How To Prevent "Brain Rot"

 

In 2024, "brain rot" was named Oxford's Word of the Year, reflecting concerns about the effects of modern digital culture on a person's cognitive health.

Many people sacrifice sleep to scroll through social media or binge-watch their favorite shows and consume trivial, low-value content. Excessive online use can reduce focus and memory, negatively affect your mental and emotional well-being, and increase the risk of cognitive decline and age-related neurodegenerative disorders like dementia. It can also contribute to social withdrawal and reduce physical activity.

Today, brain rot has become shorthand for describing the negative effects of low-value digital content—especially on social media.

Common signs of brain rot include difficulty concentrating, social isolation and brain fog (a term for a range of symptoms that cause cognitive impairment, such as the ability to think clearly, focus, concentrate, remember and pay attention. It is often described as a cloudy-headed feeling. Forgetfulness is a common complaint among older adults). 

Adopting healthy habits can help you stay mentally sharp and prevent brain rot.

1. Set Social Media Time Limits

Social media platforms are designed to grab and keep your attention. While scrolling through social media can be entertaining, prolonged scrolling often comes at the expense of your focus, productivity and mental well-being. Excessive social media usage can increase anxiety and depression and reduce your school and work performance. 

Setting limits on your time on social media (i.e. digital detoxes—unplugging and stepping away from electronics for a set period) can help protect your cognitive health, boost productivity and mental well-being.

2. Foster In-Person Social Connections

While online connections can add value and help you connect with people with shared experiences, connecting with friends and family in person is important. Make it a point to nurture offline relationships.

Human connection and meaningful social interactions are fundamental to mental and emotional health. Face-to-face communication and connection fosters deeper bonds, empathy, opportunities for meaningful conversations and emotional support. Strong social ties can improve memory and protect against age-related cognitive decline.

Moreover, spending time outdoors is one of the simplest ways to reduce the effects of digital overstimulation, prevent brain rot and improve cognitive performance.

3. Limit Multitasking

While toggling between work emails, social media and your to-do list may seem efficient, multitasking can be more harmful than helpful.

When you multitask, your brain switches rapidly between tasks rather than performing them simultaneously, straining your working memory and decreasing your ability to focus.

4. Practice Mindfulness

Regular mindfulness practice can help retrain your brain to focus, breaking the habit of mindlessly scrolling through social media or other trivial content.

5. Learn a new skill, read books or engage in creative hobbies

Learning a new skill pushes your brain to adapt and grow, enhancing neuroplasticity—the brain's ability to reorganize itself by forming new connections.

Reading is one of the most effective ways to support your brain health. It also strengthens areas of the brain associated with language and imagination, making it a powerful tool against brain rot.

In the meantime, creative hobbies like crafting, drawing, knitting, writing or playing an instrument can keep your brain engaged and foster problem-solving skills.

Moreover, you need to get enough sleep as sleep is essential for brain health. And you also need to eat a nutritious and balanced diet, which can nourish your body and your brain. Consuming high-sugar or processed foods that are low in nutrition can reduce cognitive performance.

In addition, exercise can help you stay mentally sharp while reducing the risk of cognitive decline. It also helps reduce cortisol levels, a stress hormone that can accumulate from excessive digital media consumption and contribute to mental fatigue. 

Vitamin B12 Benefits

 

Vitamin B12, like any other vitamin, is necessary for your body.

Vitamin B12 is a water-soluble vitamin, meaning it needs to be consumed more than fat-soluble vitamins (A, D, E, K) because, unlike fat-soluble vitamins, water-soluble vitamins are not stored in significant amounts in the body. Usually, the excess is excreted through urine every day. Therefore, you need to consume it daily.

Since vitamin B12 contains the mineral cobalt, it is sometimes known as cobalamin.

Vitamin B12 plays a huge role in your body:

Creating red blood cells

New red blood cells need vitamin B12 and folate (vitamin B9) to grow and develop. If these vitamins are lacking, making DNA is hard, causing the immature red blood cells to die. This leads to anemia.

Maintaining nerve cells for nerve functioning

Vitamin B12 is needed to develop the central nervous system (the brain and spinal cord).  Deficiency in vitamin B12 can lead to neurological issues (such as depression and mood changes).

Several studies show a link between depression and low levels of B12 but not a link between increasing the levels of B12 and a reduction in depression symptoms. However, it could be helpful to screen people for B12 deficiency in advance and give B12 supplements to delay or prevent the onset of depression to them.

