Reviewed by a board-certified geriatrician
High blood pressure and high cholesterol are two of the most common questions we hear from older adults and their families. Both are about the health of your arteries, the flexible tubes that carry blood from your heart to every part of your body. Knowing what changes inside them with age makes it easier to see why the everyday steps below make a real difference.
Why blood pressure tends to rise with age
Blood pressure has two numbers. The top number (systolic) is the pressure when your heart beats. The bottom number (diastolic) is the pressure between beats. In many older adults, the top number climbs while the bottom number stays the same or even drops. This is called isolated systolic hypertension, and it is the most common type after 60 [1].
The main reason is that large arteries slowly get stiffer.
Stretchy fibers wear out. Healthy arteries are lined with elastin, a protein that stretches with each heartbeat and springs back, like a rubber band. After billions of heartbeats, elastin frays and breaks. The body makes very little new elastin after we finish growing, so this wear adds up over a lifetime [2].
Stiffer material fills in. As elastin wears out, it is replaced by tougher collagen and small deposits of calcium. The artery becomes more like a garden hose than a balloon, so each heartbeat pushes the pressure higher [2].
The inner lining slows down. Arteries are lined with a thin layer of cells called the endothelium. These cells make nitric oxide, a natural signal that tells the artery wall to relax and widen. With age, and with smoking, diabetes and high blood pressure itself, the lining makes less nitric oxide, so arteries stay narrower [3].
High blood pressure usually causes no symptoms. Over time, though, it strains the heart, kidneys, eyes and brain. Keeping it in a healthy range lowers the risk of stroke, heart attack, kidney disease and memory problems.
What cholesterol does inside the arteries
Cholesterol is not all bad. Your body needs it to build cells and make hormones. It travels in the blood in small packages. LDL ("bad" cholesterol) carries cholesterol out to the body. HDL ("good" cholesterol) carries extra back to the liver to be cleared.
When there is too much LDL in the blood, some of it slips into the artery wall, especially where the lining is worn or irritated. There it can become damaged, and the body sends in white blood cells to clean it up. Over years, this builds into a fatty, inflamed bump called plaque. Plaque narrows the artery, and it can stiffen with calcium. If a plaque cracks, a blood clot can form on it and block blood flow, which is what causes most heart attacks and many strokes. Genetic, population and treatment studies all show that LDL is a direct cause of this process, and that lowering it lowers risk [4].
High blood pressure and high cholesterol make each other worse. Higher pressure wears the lining, which lets more LDL in, and plaque makes arteries stiffer, which raises pressure. That is why we look at them together, along with blood sugar and smoking.
Everyday steps that help your arteries
The wear on elastin can't be undone, but you can protect what you have and help your arteries work better. Good habits do three things: keep blood flowing smoothly, avoid damage from high blood sugar and sudden pressure spikes, and calm the low-level inflammation that builds with age.
Move at a steady, comfortable pace. Brisk walking, swimming or cycling at a pace where you can still talk (sometimes called Zone 2) is ideal. Smooth, steady blood flow along the artery lining prompts it to make more nitric oxide. Aim for about 30 minutes most days, in shorter bouts if that's easier. In studies, regular aerobic exercise lowered blood pressure by about 3.5/2.5 points on average [5]. With weights, breathe out as you lift rather than holding your breath.
Slow your breathing. Slow, deep breathing through the nose, gentle yoga, tai chi and even humming help shift the body into its "rest and digest" mode, and many people find them calming. The evidence on blood pressure itself is limited: a 2022 review found that device-guided slow breathing did not clearly lower it, and there are too few good studies of other slow-breathing practices to say [6]. Humming also raises nitric oxide in the nose about 15-fold [7], though its effect on blood pressure hasn't been well studied. A few minutes a day is a good start.
Eat for your arteries.
Less salt. Most salt comes from packaged, restaurant and takeout food, along with soy sauce and other sauces. Cooking at home makes a big difference. In the DASH-Sodium trial, eating less salt lowered blood pressure, and combining it with a DASH-style diet lowered it most [8].
More vegetables, fruit, beans and whole grains. These supply potassium and fiber. If you have kidney disease or take certain blood pressure medicines, ask before adding a lot of potassium.
Beets and leafy greens. These are rich in natural nitrates. Helpful bacteria in your mouth turn them into nitrites, which the body turns into nitric oxide. In studies, beet juice and nitrate lowered the top blood pressure number by about 4 points on average [9]. In healthy volunteers, a week of strong antiseptic mouthwash blocked this pathway and raised blood pressure slightly [10].
