Blood Pressure checking, your blood pressure, falling blood pressure

High blood pressure is acknowledged as the silent killer. That is not disputed. But new research from the UK suggests that doctors should pay attention to falling blood pressure in their older patients. The research was published in JAMA Internal Medicine (Delgado et al, JAMA Internal Medicine, online Dec. 4, 2017).

What Is the Meaning of Falling Blood Pressure Among Elders?

The scientists analyzed records from more than 46,000 Britons who died between 2010 and 2014. All were at least 60 years old. The data included general practitioners’ records on blood pressure, measured at nearly every visit.

The analysis shows that people had falling blood pressure for more than a decade before death. The drop in systolic blood pressure was more than 10 mm Hg for the majority of the individuals. This drop was not due to treatment for hypertension, although it was steeper for those with high blood pressure, atrial fibrillation, heart failure or stroke.

The scientists admit that they need more research to fully understand the causes of falling blood pressure. They suggest, however, that these findings may require doctors to pay attention when an older patient has a substantial drop in blood pressure.

Falling Blood Pressure Is Sending a Message:

In a related commentary, Dr. James Goodwin describes an elderly patient of his. She had been taking four drugs at high doses for many years just to keep her systolic blood pressure (the top number) down below 160. Then, over just three months, she needed fewer and fewer drugs. She was able to get her systolic pressure under 140 with just one drug. Naturally, the lady is thrilled. The doctor, on the other hand, is worried. Through her falling blood pressure, his patient is telling him, though she does not know it, that she is probably in the final few years of her life.

He muses:

“The challenge for physicians treating the very elderly is when to “let go,” when to stop urging more social engagement, more exercise, more food, and to realize that our patients are near death. No physician wants to clutter the last 10 to 20 months of a person’s life with irrelevant concerns and activities.”

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  1. KMC
    South Carolina
    Reply

    My father’s doctor prescribed meds for BP , blood thinners and lisinopril, which was causing a chronic cough. He was diagnosed COPD and used inhalers. Another Dr. Stopped meds and the cough went away. And my dad was able to get up and walk after yrs of weakness. He passed away at 88 and BP did drop significantly before 80/50. he fell twice because of meds didn’t need for BP and caused brain bleeding from thinners still dispensed. Seems like his physcian would have figured out what geriatric Dr. at rehab noticed immediately.

  2. Carol K
    Reply

    I should add that I also wore a thirty-day heart monitor (because I sometimes have heart pounding) in 2015. The whole time I had no heart issues, even though the heart was monitored 24/7 for the whole month and my blood pressure was a little on the low side.

  3. Carol K
    Reply

    My blood pressure has been lower ever since I lost about 50 pounds a decade ago. It averages around 115 to 120/65 to 75 when at rest, higher when I’m more active. I take my blood pressure at home about once every two weeks, and it’s stayed around that number. Occasionally it will be a little lower. My dad also had this.

    A few times he actually fainted when his blood pressure dropped. Doctors never found a cause for it. Dad had it for over 30 years, though, so I’m not so sure that it always means people will die within a few years. I’m still active too, and I don’t worry about. Nor do my doctors, at least not so far.

  4. Doris
    Ohio
    Reply

    Well, this makes me nervous. I’ve been on three BP drugs for 15-20 yrs. Same drugs, same strength. A yr ago Dr. reduced Losartan in half due to start of kidney decline. I had complained for two years of extreme fatigue and muscle and joint pain — and all test results were negative. Dr. never investigated my BP meds. Two weeks before my last Dr. appt. I reduced amlodipine from 5 mg. to 2.5. BP 132/74 so Dr. said continue with that reduction. I then weaned myself off of atenolol 50 mg. over a 4 week period. Rebound effect for 3 more weeks(periodic heart racing up to 115). Fatigue on lifting and painful nighttime foot pain are beginning to diminish. But BP fluctuates throughout the day yet always in normal to low levels — this a.m. 108/55, then after lunch and trip to store, 133/60. Diastolic is almost always 65 or under. Age 70 female.

  5. Cathy
    Reply

    I wish I could have read the rest of the story about the 80 year old woman who had stomach cancer on the related link, but it cut off in mid-sentence. But I have a couple of perspectives. Shortly after my 86-year-old mother died of dementia in 2016, I read “somewhere” that western doctors are expert at keeping patients alive, but not good at helping them die. My mother’s doctor did her best considering our culture and guided us through reduction of medications to keep her as comfortable as possible for the final 7 months of her life. My husband, who has a new diagnosis every week, is only 71, and suffering bouts of low blood pressure, which we’re trying to address and why I’m reading this article. If he has a decade yet to live, I’ll consider it a blessing. In the meantime, I won’t cancel the kidney biopsy or cardiac specialist consult or the ultrasounds of his arterial bypasses to ensure the grafts are holding or the dozen other things, while his mind is sharp and he pursues a decent quality of life, nor will I even whisper about this article as I encourage him to drink more water, eat more protein, and set goals to sustain his decade.

  6. Pixie
    Colorado
    Reply

    I was a professional singer and led a very active life, studied dance, exercised, ate right, and had low BP. My doctor used to ask me if I was still alive, when I was in my thirties. Now am in my late 70s and not active because of health issues. I am tired as well as lazy. I do not want to hang out with a bunch of old fogies and was choosey with friends. If the time comes to dying, I am not going to spend my days going through surgeries or taking pharmaceuticals. I want to live as naturally as possible without drugs. An occasional water pill and advil. Done with pushy social programs. I vant to be let alone.

  7. Harold J
    Houston Tx
    Reply

    I experienced acute kidney failure in 2001. It was immediately necessary to take multiple BP meds. This continued for several years while on dialysis. Even after a transplant, i have had to take modest dosages of two meds. This continued for more than 10 years until a year ago when my blood pressure was routinely lower. I now take one med at a lower dosage every other day. Guess I better get my affairs in order.

  8. gardencat
    Texas
    Reply

    I am in my 60’s and had periods of low blood pressure off and on for several years, with accompanying lethargy and fatigue. Doctors kept telling me they were happy my bp was on the low side–no concern for my reduced quality of life. Finally landed with a doctor who had me wear a heart monitor for a month. A complete heart block was detected and a pacemaker installed. Bp is normal now.

    My experience was not quite what this article is getting at . . . but it is another instance of low blood pressure indicating a problem.

  9. Maggie
    Houston TX
    Reply

    This is a very concerning article. I am a 68 year old white female. About 2 years ago, I started taking 2000 mg of taurine to lower my blood pressure and stopped taking Enalapril. When on Enalapril, my controlled blood pressure was still about 132/80. Now, it’s running 120/67, and I’ve been attributing this lower pressure to the success of taurine. I hope it doesn’t mean I’m in the last years of my life! This article is interesting, but other than saying statistically it’s concerning, it doesn’t offer any theories about why lower blood pressure could be a signal of a declining life.

  10. Mickey
    Fl
    Reply

    My thoughts are related to he lack of information a Doctor gives to a patient that is relevant to the rest of their life. I don’t think the Doctor should decide whether to clutter up the patient’s last days or not.

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