What to do if an elderly person has low blood pressure?
Low blood pressure in old age is a common problem that can cause a lot of trouble and even threaten health. First of all, let’s define what I consider low blood pressure. For an elderly person, the normal level is at least 120 mm Hg, and ideally 130. Anything lower requires attention.
The most common cause of low blood pressure in the elderly, in my experience as a physician, is overdose of antihypertensive drugs. Many people believe that 120/80 is the ideal «cosmonaut» pressure. But few realise that for an elderly person with age‑related changes in blood vessels and the heart, such numbers are already hypotension. The blood supply to the brain and heart muscle suffers when pressure drops below 130 mm Hg. Therefore, the first step is to review the dosages of blood‑pressure‑lowering medications. This must be done only in consultation with a geriatrician; changing the regimen on your own is dangerous.
But what if the pressure is 110–120 and the person is not taking any blood pressure medication? Then we need to look for other causes.
First, pay attention to diet. The diet of an elderly person is often monotonous – they eat only what they are used to. This can lead to deficiencies in essential nutrients. If the pressure is slightly low, you can moderately increase the amount of salty foods – pickles, salted tomatoes, herring will help retain fluid and slightly raise blood pressure. But without overdoing it!
Water is the second important point. Elderly people have a blunted sense of thirst. They simply do not want to drink, they forget to drink, and this leads to dehydration. Relatives should monitor how much fluid their elderly charge consumes. It is advisable to drink at least 1–1.5 litres per day (unless there is heart failure or other contraindications).
Movement is life. Moderate physical activity helps normalise blood pressure. It does not have to be intense training – morning exercises, walking, simple exercises are enough. But you need to start very gradually, and always after consulting a geriatrician. A sudden start can be harmful.
The most difficult and alarming situation is progressive drop in blood pressure in an elderly person who is not taking antihypertensives. If yesterday it was 100, in two days – 90, in another two days – 80 mm Hg, this is a very serious signal. At pressures below 70–80, the intestines stop working, and the blood supply to all organs is disrupted. Unfortunately, low blood pressure in the elderly is very difficult to raise – unlike high blood pressure, which is relatively easy to lower. Such a trend usually indicates that the body’s reserves are exhausted.
Why is low blood pressure dangerous for the elderly?
Hypotension is not just numbers on a tonometer. It carries real threats:
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Dizziness and weakness increase the risk of falls. And a fall in old age often leads to fractures, including hip fractures, which can be fatal.
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Blood supply to the brain, heart, and kidneys is impaired. This leads to deterioration of their functions, development of ischemia, dementia, heart failure.
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Constant fatigue, apathy, decreased activity – quality of life declines, the person becomes withdrawn, and depression may develop.
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Sleep, memory, and concentration worsen – cognitive functions suffer.
Here is an example from my practice. I was called to see a 75‑year‑old woman. Complaints of weakness and apathy. She asked for medication that would «bring her back to an active life». During the interview, I found out the following. She had previously been examined by a cardiologist, a therapist, and a neurologist. Each of them prescribed extensive therapy. At the time of my examination, the woman was taking about 12 different medications. Four of them were for lowering blood pressure. I measured her pressure – 110/80 mm Hg. Both the patient and her relatives proudly said that everything was fine with that – «like a young person’s». I prescribed a scheme of gradual, smooth, partial withdrawal of antihypertensive drugs. About 10 days later, her pressure stabilised at 140/80. The woman became much more active. She regained interest in life. She developed physical activity appropriate for her age.
This is the view of a geriatrician on the problem of low blood pressure in the elderly.
Doctor S. Pobedinsky.