Why blood pressure drops
“At age 80 your vessels tend to be hard, like a lead pipe. They don’t expand and contract [the contraction helps keep pressure from falling too quickly] the way they used to,” Brandwin says. So it takes more time for your brain to get the signal to put everything in motion to keep your pressure steady. “It may only be a gap of 30 seconds, but that’s enough to make you dizzy,” Brandwin adds.
Dehydration, which affects blood volume and causes blood pressure to drop, is a major cause of age-related low BP. “Most older adults just don’t drink enough water,” says Michael Raffinan, M.D., a family practice physician at Long Island College Hospital in Brooklyn, N.Y.
Diuretics, drugs commonly used to treat high blood pressure, lead to dehydration. “Medicine-induced hypotension in older people isn’t unusual,” Brandwin says. “Anything else that has a diuretic effect, like alcohol or urinary tract infections, can also contribute to the problem,” Saba says.
Tweaking medications
You may be taking a drug for another condition, which then causes low BP. “L-dopa, regularly used for treating Parkinson’s disease, often causes OH,” Brandwin says. So do many high blood pressure medicines. If you are feeling dizzy on any drugs, tell your doctor; he or she can look for another option.
“It isn’t unusual for older people to be getting ten medicines from five doctors. Your primary care doctor can go through all the medicines you’re being given and see what can be substituted or eliminated to avoid OH,” Raffinan says.
Sometimes it’s a matter of modifying dosages. “Diuretics still have the best long-term record for fighting high blood pressure and stroke, so instead of eliminating them, your doctor might try lowering the dose,” Saba says.
Going too low
Most doctors focus on bringing down the upper number. Now there’s evidence that if the diastolic number goes too low, it can create a danger besides dizziness: an increased likelihood of developing Alzheimer’s.
In a two-decade study of people age 75 and older released in 2004, “We found that for every 10 points under 70 the diastolic number dropped, the risk of Alzheimer’s in older adults rose 20%. So we recommend when treating high blood pressure, your doctor should also watch that lower number carefully,” says Joe Verghese, M.D., associate professor of neurology at Albert Einstein College of Medicine in the Bronx, N.Y.
Easy at-home treatments
“Low blood pressure generally isn’t life-threatening,” Saba says. To avoid the main risk—falling—stand slowly after sitting for long periods, especially after a big meal.
“If you’ve been lying down, let your legs hang over the side, feet touching the floor if you can. Sit that way for several minutes before standing,” Saba says. “For added safety, put something you can hold onto nearby.”
“Drinking enough water might take care of 90% to 95% of OH cases. We tend to lose our sense of thirst as we age. A glass of water at breakfast, lunch, and dinner might eliminate your need for medicine,” Raffinan says.
Also eat consistently. “Either eat small meals throughout the day, or make sure to have healthy snacks, like fruits and nuts, between meals,” Raffinan adds. That way your BP is less likely to experience major drops.
Compression stockings can help. “You wear them until bedtime and they help keep circulation steady. Stay seated on the bed while putting them on in the morning,” Saba says. Finally, if you have any conditions that could lead to circulatory problems (including diabetes and certain nerve conditions, like neuropathy), make sure to discuss OH with your doctor.