Barley and oats. These contain beta-glucan, a soluble fiber that forms a gel in the gut and binds bile acids, which are made from cholesterol. The liver then pulls more LDL out of the blood to make new bile. About 3 grams of beta-glucan a day, roughly 1 1/2 cups of cooked oatmeal or barley, lowered LDL by about 10 mg/dL in a review of 28 trials [11]. Barley beta-glucan has a similar effect [12].
Keep sweets and refined carbs in check. This helps keep blood sugar steady, which is better for your arteries.
Other habits that count: don't smoke, keep alcohol low, aim for good sleep, and look after your mood and stress. Our articles on staying active, restful sleep and healthy habits have more.
Medicines are often part of the plan
Lifestyle changes help everyone, but many people also need medicine to reach a healthy blood pressure or cholesterol level, especially as arteries age. In a large trial of adults 75 and older, tighter blood pressure control lowered heart attacks, strokes and deaths [13], and statins lower heart attacks and strokes at every age, with the clearest benefit in people who already have heart or blood vessel disease [14]. The right goal depends on your overall health, other conditions and what matters to you, so it is worth a conversation with your doctor rather than a single number for everyone.
When blood pressure drops too low
Blood pressure can also fall over time. This can happen after weight loss, a new diet or more activity, and in our experience sometimes after retirement, when daily work stress eases. A dose that was right for years may become too strong. Signs include dizziness or light-headedness, especially when standing up, tiredness or falls.
Check your blood pressure at home now and then, sitting and after standing for a minute, and bring the readings to your visits.
Tell your doctor about dizziness or falls. Lowering or stopping a medicine may be the answer.
Don't stop or change a blood pressure medicine on your own. Some need to be tapered slowly.
When to call your doctor
Ask your doctor which home readings they want to hear about, and write them down. Call sooner if your readings are running higher than usual for you, or if you feel dizzy or light-headed or have a fall.
Call 911 for chest pain, shortness of breath, back pain, numbness or weakness, vision changes or trouble speaking, especially along with a high reading [15]. Don't wait to recheck your blood pressure first.
This article is for general education and isn't a substitute for advice from your own doctor.
Related: Hard plaque, soft plaque, and what a calcium score can miss
Related: Protecting your kidneys as you age
Sources
Franklin SS, et al. Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives. Hypertension. 2001;37(3):869-874.
Wagenseil JE, Mecham RP. Elastin in large artery stiffness and hypertension. J Cardiovasc Transl Res. 2012;5(3):264-273.
Seals DR, Jablonski KL, Donato AJ. Aging and vascular endothelial function in humans. Clin Sci. 2011;120(9):357-375.
Ference BA, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. European Atherosclerosis Society consensus statement. Eur Heart J. 2017;38(32):2459-2472.
Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2(1):e004473.
de Freitas Gonçalves KS, et al. Device and nondevice-guided slow breathing to reduce blood pressure in hypertensive patients: a systematic review and meta-analysis. Health Sci Rep. 2022;5(3):e636.
Weitzberg E, Lundberg JO. Humming greatly increases nasal nitric oxide. Am J Respir Crit Care Med. 2002;166(2):144-145.
Sacks FM, et al. Effects on blood pressure of reduced dietary sodium and the DASH diet. N Engl J Med. 2001;344(1):3-10.
Siervo M, et al. Inorganic nitrate and beetroot juice supplementation reduces blood pressure in adults: a systematic review and meta-analysis. J Nutr. 2013;143(6):818-826.
Kapil V, et al. Physiological role for nitrate-reducing oral bacteria in blood pressure control. Free Radic Biol Med. 2013;55:93-100.
Whitehead A, et al. Cholesterol-lowering effects of oat beta-glucan: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2014;100(6):1413-1421.
AbuMweis SS, Jew S, Ames NP. Beta-glucan from barley and its lipid-lowering capacity: a meta-analysis of randomized, controlled trials. Eur J Clin Nutr. 2010;64(12):1472-1480.
Williamson JD, et al. Intensive vs standard blood pressure control in adults 75 years or older (SPRINT). JAMA. 2016;315(24):2673-2682.
Cholesterol Treatment Trialists' Collaboration. Efficacy and safety of statin therapy in older people. Lancet. 2019;393(10170):407-415.
American Heart Association. Hypertensive crisis: when you should call 911 for high blood pressure.