication while measuring hypotensive, meaning their blood pressure was below the normal range rather than above it.
The researchers linked persistent low blood pressure in this group to increased mortality and hospital admission.
Why this happens
It is rarely anyone’s mistake in particular. It is what happens when a correct decision is never revisited. Blood pressure genuinely falls with age, with weight loss, with illness, and with reduced activity. A dose that was right at 68 can be too much at 78, and nobody notices unless somebody measures.
The consequences of overshooting are not abstract in an older person: dizziness on standing, falls, fainting, confusion, and hospital admissions that follow from those.
The path from an over-tight dose to a broken hip
It is worth spelling out the mechanism, because “blood pressure a bit low” sounds harmless and the endpoint is not.
An antihypertensive dose that is too much for the person taking it produces orthostatic hypotension — blood pressure dropping on standing. That causes dizziness, unsteadiness and fainting, most often on getting out of bed or up from a low chair. In an older adult that means falls; falls mean fractures and head injuries; and a hip fracture at 80 carries a mortality and loss-of-independence risk that has nothing to do with blood pressure at all. The drug that was preventing a stroke can end up causing the event that ends independent living.
Geriatric medicine treats this as a named, actionable problem rather than bad luck. Both the AGS Beers Criteria and the STOPP/START criteria flag medication classes for exactly this reason — centrally acting antihypertensives and alpha-blockers in particular are singled out for causing postural hypotension and falls, and are not recommended as routine treatment for hypertension in older adults.
Deprescribing is a clinical discipline
There is a formal body of practice around reducing or stopping medications that no longer earn their place, and it applies to antihypertensives specifically. Published tools — Beers, STOPP/START, and STOPPFrail for people with limited life expectancy — exist to identify candidates for review, and there is trial evidence on structured withdrawal rather than guesswork.
The point is not that older people should be on fewer blood pressure medicines as a rule. It is that the decision deserves the same deliberate attention going down as it got going up, and that in practice it rarely gets it. A dose set at 68 is often still running unexamined at 82, after twenty pounds of weight loss and a decline in activity that both lower blood pressure on their own.
Deprescribing is something a clinician does with you, never something to attempt alone. Stopping an antihypertensive abruptly can cause rebound hypertension, and some of these drugs must be tapered. The action this article is asking for is a conversation, not a decision.
What the researchers recommended
Not stopping treatment — reviewing it. Consistent follow-up after starting or changing an antihypertensive, and awareness that hypotension is a real risk in a frail population, not just hypertension.
Why this matters more in home care than in a clinic
Blood pressure is measured in a clinic, sitting down, after a rest. The problems caused by it being too low happen somewhere else entirely — standing up from a low chair, getting out of bed at 3 a.m., turning quickly in a bathroom. A reading taken in the right conditions can look perfectly acceptable while the person is nearly fainting at home every morning.
This is called orthostatic hypotension — a drop in blood pressure on standing — and it is both common and under-detected in older adults. It is also one of the most direct causes of the falls that end independent living. The information that closes the gap between the clinic reading and the reality is behavioral, and it comes from whoever is in the house.
What this means for day-to-day care. This is one of the clearest examples of why the person who is there every day matters. Dizziness when standing up, unsteadiness after getting out of bed, new confusion, near-faints, or a pattern of falls in the morning are all worth reporting to the family and the person’s clinician. A personal care attendant does not administer medication or make clinical judgments — but noticing and reporting a pattern is exactly the kind of information that gets a dose reviewed.
Sources
- Age and Ageing — Older people remain on blood pressure agents despite being hypotensive, resulting in increased mortality and hospital admission
- American Heart Association — High blood pressure
- National Institute on Aging — High blood pressure and older adults
- American Geriatrics Society — AGS Beers Criteria for potentially inappropriate medication use in older adults
- Journal of General Internal Medicine — Antihypertensive deprescribing in older adults: a practical guide
- European Geriatric Medicine — Centrally acting antihypertensives and alpha-blockers in people at risk of falls
- To STOPP or to START? Potentially inappropriate prescribing in older patients with falls and syncope
This article is general information, not medical advice. It describes published research; it is not a recommendation for you or the person you care for. Never start, stop or change a prescribed medication because of something you read here — talk to the prescribing clinician first. Communicare Elite provides non-medical personal care through Missouri’s Consumer Directed Services program and does not provide medical advice or treatment.