By Daniel Romila
This is a summary of a letter to the Journal of the American Geriatrics Society published by ICORD researchers from the Department of Medicine at the University of British Columbia. The intention is to make physicians aware of sudden changing in blood pressure in elderly patients.
Original letter to the editor: Mills P, Gray D, Krassioukov A. (2014) Five things to know about orthostatic hypotension and aging. Journal of the American Geriatrics Society. 62(9), 1822-3. Find the original article here.
Orthostatic hypotension is the sudden drop in blood pressure when suddenly standing or changing position. It is defined as a fall in systolic (maximum) blood pressure of at least 20 mm Hg or diastolic (minimum) blood pressure of at least 10 mm Hg when a person assumes a standing position. Typical symptoms are dizziness, light-headedness, blurred vision, shoulder pain. Atypical symptoms include backache and discomfort in the lower parts of the body. It is not uncommon, and can happen to anyone, but is more prevalent in older people and those with low blood pressure (hypotension).
Five things to know about sudden fall in blood pressure and aging:
1. Orthostatic hypotension is itself a risk factor in elderly adults, and can cause accidents.
Doctors should identify elderly adults who are at risk of this condition. It can lead to falls, fractures and head injuries. Recent studies suggest the condition can affect the normal functioning of the brain.
2. Orthostatic hypotension can manifest in different ways.
The fall in blood pressure usually happens during or shortly after standing, but can happen even after three minutes following a change in body position. This delayed fall in blood pressure may escape detection during a visit to the doctor. It is important for doctors to know how the fall in blood pressure manifests; if it is sudden or delayed, especially when screening high-risk patients.
3. Orthostatic hypotension occurs more often with aging. The risk is higher for those taking medication and those with conditions affecting the nervous system.
Some medication may cause sudden fall in blood pressure. Medication used for high blood pressure, drugs that promotes the production of urine and drugs that allows urine to flow out of the bladder more easily and drugs for treating depression are considered high-risk medications. Diabetes and Parkinson’s are examples of conditions that increase the risk in elderly adults.
4. Orthostatic hypotension often goes unnoticed.
A large study found the condition is present in 18.2% of individuals aged 65 and older. While 43% of those experiencing sudden blood pressure drop had typical symptoms, like dizziness, visual problems and pain centered in the neck and shoulders, 33% had no symptoms at all. 24% had non-specific symptoms, including backache and lower extremity discomfort.
5. A cautious approach is necessary, starting with methods not involving medication.
Reversible causes (such as anemia) should be identified and treated. Whenever possible, high-risk medication should be removed or reduced. The treatment should be oriented more towards avoiding accidents and improving the individual’s quality of life, than obtaining a specific blood pressure level.
How does this relate to individuals with SCI?
The above 5 points should be considered by individuals with SCI, as some can be troubled with orthostatic hypotension when changing their position.
According to one of the authors, Dr. Krassioukov, in an ICORD information postcard that can be found here, people with SCI may be prone to falls in blood pressure due to changes in blood vessels, which cannot push blood back to the heart.
Orthostatic hypotension can affect the ability to participate in activities likely to provoke falls in blood pressure, including rehabilitation programs.
More information about how orthostatic hypotension specifically affects individuals living with SCI can be found in the article, “Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology”.