Your Blood Pressure Could Be A Risk Factor For Falls!

Among elders, more than half have high blood pressure (hypertension). Hypertension leads to the risk of heart attacks, strokes, kidney disease, blindness, dementia, etc.

Of equal danger, low blood pressure (hypotension) can result in dizziness, fainting and increased loss of balance. About 10%-20% of elders' experience hypotension.

Blood Pressure Lowering Drugs

The risk of falling and suffering serious injuries (such as hip fracture, brain injury, broken pelvic bones, etc.,) is present for a 2-week period with any change in BP therapy. This occurs whether starting or adding a new BP drug or increasing the dosage of current BP medications. After persons have been on the changed medication for a while, the risk of falling is decreased.

Consequently, if the doctor is starting or increasing BP drugs, elders need to be careful in the short term. Some of the drug side effects that could potentially lead to falls and injury include low BP, problems with balance and walking, dizziness, and electrolyte abnormalities.

It's important that family caregivers keep a close eye on their loved ones during changes in BP medications (observing for dizziness and balance loss), and/or schedule more doctor visits in the short term to make sure that the medication change is being tolerated.

Postural Hypotension

Postural hypotension is a drop in blood pressure that occurs when changing position from lying to sitting (such as getting up in bed) or from sitting to standing (such as standing up from the bed).

Recent findings found that 5 factors are predictive of postural hypotension; they include:

• Being older than age 65
• Having a fall in the past 12 months
• Having a previous stroke
• Having high BP
• Having Parkinson's disease.

Taken together, these 5 factors can help to predict future falls in the next 2 or 3 years. Moreover, the 5 factors were also predictive of cognitive impairment, which is another important fall risk factor. Individuals with confusion and/or memory loss have difficulty telling the difference between safe versus hazardous environments and/or activities.

Elders with Parkinson's disease and/or stroke, who have a history of falling, should get an evaluation, preferably by a geriatrician (a family physician or internist who specialized in the problems of older people) to assess underlying fall risk factors (diseases, drugs, and home safety hazards), and recommend a plan to avoid falling.

Also, elders with postural hypotension have a 50% chance of developing heart failure. Persons with heart failure experience a greater risk of falling due to:

• Drops in BP
• Cognitive impairments
• Side effects from drugs used to treat heart failure.

Individuals with postural hypotension need to be followed by their doctor (and watched by their family caregiver) for signs of heart failure (such as fatigue, diminished exercise capacity, shortness of breath, and swelling or edema).

BP Treatment Goals

Medical experts are debating the various goals in treating high BP. The general recommendation for elders is to achieve a BP of less than 140/90 mm Hg. Going lower helps to improve the cardiovascular health of persons with hypertension; less stroke, less heart attacks, less falls!

How much lower below 140/90 mm Hg remains the subject of debate. When treating high BP, doctors have to balance the expected benefits versus the risks of aggressive lowering of BP.

Trying to achieve a lower BP means using higher doses or more number of antihypertensive drugs, which can cause more side-effects including dizziness and syncope (fainting). This can lead to falls and injuries and other complications of markedly low BP.

For most elders, a BP less than 140/90 mm Hg remains the “sweet spot”. A lower BP may be best for persons with diabetics and those with chronic kidney problems, especially if high BP is interfering with managing underlying health conditions. But again, doctors have to weigh the pros and cons, and individualize BP treatment goals. The bottom line: one size does not really fit all in the treatment of high BP.

BP Prevention

The prevention of high and low BP remains the same:

Knowing Who's at Risk

• Being overweight
• Having family history of high blood pressure
• Eating too much salt
• Drinking too much alcohol
• Not getting enough potassium in your diet
• Not doing enough physical activity
• Having long-lasting stress
• Smoking (smoking can cause a temporary rise in blood pressure)

Get BP Checked

If you have one or more risk factors, get your BP checked. High BP usually has no signs or symptoms. High BP is called the silent killer because an individual can have it for years without knowing it. The only way to find out if you have high blood pressure is to have your blood pressure measured.

Only your doctor can tell you whether or not you have high blood BP. Most doctors will check a person's BP several times on different days before deciding that he/she has high BP. Some individuals experience the phenomenon of "white coat hypertension" — the tendency for blood pressure to shoot up when it's tested in a doctor's office. But the opposite can also happen. BP readings may be perfectly normal at the doctor's office and elevated as soon as the person gets home, a condition called "masked hypertension." That's why multiple BP readings are generally required to determine High BP.

A diagnosis of high blood pressure is present if repeated readings are 140/90 mmHg or higher, or 130/80 mmHg or higher in those individuals with diabetes or chronic kidney disease.

Life Style Modifications

Adhering to the following helps to control high BP:

• Weight reduction; maintain normal weight
• Consume a diet rich in fruits, vegetables, and low fat dairy products
• Reduce dietary salt intake
• Engage in regular aerobic physical activity (such as walking) at least 30 minutes per day/5 days per week
• Moderate consumption of alcohol (no more than 3-4 drinks a day)

Rein Tideiksaar Ph.D., PA-C is the president of FallPrevent, LLC, Blackwood, N.J., a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr. Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant.