While doing some health coaching, I always enjoy chatting with elderly people. I enjoy their stories, and they have experienced so much in life. They know better than anyone; life has its ups and downs. When someone is elderly, their blood pressure also has its ups and downs and fluctuates throughout the day. This leads to the question, what causes fluctuating blood pressure in the elderly?
The following are causes of fluctuating blood pressure in the elderly:
- Cardiovascular disease
- Hardening of the arteries
- Lowering systolic blood pressure in the elderly.
- Heart valve problems.
- Low heart rate.
- Medications used for surgery.
- Parkinson’s disease medication.
- Erectile dysfunction medicine.
- Alpha-blocker medications
- Bladder and prostate problems.
I’ll discuss these causes in full detail and inform you of what dangers can occur as a result of it. More importantly, I’ll let you know the treatments and ways to prevent it from happening.
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Causes of Fluctuating Blood Pressure in the Elderly
Elderly people have a higher risk of cardiovascular disease. There are many different medications someone may be taking for a condition. The amount of medication and the times it’s taken, can cause fluctuations.
A clogged artery on one side of the body can cause different readings between both arms. Typically, without any problem, the measurements between the right and left arms can vary up to 10 mmHg 1. If you’re changing arms frequently to measure your blood pressure, the readings may go up and down.
There was a woman who was given medication and hospitalized because of an error in taking blood pressure on the wrong arms. It’s a scary story; you can check it out here in my blog post, Which Arm To Take Blood Pressure.
Hardening of the Arteries
Arteries consist of collagen, elastin fibers and cells. When they are young, they have more flexibility and can bounce back between heart beats. As you age, they get stiffer for the following reasons:
- Elastin fibers decay with age.
- Calcification is caused by increases in calcium.
- Changes in collagen disrupt the elasticity.
- Lowering systolic in the elderly.
Lowering Systolic Blood Pressure In The Elderly
It’s typical for systolic blood pressure to raise as a person ages. This occurs because of stiffening arteries and plaque build-up. High systolic blood pressure is a major risk factor for cardiovascular disease in people over age 50 2.
In addition to lifestyle changes, medications are often prescribed to help lower systolic pressure. This also lowers diastolic pressure, even though it wasn’t the reason for the treatment. If diastolic was low to begin with, this can cause fluctuations throughout the day.
Heart Valve Problems
Due to increased life expectancies, heart valve issues have also increased. The job of the 4 valves is to open and allow blood to flow through to the next chamber and to close, so blood does not flow the wrong way backwards. Heart valve disease is more common with the elderly and can cause blood pressure to fluctuate 3. The following are reasons why heart valve issues develop with age 4. :
- Calcium deposits: Calcium build-up causes the valve flaps to become stiffer and thicken.
- Aortic stenosis: Blood flow from the left ventricle to the aorta is reduced because the valve doesn’t open enough.
- Mitral regurgitation: A leaky valve causes blood to leak back from the left ventricle into the left atrium.
- Tricuspid regurgitation: Blood leaks from the right ventricle back into the right atrium.
Elderly people are more prone to a slow heart rate. A condition, like bradycardia slows the heart rate and be caused by many age related issues or medication. It’s complications include both low and high blood pressure 5.
Medications for Surgery
High blood pressure before and after surgery increases the risk of a cardiovascular event like a heart attack. Because of this, it is the number one reason for surgery postponements. Blood pressure medication is often given to a patient who has higher than normal pressure 6.
Parkinson’s Disease Medication
Most people diagnosed with Parkinson’s disease are over age 60. Common medications have many side effects, lowering blood pressure is one of them 7.
Erectile Dysfunction Medication
Many elderly men are taking erectile dysfunction pills. The active ingredient, sildenafil citrate, relaxes and opens up the blood vessels to allow more blood flow. This can cause fluctuations in blood pressure because it will lower while taking the medication 8.
Did you know that Viagra’s original purpose was supposed to be for blood pressure and not for sexual dysfunction? It’s an interesting story which I talk about in my blog post and how it affects BP, Does Viagra Lower Your Blood Pressure or Raise It?
Alpha-blockers are used for a variety of reasons including elderly men with prostate problems. They lower blood pressure because they dilate your blood vessels. This medication, like any other, can cause fluctuations in your pressure 9. Prostate problems lead me to the next reason.
