Sudden Blood Pressure Changes in Elderly Patients

Grandma's hypertension has suddenly turned into low blood pressure, and her pulse has become rapid?

Hello, Director He.
My grandmother is 87 years old and has a history of hypertension.
She exercises in the morning and has been on medication for long-term control, with her systolic blood pressure mostly around 130 and a pulse rate of about 60.
However, in the past two weeks, her blood pressure has dropped to a systolic level below 100 daily, and at times even to the 80s, while her pulse rate has increased to the 70s.
Although I have asked her if she feels dizzy, she reports no discomfort.
The sudden change in her blood pressure compared to her usual levels has me a bit worried, especially since her next appointment is not until the end of June.
I would like to know if I should take her to see a doctor sooner.
Am I being overly concerned? What would be the most appropriate course of action in this situation? Currently, my grandmother is taking the following medications: Concor (Bisoprolol) 5 mg/tab once daily, Co-Diovan (Valsartan/Hydrochlorothiazide) 160/12.5 mg once daily, and Vytorin (Ezetimibe/Simvastatin) 10/20 mg every other day at 0.5 tablet.
Thank you for your response.

Sun, 20~29 year old female. Ask Date: 2019/05/05

Dr. He Dongjin reply Cardiology

Hello, your blood pressure is too low, which may be due to a high concentration of Concor and Co-Diovan in your system.
It is recommended to stop the medication for one day and resume it once your blood pressure stabilizes.
Changhua Hospital cares about you.

Reply Date: 2019/05/05

More Info

Sudden changes in blood pressure, particularly in elderly patients, can be concerning and warrant careful evaluation. In your grandmother's case, her blood pressure has dropped significantly from her usual readings of around 130 mmHg to below 100 mmHg, with instances of it falling into the 80s. While she reports no symptoms such as dizziness or discomfort, this change is notable and could indicate an underlying issue that needs to be addressed.

There are several potential causes for sudden drops in blood pressure in elderly individuals. One common reason is medication-related. Your grandmother is currently taking Concor (Bisoprolol), Co-Diovan (Valsartan and Hydrochlorothiazide), and Vytorin (Ezetimibe and Simvastatin). These medications are effective for managing hypertension, but they can also lead to hypotension (low blood pressure), especially if the dosage is too high or if there are changes in her body's response to these medications. It is essential to monitor her blood pressure closely, particularly after any changes in her medication regimen or if she has experienced any recent health changes.

Another factor to consider is dehydration, which can be more common in older adults. Dehydration can lead to a decrease in blood volume, resulting in lower blood pressure. This can be exacerbated by factors such as hot weather, inadequate fluid intake, or certain medical conditions that affect fluid balance. It is crucial to ensure that your grandmother is adequately hydrated, especially if she is active in the mornings.

Additionally, changes in physical activity can impact blood pressure. While regular exercise is beneficial, sudden increases in activity or changes in routine can lead to fluctuations in blood pressure. If your grandmother has recently altered her exercise habits, this could be a contributing factor.

Furthermore, autonomic dysfunction is more prevalent in older adults and can lead to blood pressure instability. This condition affects the body's ability to regulate blood pressure in response to changes in posture, activity level, or stress. If your grandmother experiences significant drops in blood pressure when standing up or after meals, this could indicate orthostatic hypotension, which is common in the elderly.

Given these considerations, it is advisable to consult with her healthcare provider sooner rather than later. While she may not currently exhibit symptoms, the significant drop in blood pressure is concerning and should be evaluated. The healthcare provider may want to review her medications, assess her hydration status, and possibly conduct further tests to rule out any underlying conditions that could be contributing to her hypotension.

In the meantime, you can monitor her blood pressure regularly and keep a record of any readings, noting the time of day and any activities she was engaged in prior to the measurement. This information can be valuable for her healthcare provider in determining the best course of action.

In summary, while your grandmother may not feel unwell, the sudden drop in blood pressure is significant and should not be ignored. Early intervention can help prevent potential complications associated with low blood pressure, such as falls or fainting. It is always better to err on the side of caution, especially with elderly patients who may be more vulnerable to the effects of hypotension.

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