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Hypotension: Could declining blood pressure signal impending death in the elderly?

Many people are concerned about hypertension (high blood pressure). Nevertheless, some experience hypotension (low blood pressure) which also has its challenges.

When the blood pressure of older persons begin to decline, should that make you worried? Or should this be dismissed as an expected part of growing old? That question was recently explored by a group of researchers from the University of Exeter Medical School. The result? A decline in blood pressure was reported 14 or more years before death irrespective of the older persons health status.

Blood pressure in the elderly gradually begins to decrease about 14 or so years before death, according to a new study published today in the Journal of the American Medical Association Internal Medicine.

Researchers from UConn Health and the University of Exeter Medical School in the U.K. looked at the electronic medical records of 46,634 British citizens who had died at age 60 or older. The large sample size included people who were healthy as well as those who had conditions such as heart disease or dementia.

They found blood pressure declines were steepest in patients with dementia, heart failure, late-in-life weight loss, and those who had high blood pressure to begin with. But long-term declines also occurred without the presence of any of these diagnoses.

“Our work highlights the importance of conducting research evaluating older patients like those seen in physician practices everywhere,” said George Kuchel, one of the study authors and director of the University of Connecticut Center on Aging at UConn Health.  

However, Kuchel emphasized, “I would be very concerned if anyone were to interpret our article as suggesting that hypertension should not be treated in late life or that they should stop their blood pressure medications.”

The findings should make both doctors and researchers carefully consider what dropping blood pressure really means for older patients, he added.

Doctors have long known that in the average person, blood pressure rises from childhood to middle age. But normal blood pressure in the elderly has been less certain.

Some studies have indicated that blood pressure might drop in older patients and treatment for hypertension has been hypothesized as explaining late-life lower blood pressures. But this study found blood pressure declines were also present in those without hypertension diagnoses or anti-hypertension medication prescriptions.

Further, the evidence was clear that the declines were not due simply to the early deaths of people with high blood pressure.

More research is needed to figure out why blood pressure declines in the elderly in this way.

“It is important for physicians to understand as much as possible around aging and blood pressure, to help personalize treatment,” said David Meltzer, the study’s lead author and professor of epidemiology and public health at the University of Exeter.

“Observational studies such as ours need to be followed by rigorous clinical trials in order to guide clinical care guidelines,” said Kuchel, the Travelers Chair in Geriatrics and Gerontology at UConn Health.


Depending on your age and health status, low blood pressure (hypotension) may occur. What can you do to prevent low blood pressure? Consider the following tips from the National Heart, Blood and Lungs institute:

Recognize the signs of  Hypotension (low blood pressure). These include:

  • Dizziness or light-headedness
  • Blurry vision
  • Confusion
  • Weakness
  • Fatigue (feeling tired)
  • Nausea (feeling sick to your stomach)

Make lifestyle changes to manage hypotension (low blood pressure):

  • Drinking plenty of fluids, such as water or sports drinks that contain nutrients like sodium and potassium.
  • Avoid drinking alcohol or caffeine which may leave you dehydrated.
  • Consider standing up slowly
  • Avoid crossing your legs while sitting.
  • Slowly increase the amount of time you sit up if you’ve been immobile for a long time because of a medical condition.
  • Eat small, low-carbohydrate meals if you have postprandial hypotension (which is associated with eating large meals)

If you are experiencing dizziness, a common sign of hypotension, sit or lie down right away. Elevate your feet (eg with pillow). Seek medical help immediately if the symptoms persist.

Talk with your doctor about using compression stockings. These stockings apply pressure to your lower legs. The pressure helps move blood throughout your body.

If medicine is causing your low blood pressure, your doctor may change the medicine or adjust the dose you take.

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