Vitamin B12 deficiency is also associated with cognitive problems (problems with thinking, judgement and learning) and memory issues and may play a role in getting Alzheimer's disease and stroke.

One study gave B12 vitamins to people with mild cognitive issues and low levels of B12 and showed that most people improved their cognitive symptoms. However, other studies have not seen a connection between low levels of B12 and cognitive problems or an improvement in these symptoms after getting extra doses of B12.  More research is needed.

Keeping skin, hair and nails healthy

Skin 

If you have a very low level of B12, you may be subject to hyperpigmentation (dark spots) on the skin, as well as to vitiligo (light patches on the skin), mouth ulcers, eczema and acne.

On the other hand, too much B12 in the body can also give you vitiligo, mouth ulcers, eczema and acne.

Hair 

B12 deficiency is associated with hair loss. But there is not enough evidence to show that taking B12 supplements will help hair grow back.

Nails

If you have too little B12 in the body, your nails might turn brown-gray or bluish. This should change when you up the B12 level to normal. However, there are no studies showing that taking B12 if your levels are normal will help your nails grow stronger or longer.

Bone health

Several studies have positively linked B vitamins, including B12, with a lower risk of osteoporosis (a disease that weakens the bones) and hip fractures. 

Factors that cause vitamin B12 deficiency in the body include:

Intestinal malabsorption

Conditions that affect your small intestines like Crohn's disease, celiac disease, bacterial growth, or a parasite can lead to vitamin B12 deficiency so can having an autoimmune disease called atrophic gastritis, in which the stomach lining has thinned. This means the body does not make enough hydrochloric acid and intrinsic factor in the stomach, both needed to absorb B12. (Hydrochloric acid separates B12 from the protein it is attached to in food; the freed B12 then combines with intrinsic factor so that the body can absorb the vitamin.)

Also, if you have had weight loss surgery or another operation that removed part of your stomach, you might no longer make enough hydrochloric acid and intrinsic factor to absorb vitamin B12.

Pernicious anemia

Pernicious anemia is an autoimmune disease in which your body cannot make intrinsic factor, a protein that needed to absorb B12 mentioned above. Pernicious anemia is the most common cause of B12 deficiency.

Thus immune system disorders, such as Graves' disease or lupus, are linked with vitamin B12 deficiency, because people who have them tend to also have pernicious anemia or atrophic gastritis, which prevent absorption of the nutrient.

Alcohol

Misusing alcohol or drinking heavily can also make it harder for your body to absorb nutrients, including B12.

Medicines

Taking certain medicines can interfere with the absorption of vitamin B12. These include some heartburn medicines like proton pump inhibitors such as esomeprazole (Nexium).

Vegan diet

If you follow a vegan diet or you are a vegetarian who does not eat enough eggs or dairy products, you could be lacking in vitamin B12. You can add fortified foods to your diet or take supplements to meet this need.

Aging

With age, it can become harder to absorb this vitamin. Many people over 50 do not make enough hydrochloric acid in their stomachs to absorb B12 from foods.

The average recommended daily amounts, measured in micrograms, vary by age. For adults, it needs about 2.4 micrograms.

You can prevent vitamin B12 deficiency by eating animal products (meat, fish, poultry, eggs, milk, etc.) or from foods that have been fortified with it (such as fortified breakfast cereals) or from supplements.

As mentioned, if you have vitamin B12 deficiency, you could become anemic. And if you are pregnant, without enough vitamin B12, your baby could have developmental delays and not thrive the way they should as B12 is very important for brain and spinal development.

A mild deficiency may cause no symptoms. But if untreated, it may lead to weakness, tiredness, lightheadedness, numbness, tingling, depression, mood swings and other symptoms.

A rare condition from a lack of vitamin B12 is optic neuropathy. This means that the optic nerve, the nerve that transmits visual information from the eye to the brain, is damaged. This can lead to a gradual loss of vision, as well as to your seeing blind spots. Less than 1% of people with B12 deficiency report getting optic neuropathy.

On the other hand, excess vitamin B12 in the body is rare because the excess can be excreted through urine. Usually, the manifesting side effects are an indicative sign of kidney dysfunction or liver diseases such as people who have diabetic nephropathy (diabetes that leads to loss of kidney functioning) as the body does not process and secrete the excess vitamin properly.

Is Obesity a Disease?

