TLDR;
This video discusses low blood pressure (hypotension) in older adults, including its definition, common causes, symptoms, and management. It emphasizes the importance of monitoring blood pressure, especially in older adults, and seeking medical advice if experiencing related symptoms.
- Normal blood pressure is less than 120/80 mmHg, while hypotension is generally defined as less than 90/60 mmHg.
- Common causes of low blood pressure in older adults include medications, dehydration, and autonomic insufficiency.
- Orthostatic hypotension, a drop in blood pressure upon standing, is prevalent among older adults and can lead to falls.
- Management involves reviewing medications, addressing dehydration, and implementing strategies to minimize symptoms.
Introduction to Low Blood Pressure in Aging [0:00]
Dr. Lesley Kernison introduces the topic of low blood pressure (hypotension) in aging adults, as part of a series on blood pressure. The video aims to provide an understanding of low blood pressure, particularly for individuals on blood pressure medications or those with concerns about low blood pressure. The episode will cover the definition of low blood pressure, common causes in older adults, signs and symptoms, orthostatic hypotension, and geriatrician's approach to managing low blood pressure, concluding with suggestions for concerned individuals.
Defining Hypotension and Low Blood Pressure [2:17]
Normal or optimal blood pressure is defined as less than 120/80 mmHg. Hypotension is generally accepted as a blood pressure less than 90/60 mmHg, though not officially defined in current guidelines. A systolic blood pressure between 90 and 110 might be considered low, but its significance depends on individual context, symptoms, medications, and other health conditions. The primary focus is usually on the systolic number when discussing low blood pressure concerns.
Causes of Very Low Blood Pressure [5:48]
Very low blood pressure warrants investigation to identify potential underlying causes. Sudden onset of very low blood pressure, especially with a systolic under 80, is a medical emergency. Potential causes include hypovolemia (low blood volume) due to bleeding or severe dehydration, sepsis (infection spreading to the bloodstream), anaphylaxis (severe allergic reaction), heart attacks, and adrenal gland crises. Prompt medical evaluation is crucial for very low blood pressure, especially after a fall, injury, or sudden symptoms.
Vasovagal Hypotension [8:21]
Vasovagal response is a temporary form of very low blood pressure caused by a neural reflex that briefly drops blood pressure. The danger lies in potential fainting and falls due to the sudden drop. Symptoms may include lightheadedness, nausea, sweating, and paleness, sometimes triggered by urination or defecation. It's a common cause of passing out, especially in older adults, and head injuries sustained during such episodes require emergency room evaluation.
Common Low Blood Pressure Causes in Aging [9:34]
Common causes of lowish blood pressure (systolic 90-110) in older adults include medications, particularly those for high blood pressure, and other medications like tamsulosin (Flomax) for enlarged prostate. Dehydration and autonomic insufficiency, where the autonomic nervous system malfunctions, are also significant factors. Autonomic insufficiency can be associated with conditions like Parkinson's, Lewy body disease, diabetes, and can cause postprandial hypotension (drop in blood pressure after eating). Other causes include slow blood loss, heart failure, advanced liver disease, and hormonal problems.
Understanding Orthostatic Hypotension [13:15]
Orthostatic hypotension involves a drop in blood pressure upon standing or changing position, common in older adults due to the aging of the body's blood pressure regulation system. It's defined as a systolic drop of 20 mmHg or more, or a diastolic drop of 10 mmHg or more. Affecting about 25% of older adults, it's of special interest in geriatrics due to the risk of falls and near falls. Causes include aging, medications, dehydration, autonomic insufficiency, and vasovagal components. Checking for it involves measuring blood pressure and pulse after lying down and then after standing for 1-3 minutes, while also noting any symptoms.
Signs and Symptoms of Low Blood Pressure [17:23]
Symptoms of low blood pressure depend on how low the blood pressure is, how much lower it is than usual, and the underlying cause. Very low systolic blood pressure (under 80) often causes passing out and is a medical emergency. Lowish blood pressure may cause fatigue, lightheadedness (especially when standing), falls, and a fast heart rate as the body tries to compensate. However, some individuals may experience no symptoms at all. It's important to report heart rate along with blood pressure readings.
Managing Low Blood Pressure in Geriatrics [20:14]
In geriatrics, managing lowish blood pressure involves a proactive and reactive approach. Proactively, geriatricians investigate systolic blood pressure readings less than 120 mmHg, asking about symptoms, checking for orthostatic drops, reviewing medications, and considering dehydration. Reactively, they consider low blood pressure or orthostatic hypotension when older adults present with symptoms like falls, fatigue, dizziness, or reduced mobility. Common medications to review include those for high blood pressure, heart conditions, enlarged prostate, erectile dysfunction, diuretics, diabetes, and antidepressants.
If You’re Concerned About Low Blood Pressure [26:29]
If concerned about low blood pressure, especially with symptoms, consult a healthcare provider for evaluation. Use a home blood pressure monitor, record pulse and symptoms, and track when they occur. Increase fluid intake if dehydration is possible. Bring blood pressure readings (both symptomatic and asymptomatic) and all medications to the appointment. If there are no symptoms but blood pressure is consistently low (less than 110 systolic), get more data points and discuss blood pressure treatment goals with the provider, considering medication adjustments, especially for those over 75 or 80.
Recap [29:27]
The video recaps key points: normal blood pressure is less than 120/80, hypotension is generally under 90/60, and systolic blood pressure of 90-110 is considered low, especially in older adults. New, very low blood pressure usually causes symptoms and is a medical emergency. Vasovagal response and orthostatic hypotension are common causes of temporary blood pressure drops and falls. Low blood pressure (90-110 systolic) should be investigated in older adults, considering medications, dehydration, and autonomic insufficiency. The approach involves investigation, symptom assessment, orthostatic drop checks, medication review, and addressing potential dehydration.