Hypotensive responses to common daily activities in institutionalized elderly: a potential risk for recurrent falls

Article Abstract:

Transient hypotension is the occurrence of brief episodes of abnormally low blood pressure, which may cause faintness, dizziness and lightheadedness, which again may contribute to the high frequency of falls among elderly persons. The prevalence and degree of hypotension associated with common daily activities were assessed in elderly persons residing in institutions. In addition, the relation of hypotension to falls in the elderly was examined. Blood pressure and heart rate were measured during various activities in 38 elderly persons who experienced recurrent falls, 20 elderly patients who did not fall frequently, and 10 young healthy subjects. Blood pressures were higher during all activities in elderly subjects as compared to younger subjects. Heart rate was higher during all activities in younger subjects as compared to older subjects. Blood pressure was markedly reduced in older patients after a meal or treatment with the cardiovascular drug, nitroglycerin. This drop in blood pressure was greater in recurrent fallers as compared to elderly subjects who did not fall frequently. The results show that elderly persons residing in institutions have a wide variation in blood pressures, and in general they experience hypotension in response to meals and nitroglycerin. A decline in blood pressure during periods of stress may also contribute to the tendency to fall among elderly persons. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Falls (Accidents), Accidental falls

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Reduced susceptibility to syncope during postural tilt in old age: is beta-blockade protective?

Article Abstract:

Syncope, an episode of fainting, commonly occurs in the elderly. Vasovagal syncope, the combined response of blood vessels and nerves, is caused by a fall in blood pressure when standing upright, and can result in a loss of consciousness. Studies have shown, however, that vasovagal syncope is less common among the elderly. Possible explanations are either that age decreases the response of the nervous system or that the blood vessels of older people are less responsive to chemicals naturally secreted by beta-adrenergic cells, which constrict blood vessels and raise blood pressure. To see whether blocking the beta-adrenergic release with the beta adrenergic blocking agent propranolol enhances the constriction of blood vessels and prevents syncope, both younger subjects between 21 and 31 and older subjects between 77 and 89 were evaluated while changing their posture by tilting them on a table. It was found that vasovagal symptoms are not as common in the elderly and that the administration of propranolol was not effective in preventing the vasovagal response in the young.

Research, Fainting, Adrenergic beta blockers, Adrenergic beta-antagonists

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Postprandial hypotension: epidemiology, pathophysiology, and clinical management

Article Abstract:

The elderly and patients with autonomic nervous system failure may experience bouts of low blood pressure after eating. Meal-related low blood pressure is a drop in systolic blood pressure of at least 20 points within two hours after eating. This common disorder of blood pressure regulation is associated with physiologic changes that occur during the aging process and with specific diseases. Elderly people with high blood pressure are at particular risk for this condition. Meal-related low blood pressure may cause dizziness, weakness, fainting, falls, chest pain, and minor strokes. Non-drug treatment may include patient education about meal size and nutrient composition and fluid intake. Drug therapy for patients with high blood pressure is safe and may reduce meal-related low blood pressure. Octreotide may be effective in treating severe cases of meal-related low blood pressure.

Care and treatment, Aged, Elderly, Physiological aspects, Blood pressure, Ingestion, Blood pressure regulation, Nervous system, Autonomic, Autonomic nervous system

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