 

Obesity refers to excessive fat in the body. Obesity may increase the chance of developing health conditions like heart disease, diabetes, high blood pressure, high cholesterol, liver disease, sleep apnea and certain cancers. But there are no unique characteristics or symptoms that doctors can attribute to obesity.

The American Medical Association (AMA) recognizes obesity as a disease that involves genetic, metabolic and behavioral aspects that require medical support. The decision was initially made in 2013 and confirmed in 2023.

The US Centers for Disease Control and Prevention (CDC) also considers obesity a serious chronic disease that demands prevention and intervention strategies in children and adults. The goal of this definition is to develop clear strategies that help prevent and treat obesity-related health complications.

Other medical experts and countries, however, may disagree or feel hesitant about defining obesity as a disease because:

Lack of diagnostic criteria: Classifying a condition as a disease implies certain standards and criteria must be met for its diagnosis. Obesity does not have any characteristic or unique symptoms, and it does not always lead to the same body function impairments. The lack of consistent diagnostic criteria may make it more difficult to categorize obesity as a disease.

Inconsistent measurement standards: Because indexes and standards to measure obesity do not apply to everyone, such as endurance athletes and weightlifters. In other words, weighing more does not always mean obesity is present.

Overall health as a factor: Although obesity affects the body in many ways and may increase the risk of medical conditions like heart disease and diabetes, not everyone with obesity develops health challenges or symptoms. Also, not everyone with health challenges develops obesity.

Patient responsibility and public policies: Some people may worry that categorizing obesity as a disease may take responsibility away from the person and promote a feeling that lifestyle guidelines will not help as much if they have the disease. Instead, some people may tend to rely on weight loss medications or medical interventions to lose weight.

Although studies often suggest that obesity is a risk factor for certain health conditions, they rarely account for the role weight stigma and discrimination play in health.

Discrimination is one of the social determinants of health — the conditions in daily life that affect a person’s health — and it can and does contribute to health inequities. And experiences of weight stigma in daily life are associated with negative mental and physical health outcomes.

Weight discrimination in healthcare can prevent people with high body weights from seeking medical care — and those who do may not receive accurate diagnoses or treatment because doctors may attribute their health concerns solely to their weight.

Two common measurements used by doctors to decide if obesity is present are body mass index (BMI) and waist circumference.

Body mass index (BMI) - measured by your body weight divided by the square of your height.

The American Society for Metabolic and Bariatric Surgery defines three classes of obesity based on BMI:

• ·         class I obesity: 30–34.9
• ·         class II obesity, or serious obesity: 35–39.9
• ·         class III obesity, or severe obesity: 40 and higher

Waist circumference

Excess abdominal fat, relative to the rest of your body, may lead to a greater risk of health complications, even if your BMI does not indicate obesity.

A healthcare professional may consider you have central obesity if your waist circumference (by measuring your waist just above your hip bones) is wide or your waist-to-hip ratio is high.

According to the CDC, a person has a greater chance of obesity-related conditions when their waist circumference is more than 40 inches for males and 35 inches for females.

BMI and waist-to-hip ratio are only estimates of body fat and may not always help to establish whether someone lives with obesity. As mentioned, some bodybuilders and performance athletes have a muscular composition that may lead to a BMI that falls in the range of obesity.

There are many reasons why some people have trouble losing weight. Often, obesity results from inherited, physiological and environmental factors, combined with diet, physical activity and exercise choices.

The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. A healthier diet, increased physical activity and behavior changes can help you lose weight. 

Whole30: A 30-Day Diet for Better Health?

 

The Whole30 diet is a strict 30-day elimination diet that many people turn to for weight loss or help with digestive concerns.

It was developed in 2009 by two certified sports nutritionists. The founders claim that strict adherence to the diet allows the body to reset in isolation from certain foods that may cause inflammation, gut disruptions or hormone imbalances.

The idea behind the Whole30 program is simple: For 30 days, you completely cut out foods that may harm your health.

Following the Whole30 diet involves eating as much as you would like from the approved list of foods while avoiding certain foods for 1 month.

You can eat meat, vegetables, fruit, tree nuts and seeds (except peanuts because they are legumes) and healthy fats.

However, you must avoid sugar, grains, legumes, dairy, alcohol, processed food additives and baked goods, snacks, or treats — even with Whole30-approved ingredients. Eliminating these foods from your diet is supposed to help your body recover from the negative effects and promote long-term health.

Smoking is forbidden for the duration of the diet.

