Winter Blood Pressure Changes in the Elderly

Q: Winter Blood Pressure Changes in the Elderly

Dear Ms. <br>Zhen： <br>V = I × R (Voltage = Current × Resistance) Similarly： BP (Blood Pressure) = CO (Cardiac Output) × TPR (Total Peripheral Resistance) = (SV (Stroke Volume) × HR (Heart Rate)) × TPR <br>R = 8ηL/πr^4 <br>Where R： Resistance; η： Viscosity; L： Length; π： Pi; r： R

Winter Blood Pressure Issues in the Elderly

Hello, doctor.
I would like to ask about blood pressure issues in the elderly.
I found some information online stating that it is normal for blood pressure to be higher in winter.
Since I work in a nursing facility, there has been significant weather changes recently.
One elderly lady often complains of dizziness in the afternoon.
When I measured her blood pressure (using both electronic and mercury sphygmomanometers), I found it to be about 20 mmHg higher than usual (specifically in diastolic pressure).
However, this lady does not seem to be sensitive to cold; while everyone else is wearing jackets, she is only wearing a thin top.
When I suggested she wear a jacket due to the strong wind and low temperature, she replied, "But I won't feel cold, I can't wear it." I would like to know if her blood pressure can still increase due to the low outdoor temperature, even if she does not feel cold and her body feels warm to the touch.

Zhen, 20~29 year old female. Ask Date: 2018/01/05

Dr. Xiao Yongxun reply Internal Medicine

Dear Ms.
Zhen:
V = I × R (Voltage = Current × Resistance) Similarly: BP (Blood Pressure) = CO (Cardiac Output) × TPR (Total Peripheral Resistance) = (SV (Stroke Volume) × HR (Heart Rate)) × TPR
R = 8ηL/πr^4
Where R: Resistance; η: Viscosity; L: Length; π: Pi; r: Radius of the blood vessel.

When the weather gets cold, it causes peripheral blood vessels to constrict.
Since peripheral resistance is inversely proportional to the fourth power of the internal radius of the blood vessels, even a slight constriction of the vessels will lead to an increase in peripheral resistance, and consequently, an increase in blood pressure.
This is the physical principle explaining why blood pressure tends to rise in cold weather.

Elderly individuals often experience dysregulation of autonomic nervous responses and sensory nerve functions due to aging or multiple health conditions, leading to diminished sensitivity.
As a result, the autonomic nervous system's regulation of blood pressure may also be less effective.
This is my personal insight.

I recommend that you measure and record the elderly person's blood pressure and heart rate at least twice daily for about 3 to 5 days.
If there is a consistent increase in either systolic or diastolic pressure, it is advisable to consult a cardiologist or their primary care physician to prevent serious events such as stroke or myocardial infarction.

Reply Date: 2018/01/05

More Info

Understanding winter blood pressure changes in the elderly is crucial, especially for caregivers and healthcare providers working with older adults. It is well-documented that blood pressure can fluctuate with seasonal changes, particularly in colder months. This phenomenon is primarily due to physiological responses to temperature variations, which can affect vascular resistance and overall cardiovascular health.

When temperatures drop, the body responds by constricting peripheral blood vessels to conserve heat. This vasoconstriction increases peripheral resistance, which can lead to elevated blood pressure. The relationship can be understood through the basic principles of hemodynamics, where blood pressure (BP) is a product of cardiac output (CO) and total peripheral resistance (TPR). In colder weather, the increased resistance due to narrowed blood vessels can lead to higher blood pressure readings, even in individuals who may not feel cold.

In the case of the elderly woman you mentioned, her reported symptoms of dizziness and the significant increase in her blood pressure readings (approximately 20 mmHg in diastolic pressure) warrant attention. While she may not feel cold and her skin temperature appears normal, her body could still be experiencing the physiological effects of cold exposure. Older adults often have altered thermoregulation and may not perceive temperature changes as younger individuals do. This can lead to a disconnect between their subjective feelings of warmth and the actual physiological responses occurring in their bodies.

Moreover, the elderly are often more susceptible to fluctuations in blood pressure due to age-related changes in the cardiovascular system, including decreased elasticity of blood vessels and potential underlying health conditions. These factors can exacerbate the impact of cold weather on blood pressure regulation. It is also important to note that autonomic nervous system responses, which control blood pressure, may be less efficient in older adults, leading to more pronounced blood pressure changes in response to environmental factors.

Given these considerations, it is advisable to monitor her blood pressure regularly, especially during periods of significant temperature change. Keeping a log of her blood pressure readings can help identify patterns and determine if the elevations are consistent or isolated incidents. If her blood pressure remains elevated over several days or if she continues to experience symptoms like dizziness, it would be prudent to consult with a healthcare professional. They may recommend adjustments to her medication regimen or further evaluation to rule out other underlying issues.

In summary, even if an elderly individual does not feel cold, their blood pressure can still be affected by low temperatures due to physiological responses such as vasoconstriction. Regular monitoring and open communication with healthcare providers are essential to ensure that any significant changes in blood pressure are addressed promptly, thereby reducing the risk of complications such as stroke or heart attack.

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