Five things to know about sudden fall in blood pressure and aging

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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”.

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10 thoughts on “Five things to know about sudden fall in blood pressure and aging

  1. My father has high blood pressure but suddenly his blood pressure drops followed upwith allergic conditions like rashes starts to appear on his whole body, Doctors say everything is normal but it happened a couple of times in 2 years and we don’t have any clue. Can someone explain???

    • One night my father came up to me, trembling. Like he had a bad case of the chills, I thought for sure he was going to have a high fever but he was sweating. It stopped after about 20 minutes. The next morning I found him passed out on the bathroom floor. We went to the ER, his blood pressure was at 81. They could not figure out what was wrong. He too has random Hive rashes. One day months before the scare, he woke up and one eye was swollen shut, like someone beat him for 5 minutes. He takes Benadryl to calm it but it randomly happens from time to time. Sometimes on this legs or arms. But reading your story makes me wonder if it all connected. They still can’t figure out what happened and also why the hives happen.

  2. That same issue is going on with my dad now who is in the hospital. Did you ever get an answer to your question from anyone?

  3. It was great that you mentioned signs of low blood pressure dropping, like dizziness or even vision problems. My dad was walking down to the basement when he started getting dizzy, and he looked pale as well. We will take him to a clinic for evaluation and see if it was his pressure dropping.

  4. I will be fine when I first stand up. Then I feel giddy,my legs and arms feel lame have blurred vision. My husband says I look blank.
    I then lie down and fall asleep.

  5. I have controlled high bloodpressure but I have had issues of my pressure dropping and passing out. It always happens at night and it starts with me feeling like I need to go to restroom. When I sit on toliet a few minutes I start sweating horribly and shaking the next thing I remember is getting up of bathroom floor.

  6. Are these blood pressure drops in any way affiliated with head trauma or traumatic brain injury cases?

  7. I have now had three episodes of plunging blood pressure. All three involve the need to be on the toilet even though they start before that. After the second episode I had the good sense as it was passing to take my BP and it was very low—about 100 over 40. I spoke briefly with the doctor and she said I might be dehydrated and should drink water—which I know I don’t do enough. This last time I was not at home and ended up passing out in the church kitchen where I went to get water. About a half hour later when I was somewhat recovered and driven home, my BP was 103 over 40. I did not take my BP meds that night and by morning it was 136 over 53. Now it’s back to more normal but it’s worrisome. A friend told me her husband had similar episodes and it was related to caffeine, but she couldn’t explain.

  8. I am 64-year-old male and a have had three such incidents in the last two years. I was on a low dose of blood pressure medicine and had an incident at a rehab facility for surgery and was transported to a hospital after fainting. They were not able to find anything except for possible dehydration. about six months later I had another episode on an airplane. it was preceded by a feeling of sudden fever, profuse sweating, and needing to get up to go to the restroom. I made it about three forths of the way there and the next thing I remember I was on the floor in the aisleway of the plane. The third episode was about two days ago again at a rehab facility for another surgery on the same hand. I was able to catch it before passing out completely but there was profuse sweating and about a 15 minute period of completing immobility. I think a pattern is developing for me and in the other replies to this question. Aging increases the tendency, dehydration is a significant contributor, perhaps the biggest, it is difficult to drink when you don’t feel thirsty but you must. I take Flomax to assist with urinary function, and I do believe now that could contribute as well. Increased urination with decreased hydration is a bad combination. Any diuretic including tea and caffeine can increase the tendency to have this problem. So, hydrate more, consider allowing your blood pressure to be a little bit higher which is better than injuries that could occur falling Or during driving.

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