Many people follow this diet in hopes of losing weight. Some may use the program to identify food intolerances or achieve some of its proposed health benefits.

During the month-long elimination period, no cheating is allowed. It is recommended that you start the challenge over from day 1 if you get off track.

Unlike many other diets, there is no need to track calories, measure portions or count points. Also, weighing yourself is strictly reserved for days 1 and 30 of the program.

Following the Whole30 diet perfectly for 30 days is said to have many health benefits, including:

• fat loss
• higher energy levels
• better sleep
• reduced food cravings
• improved athletic performance

The Whole30 diet is claimed to provide you with physical and psychological health benefits above and beyond simple weight loss. However, there is no sound evidence to back up these claims.

After the initial 30 days, you slowly reintroduce some foods while monitoring the effects they have on your body - the reintroduction phase.

In this phase, you slowly reintroduce certain foods into your diet. You evaluate how they make you feel in regard to your metabolism, digestive tract, immune system and relationship with food.

The suggested way to reintroduce off-limit foods is to add back only one food group at a time. For instance, dairy can be reintroduced on day 1 after completing the Whole30 program.

You are then encouraged to return to the Whole30 diet and avoid milk on days 2 through 4, while paying attention to any potential symptoms. If all goes well, you can reintroduce a different food group on day 5, then repeat the process.

Reintroducing only one food group at a time while keeping the rest of the diet the same is promoted as a way to better identify which foods cause negative symptoms, such as bloating, skin breakouts or achy joints.

Once all food groups have been individually tested, you can add the ones your body tolerated well back into your regular diet.

Naturally, individuals are not required to reintroduce all foods. In fact, you are strongly encouraged to avoid reintroducing foods that you do not miss.

Before the diet, some people may unknowingly have food intolerances that cause digestive symptoms, which the diet’s reintroduction phase can help identify.

In addition, several aspects of the Whole30 program are in line with a nutritious diet, for instance, consuming minimally processed foods and a high intake of fresh fruits and vegetables.

However, avoiding nutrient-rich foods like legumes, soy, and dairy may make meeting all the daily nutrient recommendations more difficult. And there is also no strong reason to restrict dairy, grains, or legumes.

This may create negative health effects if the diet is continued for more than 30 days.

And although rigid rules can be a good way to reset eating habits for some people, restrictive diets with no allowance for indulgences are generally not sustainable over time.

A calorie deficit is needed for weight loss. Because of its restrictive nature, the Whole30 diet will likely help create this calorie deficit. But unless the food choices you make on this diet become a habit, the weight loss you experience may not be sustainable in the long term.

What Is Dirty Fasting?

 

Dirty fasting is a different approach to intermittent fasting.

Intermittent fasting involves periods of little to no eating. One common way to practice intermittent fasting is through time-restricted eating.

Time-restricted eating requires limiting the hours you eat within a day to a 12-, 10-, or even eight-hour window.

The latter option, also known as the 16:8 intermittent fasting diet, involves a 16-hour fast followed by an eight-hour eating window.

Time-restricted eating helps prevent overeating, maintain a consistent eating schedule and eat more mindfully.

Traditionally, during fasting hours, you only consume beverages with zero or minimal calories—like water, black coffee or tea, and unsweetened herbal tea. This type of fasting is known as "clean fasting."

Clean fasting may offer benefits that include:

• Improved heart health
• Reduced blood pressure and blood sugar
• Weight loss

In a 2021 study published in Frontiers in Endocrinology, researchers explain that the science behind time-restricted eating relates to the circadian clock. Our body's circadian clock is tightly connected to our body's metabolism, and meal timing is an essential factor in metabolism.

Dirty fasting is a specific type of time-restricted eating that allows you to consume about 100 calories during the otherwise clean fasting periods. The goal is to disrupt the concept of fasting as little as possible while achieving similar benefits as a clean fasting. Here is the theory behind dirty fasting:

Fasting is known as the absence of calories. But if the body cells do not react as they likely do during a "fed" state, people can still possibly achieve that fasting state even with the limited caloric intake that a dirty fast allows.

The rules of dirty fasting differ depending on the sources.

In the 2021 Nutrients study, researchers assigned 105 adults either water, a traditional breakfast, or a commercially available bar called Fast Bar (made from nuts, seeds, vegetable fiber and honey, with about 200 calories) after a 15-hour overnight fast.

The researchers found that the Fast Bar group had glucose levels comparable to that of the water-only group throughout the hours after the meal. Also, their ketone levels were similar to the water-only group two or more hours after the meal.

