Dear doctors: I’m a 97-year-old woman. Sometimes, my blood pressure drops, and I faint. It lasts just a few seconds because, as soon as I’m prone, I wake up. I don’t have any cardiac issues, and there’s no pain. What might be causing this?
Dear reader: Each time the heart beats, it sends freshly oxygenated blood into the closed loop of the circulatory system.
The result is a sustained force against the walls of the arteries, veins and capillaries, which we refer to as blood pressure.
When we think about how blood pressure can adversely affect health, the focus is primarily on hypertension — blood pressure that’s higher than normal, which increases the risk of developing heart disease and having a stroke.
But having blood pressure that’s lower than normal — hypotension — can have a negative impact on health. When blood pressure drops too far, body tissues begin to develop a deficit of oxygen. This can cause symptoms that range from mild to severe. A substantial or sustained drop in blood pressure can be life-threatening.
Readings of less than 90/60 mm Hg are considered hypotension.
But how far blood pressure can drop before someone begins to feel the effects varies. Symptoms include feeling lightheaded or dizzy, headache, confusion, fatigue, nausea, having episodes of blurred or altered vision, pain in the neck or back, changes to heartbeat and fainting. It’s possible you are experiencing one or more of these and not associating them with low blood pressure.
Hypotension can arise from causes including dehydration, infection, exhaustion, nerve damage from diabetes, the effects of alcohol, abnormal heart rhythms, heart disease and certain heart conditions. Sudden changes in position, such as from sitting to standing, can cause a drop in blood pressure. So can certain medications, including those used to manage heart failure and hypertension.
Treatment can include a change of medication, changes to hydration or diet and treatment to address cardiac issues. Compression stockings, which help blood stay in the upper body, also can help.
Because your episodes of hypotension lead to fainting, it’s important to seek prompt medical attention. Fainting is dangerous for anyone, but the risk of fracture or head injury is greater in older adults.
Dr. Eve Glazier and Dr. Elizabeth Ko are UCLA Health internists.
