A retrospective cohort study published in JAMA Internal Medicine looked at the hospital and primary care records of 46,634 patients for whom 20 years of blood pressure measurements were available. This investigation demonstrated that among the very elderly blood pressure peaks 14 to 18 years before death and then declines gradually. Among patients over the age of 90, the mean blood pressure drop is -22 mmHg and the decrease becomes linear between 3 and 10 years before death. The implication of these studies is that those who die of “old age” experience a gradual and predictable blood pressure decline. 
An additional study published in JAMA Neurology performed autopsies on 303 persons who died with a mean of 87.2 years of age. Among the 297 who had blood pressure measurements 15.8% had chronic microinfarcts, 63.8% had cortical microinfarcts, 40.4% had subcortical microinfarcts, and 8.5% had infratentorial microinfarcts. Patients with and without infarcts had similar baseline systolic and diastolic blood pressures, but those with subcortical microinfarcts had a greater annual decline in blood pressure. 
The tentative conclusion which can be drawn from these studies is that among the very old blood pressure in the range of 120 to 140 mmHg systolic may be beneficial for the maintenance of cerebral perfusion and avoidance of cognitive decline. Use of medications to control blood pressure among patients over the age of 85 should be examined closely to determine need, and where need is uncertain patients should be gradually tapered down under close medical supervision.
 Delgado J, Bowman K, Ble A, et al. Blood Pressure Trajectories in the 20 Years Before Death. JAMA Intern Med. 2018;178(1):93–99. doi:10.1001/jamainternmed.2017.7023
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