In contrast, the breakfast meal spiked glucose and reduced ketones. The Fast Bar eaters also experienced high self-rated levels of fullness and a decreased desire to eat compared to the water-only group.

Thus one Fast Bar consumed during the fasting window does not interfere with physiological fasting.

But without more research on how various foods, macronutrients, ingredients, and caloric intake impacts the body during dirty fasting, there are no science-backed rules about what you can eat during fasting hours.

Some say that any food or beverage during the fasting hours is okay, as long as it is less than 100 calories. Others only sanction high-fat foods, which do not immediately spike insulin, or allow higher-protein foods, like bone broth or collagen, during the fasting window.

In contrast, one 2021 study in the journal Nutrients pointed out that a lower protein intake is more effective at not triggering metabolic pathways in the body that sense the availability of nutrients.

Also, some may allow artificial sweeteners because they are zero calories. Still, a 2017 study in Physiology and Behavior showed that those sweeteners might increase insulin levels during a fast, even when tasted and not swallowed.

Many people interested in dirty fasting seek the health benefits of time-restricted eating but the flexibility to eat or drink something with caloric value during the fasting window. Flexibility helps them stay on track with their fasting routine because they are not as limited or as hungry.

But much more research is needed to understand the best way to practice dirty fasting and its possible benefits.

Nevertheless, regardless of what research does or does not say about the physiological effects of dirty fasting, there can be psychological or behavioral benefits.

For example, being able to nibble on something in the morning prevents over-splurging later in the day. And knowing what you can eat or drink helps you get through the tail end of a fasting window, even if you do not need the food or drink. 

But experts point out that the quality of what you eat during non-fasted hours (or the small dirty fasting windows) matters.

Nutrition is still the key. Be sure to build in a variety of vegetables, fruits and other whole foods daily to optimize the intake of vitamins, minerals, fiber, antioxidants and macronutrients.

Ways to Live a Longer Life

 

Human longevity is affected by a complex number of factors, including lifestyle.

Research indicates that lifestyle choices, particularly diet and exercise, play an outsized role in determining whether or not we live long, healthy lives.

“The question we really should be asking and focusing on is what is healthy aging and healthspan, not life span,” Amanda Boyce, Health Scientist Administrator in the Division of Aging Biology, NIH’s National Institute on Aging, said.

At age 50, you could live up to 14 years longer if you have:

• follow a healthy diet
• never smoked
• maintain a healthy weight
• are regularly active (over 30 minutes per day of moderate or vigorous activities)
• keep alcohol to a moderate consumption (5 to 15 g per day for women and 5 to 30 g per day for men)

Healthy Diet

When it comes to diets that improve longevity and prevent disease, the Mediterranean diet and the Japanese/Okinawan diet are the best. Both emphasize similar dietary patterns: 

They are heavy on fish as a source of protein, which is rich in brain-boosting and heart-healthy fats. They also include plenty of whole vegetables (fresh or fermented) and limit heavily processed foods and sugar.

In a 2020 study, adults who followed a diet rich in fruits and vegetables for 8 weeks had a reduced risk of cardiovascular disease.

Another 2020 study found that every 66-gram increase in daily fruit and vegetable intake was associated with a 25% lower risk of developing type 2 diabetes.

A 2020 review of studies also suggests consuming an adequate amount of fruit and vegetables is associated with lower risk of:

• heart disease
• stroke
• cancer
• premature death

Meanwhile, in an observational study of almost 200,000 adults, those who ate the most whole grains had a 29% lower rate of type 2 diabetes than those who ate the least.

Research from 2020 links consuming more whole grains with reduced risk of:

• diabetes
• obesity
• cardiovascular disease
• cancer

“When we think about longevity, we must consider dietary patterns and changes that will provide long-lasting impact and, most importantly, are sustainable!” said Alyssa Kwan, Clinical Dietitian in Cardiology, Stanford Medicine.

Shed excess pounds

Obesity is linked to numerous chronic illnesses, including cardiovascular disease and diabetes, and even a shorter lifespan.

But rather than just trying to lose weight, learn about the ideal body weight for your age, sex and height.

“Maintaining a healthy weight across life stages is critical for healthy aging and for improving both lifespan and healthspan,” said Frank B. Hu, professor and chair of the Department of Nutrition, Harvard T.H. Chan School of Public Health.

