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.

Introduction

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). Yohimbe is an effective but controversial natural erectile dysfunction treatment. It is present in many over the counter ED medications. According to https://www.policymed.com/ed-drugs, there is a debate as to whether or not its herbal form is as strong as its pharmaceutical form, yohimbine hydrochloride. Besides that, it does have many side effects such as headaches, dizziness, anxiety and high blood pressure. 4 milligram doses taken three times a day is an effective dose for many men.

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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34 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.

    • Did they think he was dehydrated? My mom does that staking and feels like she wants to pass out. It was dehydration with her as well as her potassium was too high. She took a supplement everyday for years of 99% potassium because her doctor instructed her. But as they get older things can change so fast within no time. But the sharing and weakness was dehydration Lucille

  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.

    • Exactly same thing happened with my father couple of times in last six months, got his cardiac check up done and all fine. He’s 70 years old.
      He’s diabetic too. Only thing we worked out after reading on internet is after waking up keep foot on higher level while still in bed, wait for ten minutes and then move, it’s going good till now.

  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.

    • Could be vasovagal syncope and my father in law has very low blood pressure and has fallen many times and they now contribute it to amyloidosis.

  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.

    • My father in law had to stop taking flomax. Unfortunately they now contribute his low blood pressure to cardiac amyloidosis.

  9. Since my last post I have had two more episodes, both in the same week! I was very busy cooking all day on Thanksgiving and by late afternoon I could feel it coming so I laid down on the bed and drank a bottle of water. It never became full blown. But two days later I had another that was so bad I thought it might do me in. While I never lost consciousness, I was close to it, as my vision and hearing were beginning to be impaired. It took a long time before it passed. All but one of the six episodes I’ve experienced involved the feeling of having to go to the bathroom which I don’t understand. I am on a BP med called lisinopril and I wonder if that is a common element. I am absolutely convinced that it is the result of dehydration and even knowing this it is difficult for me to remember to consume water periodically throughout the day. As the Amish say “too soon old, too late smart.”

    • Have you ever heard of postural tachycardia syndrome PoTS. A thing called an active stand test will show if your autonomic system is working properly. Worth looking it up.

    • I did the tilt table test and it came out positive and suggestive of neurogenic orthostatic hypotension at this point i am happy just knowing there is a cause for for sudden drop in BP. We are trialing a drug called pyridostigmine. I hope it helps to some degree.

  10. Mine falls from 149 to 109 after I eat something warm. Then I’m out for the night sometimes headache, dizzy, absolutely exhausted.

    • I used to be like this after eating sweets but after that pass now I have the problem of being dizzy and lightheaded and vision loss.

  11. I’m turning 80 in June. I have problems for breakfast or lunch but never dinner. Dizzy and brain fog. Have to lie down.always gone by 4ish

  12. My 93 year old mother has been experiencing these episodes. The symptoms are what is described in these posts. She recovers once her pressure returns to normal. She is also on lisinopril.

  13. This is so interesting, I’m 68 not on bp meds & experiencing the same symptoms. Weakness, low bp, brain fog, head & body pains, need to go to bathroom etc. So perplexing & life altering. Wish there were some answers.

  14. I’m in my mid 70’s…had my first dizzy yesterday..made me feel very uncertain and a bit nauseous…neck and shoulder aches…etc..
    I do take meds for high blood pressure…
    Many thanks to invite for this information.

  15. I’m 71, my dr has had me watching my blood pressure due to it getting to high. It’s normally 137/87. But suddenly this week it dropped and was shopping didn’t think I was going to make it back to my car. It’s been 2 days now and it is still extremely low for me. I have reduced my mess accordingly.

  16. My FIL had multiple falls and hospital stays for years. He was diagnosed in November of 2019 with cardiac amyloidosis and now has developed congestive heart failure. His blood pressure plummets.

  17. I’m 54 had my first passing out 2 year ago just felt dizzy. My 2nd experience was couple of months ago sat in my garden felt tired suddenly and the dizzy, got myself indoors felt uncomfortable so laid down until the dizziness and sweating stopped which was about 20 minutes and drank a bottle of water. The 3rd episode happened this Saturday at a friend’s house party when all of a sudden I felt I needed the bathroom then felt dizzy and fainted for a few seconds after being sick and sweating perfusion. Vist to GP to check blood pressure and found it high on first reading, on second reading asked to stand up the reading was low by 20 units. I drink water all day but do take water tablets daily with other 3 high blood pressure medication… which now needs reviewing over the next month. I’m scared as the passing out is sudden with no warning.

  18. I had my first episode yesterday and then again this morning. Felt weak, dizzy, & lightheaded. My bp was 87/70 and gradually increased to 100/68 later in the day. This morning it was 101/75. I’m on 2.5 mg of Lisinopril and I drink plenty of water due to kidney stones. For the past 3 days I’ve decreased my sodium intake but don’t think bp would drop that quickly.

  19. For the past 2 1/2 years I’ve had episodes when I start feeling lightheaded and might faint. Started checking blood pressure and systolic pressure drops 40 to 50 points then goes back to normal. I was taken off all blood pressure meds and haven’t taken them in 1 1/2 years but still have episodes. I will have several episodes in a day or 2 then they go away for a few weeks then sometimes they happen every couple of days. I was referred to a renowned Cardiologist in Dallas who works with astronauts. Was there 4 hours as he did autonomic testing. Did not find anything so he ordered a sleep apnea test I was diagnosed with moderate sleep apnea and have been waiting for almost 3 months for CPAP machine. The doctor will not proceed with any further testing until I start using the machine. I went to a Neurologist for MRI and MRA and nothing detected with brain & neck scans. I think I will see an Endocrinologist for testing also. This is so frustrating as all doctors so far do not know what is causing the random episodes of sudden drop in systolic blood pressure.

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