Some elderly men and women have to urinate more frequently. About one in five people over the age of 40 suffers from more frequent urination. The prostate is just one reason why this problem occurs. Others can include Alzheimer’s disease, multiple sclerosis and menopause.
Having the urge to urinate with a full bladder can raise your blood pressure by as much as 10 to 15 mmHg systolic higher 10. This is why measuring your blood pressure with an empty bladder is recommended. You can check out all the other steps to take before measuring your BP in my blog post, How To Use a Home Blood Pressure Monitor The Right Way.
Other Reasons For Fluctuating Blood Pressure
The causes above are more specific towards the elderly but can sometimes occur in people of all ages. On the flip side, there are other causes which can fluctuate BP that’s not specific for the elderly but can occur at any age. They include the following:
- Time of day.
- After eating.
- Room or water temperatures.
- Masked hypertension.
- White coat syndrome.
- Kidney problems.
- Adrenal Problems.
- Labile hypertension.
- Illegal drugs.
- Nutritional deficiencies.
- Changes in body positions.
- Severe allergic reactions
- Severe infections.
- Internal bleeding.
Fluctuating Blood Pressure Complications
There has been an association between fluctuating blood pressure and complications down the road when elderly.
Researchers studied 1,674 people over the age of 60 who monitored their day-to-day blood pressure. The results indicated an increase in blood pressure fluctuations was related to the development of dementia 11.
Another study examined 94 elderly people for associations between blood pressure fluctuations and cognitive function. They found a connection between diastolic BP changes and poorer verbal and memory loss 12.
Studies have compared people with normal blood pressure to those with fluctuating pressure for cardiovascular risk. The group with fluctuations were more likely to develop cardiovascular disease and have a higher risk of dying 13.
After reading about the complications above, it’s no surprise fluctuating blood pressure has a higher risk of high blood pressure when older.
Fluctuating Blood Pressure In the Elderly Treatments and Prevention
To achieve a better understanding of your fluctuating blood pressure, a doctor will likely have your pressure monitored. The best way to accomplish this is by prescribing a 24 hour home ambulatory blood pressure monitor.
It’s a device that has a traditional arm cuff attached to a monitor you keep with you all day and night. These monitors can be adjusted to take your pressure at different intervals throughout the day. Typically, it will be set to measure your blood pressure three times an hour during the day and once an hour while sleeping.
Depending on the severity of your blood pressure readings and fluctuations, medication might be prescribed. In all cases lifestyle changes will be recommended like the following:
- Avoid trans fats.
- Limit excess sodium.
- Avoid added sugars, natural sugars found in most fruit are okay.
- Eat plenty of vegetables.
- Consume healthy protein like fish, skinless chicken, beans and eggs.
Start with 20-30 minutes per day of some type of activity. It doesn’t have to be strenuous activity, walking is a good start. Other options are:
- High Intensity Exercise or weight training at home.
- Self massage
- Breathing exercises
First Blood Pressure Reading Always High
If you found this Blood Pressure topic interesting check out these related blood pressure articles also found in this same website:
- Blood Pressure Cuff Placement
- Causes Of False Blood Pressure Readings
- Checking Blood Pressure Too Often
- Journal of The American College of Cardiology: 2017 Guidelines[↩]
- National Center for Biotechnology Information: The Second Fifty Years[↩]
- American Heart Association: Risks for Heart Valve Problems[↩]
- National Center for Biotechnology Information: Heart valve disease in the elderly[↩]
- American Heart Association: Bradycardia: Slow Heart Rate[↩]
- National Center for Biotechnology Information: Management of hypertension in patients undergoing surgery[↩]
- Journal Hypertension: Dopamine Receptors[↩]
- National Center for Biotechnology Information: Effects of Sildenafil Citrate (Viagra) on Blood Pressure in Normotensive and Hypertensive Men[↩]
- American Heart Association: Types of Blood Pressure Medications[↩]
- Journal of Hypertension: European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement[↩]
- Circulation: Day-to-Day Blood Pressure Variability and Risk of Dementia in a general Japanese Elderly Population[↩]
- National Center for Biotechnology Information: Blood Pressure Variability and Cognitive Function Among Older African Americans[↩]
- National Center for Biotechnology Information: Visit-to-Visit variability of blood pressure and coronary heart disease, stroke, heart failure and mortality: A cohort study[↩]