 “Maintaining a healthy body weight through diet and exercise is something that I have continually strived for,” Hu added.

Cut down on sitting

As our lives have become more sedentary, science has homed in on the negative effects that can have on longevity and disease risk.

“Sedentary behavior, such as prolonged TV watching, has been associated with an increased risk of chronic diseases, including diabetes, cardiovascular disease and premature death. This heightened risk is primarily attributed to increased obesity and the displacement of physical activity,” said Hu.

Even if you exercise regularly, sedentary behavior has serious health risks associated with it. 

Exercise — the more, the better

Regular exercise is one of the best things you can do for your health. The benefits extend to brain health and cognition, too.

New research published in December 2024 found that among older adults, cardiorespiratory fitness was an excellent indicator of brain health across multiple domains of cognition, including memory.

“The two things in older adults that we see as a result of aging that lead to decreases in their quality of life are changes in cognition, and functionality, staying up on your feet. Exercise is far and away the thing that impacts both of them,” Katherine T. Ward, clinical section chief of geriatrics at Stanford Medicine, said.

In a 2020 study of 44,000 adults, researchers found that those who got 11 minutes of moderate-to-vigorous physical activity each day had a lower risk of death compared to those who only exercised at that intensity for 2 minutes.

The U.S. Centers for Disease Control and Prevention recommends 150 minutes of moderate intensity exercise per week, plus 2 days of muscle strengthening exercise.

Finding ways to increase physical activity and cut down on sedentary time in a manner that is enjoyable is key to making the habit sustainable.

Stop smoking

In a study led by Frank Hu and published in 2018, researchers found that “never” smoking was one of five key factors for prolonging life expectancy. The others were:

• maintaining a healthy weight
• regular physical activity
• healthy diet
• only consuming a moderate amount of alcohol

Cigarette smoking is associated with roughly one of every five deaths in the United States each year, amounting to more than 480,000 deaths annually.

Smoking is linked to everything from cancer and heart disease to diabetes and COPD (Chronic obstructive pulmonary disease). Stopping smoking not only lowers the risk of all these diseases but can add as much as ten years to life expectancy.

 “Overall, to improve longevity, think about sustainability. Consider other factors such as maximizing sleep, minimizing stress levels, and engaging in an active lifestyle ~150 minutes of physical activity weekly,” added Kwan.

To control stress, try to have strong relationships and staying in communication with friends to support mental health. Exercise can reduce stress by releasing pent-up energy and boosting the release of mood-lifting hormones called endorphins. Other mindfulness practices including meditation also help.

Hypertension Guideline Update

 

Hypertension represents a major modifiable risk factor for coronary artery disease, heart failure, stroke, chronic kidney disease and dementia. Two well-established clinical practice guidelines on hypertension include the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults and the 2023 European Society of Hypertension (ESH) Guidelines for the Management of Arterial Hypertension.

The ESH recommends a threshold of >140/90 mm Hg (Grade 1) for the diagnosis of hypertension, whereas the ACC/AHA guideline recommends a lower threshold of >130/80 mm Hg (Stage 1). Systolic blood pressure (SBP) ranging between 130 and 139 mm Hg or diastolic blood pressure (DBP) ranging between 80 and 89 mm Hg represent Stage 1 hypertension in the ACC/AHA guideline, whereas the ESH guidelines classify these ranges as "normal" or "high-normal" (130-139/85-89 mm Hg). Whereas the ACC/AHA guideline categorizes BP ≥140/90 mm Hg as Stage 2 hypertension, the ESH guidelines subdivide BP levels ≥140/90 mm Hg into Grades 1, 2, and 3 hypertension.

                     * Target <130/80 if tolerated

With increasing age, blood pressure rises as a consequence of arterial stiffness, caused by the biological process of ageing and arteries becoming clogged with fatty substances, otherwise known as arteriosclerosis.

Since arterial hypertension (high blood pressure in the arteries) is the most important preventable cause of cardiovascular disease, lowering blood pressure can lower the risk of heart attacks, stroke, and all-cause mortality, even in people over 80.

However, for mental abilities, age seems to play an important role. At old age, low blood pressure is associated with worse cognitive function and increased mortality than people with higher blood pressure especially when they are frail.

Thus doctors thinking about prescribing blood pressure lowering therapy in older patients should consider the specific patients. A more individual approach instead of “one size fits all” seems most appropriate and is also more patient-centered. This is especially important for very old and frail patients not just to follow the guidelines.