What are the causes of hypotension in the elderly?

Now many elderly people have low blood pressure, so what about low blood pressure in the elderly? What food is suitable for the elderly with low blood pressure? What are the causes of hypotension in the elderly? Let me tell you!

What is the cause of hypotension in the elderly (1)?

The etiology and inducement of hypotension and/or syncope in the elderly are quite complicated. Besides cardiogenic diseases, neurological, endocrine and metabolic diseases are also quite common.

1. cardiogenic

(1) overload:

① Stenosis of aorta, pulmonary artery or its valve leads to increased outflow resistance, decreased stroke volume and insufficient perfusion of important organs.

② Asymmetric hypertrophic cardiomyopathy leads to a sharp decrease in stroke volume and an increase in pressure gradient in the middle and late systolic period.

(3) Pulmonary hypertension and pulmonary infarction lead to decreased right cardiac output, right heart failure, decreased pulmonary circulation and systemic congestion.

(2) insufficient front load:

① Mitral stenosis caused by rheumatic valvular disease or calcified mitral stenosis in the elderly leads to blocked left ventricular filling and decreased cardiac output.

② Myxoma of the left atrium leads to insufficient left ventricular filling and decreased stroke volume in the middle and late stage.

(3) The obstruction of vena cava leads to the decrease of peripheral blood volume and insufficient ventricular filling.

(3) Cardiac systolic dysfunction:

① Exercise-induced hypotension, myocardial infarction, myocarditis and heart failure caused by coronary heart disease reduce the effective work of myocardium and the ejection fraction, and the important organs, especially the brain, are insufficiently perfused.

② Cardiac tamponade and constrictive pericarditis lead to abnormal cardiac function, poor ventricular filling and decreased stroke volume.

(4) Arrhythmia or arrhythmia, dysfunction of pacemaker, such as ⅲ atrioventricular block, and accelerated heart rate of sick sinus syndrome.

2. Increased tension of peripheral nerves or blood vessels.

(1) The excitability of vagus nerve increases, such as the hypersensitivity of baroreceptors such as carotid sinus, which reflects impulses to the cardiovascular center, leading to the decrease of heart rate and blood pressure.

(2) Chronic alcoholism, diabetes and vitamin deficiency lead to impaired autonomic nervous function and impaired vascular regulation.

(3) Postural changes: Most of the reversible hypotension caused by it is peripheral venous congestion, slow blood flow, hypotension or excessive diuresis. When the posture changes, the nerves, blood vessels and effective blood volume of the elderly are too late to adjust; Irreversible hypotension is mostly caused by idiopathic systemic atrophy and impaired autonomic nerve and vascular function. Some secondary postural hypotension also falls into this category.

3. Endocrine or metabolic dysfunction

(1) pheochromocytoma caused excessive catecholamine poisoning, and cardiac function and peripheral circulation dysfunction occurred after blood pressure rose sharply.

(2) Addison's disease and hypoglycemia lead to the decrease of corticosteroid secretion and metabolic function; Insufficient energy affects the normal function of the heart and brain, and the resistance of peripheral blood vessels decreases.

(3) Hypothyroidism leads to a decrease in the concentration of thyroxine in blood, thus weakening its pressor function through the normal regulation of autonomic nerves, blood vessels or metabolism.

(4) Carcinoid or bradykinin leads to excessive vasodilators such as bradykinin and histamine, which leads to decreased blood flow, hypotension and even syncope.

(5) acidosis and electrolyte disorder lead to impaired cardiac function and decreased vascular resistance.

4. Long-term bed rest and improper use of diuretics after uremia or renal dialysis lead to electrolyte disorder, insufficient effective blood volume, loss of some vasoconstrictors in blood, decreased myocardial contractility, poor vascular regulation, insufficient blood volume and decreased cardiac output.

5. Improper application of anesthetic after anesthesia, surgery or sympathectomy, excessive bleeding or severe cardiac insufficiency during operation, myocardial infarction, etc. ; After sympathectomy, poor vascular regulation, decreased peripheral resistance, poor peripheral blood return and insufficient cardiac output will all affect blood pressure.

6. Vascular regulation disorder can be caused by dysfunction of central nervous system and autonomic nervous system, such as senile dementia, Parkinson's disease, cerebrovascular disease and myelopathy.

7. Vasodilators, antihypertensive drugs, antianginal drugs, antiarrhythmic drugs, sedatives, tricyclic drugs, excessive insulin and other drugs can lower blood pressure and even cause severe hypotension.

8. Others such as shock, pernicious anemia, polycythemia, blood loss, dehydration, aortic dissection hematoma and aortic arch syndrome can also lower blood pressure through different mechanisms.

(2) Pathogenesis

The etiology of hypotension in the elderly is complex, and the pathogenesis has not yet been clarified. It is speculated that it is caused by diseases related to aging, neuroendocrine dysfunction or long-term effects of drugs.

How to prevent hypotension in the elderly should pay attention to the following points:

1. Asymptomatic hypotension does not need treatment because the cerebral blood flow has not decreased significantly, but patients should be encouraged to get up and walk, avoid long-term bed rest or sedentary, correct medical diseases, take measures to increase blood volume, improve blood circulation, enhance heart function, do not use diuretics during dehydration, develop good defecation habits, and avoid excessive exertion during defecation.

2. Slowly change posture and posture. Avoid getting up suddenly or changing posture quickly, and rest for 2 ~ 3 minutes every time you change posture, so that the posture compensation response can adapt to each posture change. You should sit in bed for a few minutes before you get up, stand up or start walking in the morning. When going to the bathroom and toilet, you will fall down because of postural hypotension, which may lead to injuries such as fractures. Using bedside urinals or urinals can prevent accidents.

3. Avoid overeating, eat less and eat more meals, ingest a lot of digestible carbohydrates, properly ingest sodium salt, and properly drink water to maintain normal blood volume.

4. The bath water temperature should not be too high and the bath time should not be too long.

5. Reduce sweating in hot summer.

6. Wear elastic socks to increase blood volume.

7. Try to avoid drugs that unnecessarily affect blood pressure.

Elderly people with low blood pressure should avoid overeating, eat less and eat more meals, eat less digestible carbohydrates, take proper sodium salt and drink water to maintain normal blood volume.

The bath water temperature should not be too high, and the bath time should not be too long, so as to avoid water loss or vasodilation in the body and aggravate hypotension.

Reduce going out in hot summer and sweating a lot. If you sweat a lot, you need to add some salty drinks appropriately.

What are the clinical manifestations of hypotension in the elderly?

(1) Asymptomatic hypotension is almost always found occasionally during physical examination or outpatient or hospitalization due to other diseases. The elderly have a good tolerance for hypotension, and it is easy to be ignored because of diseases such as slow response. In fact, after detailed medical history inquiry, there are few people who are absolutely asymptomatic. Patients often have mild fatigue, occasional dizziness, dizziness and so on. Generally, there are no organic lesions. It has low blood pressure, depressed pulse, slow heart rate, introverted personality and is not easy to get excited. Obesity and emaciation can be seen, and there are more emaciated people, the elderly are more common than young people, and women are more common than men.

(2) Symptomatic hypotension often has mild or moderate ischemic symptoms of brain and other organs, such as fatigue, dizziness, headache, insomnia, poor memory, and difficulty in concentration. Some hypertensive patients have long-term low blood pressure after large-scale and severe myocardial infarction. Besides hypotension, there is evidence of myocardial ischemia.

(3) When the symptomatic hypotension is severe, there may be a sudden and short-term loss of consciousness accompanied by the disappearance of postural tension, that is, syncope.

The precursor of syncope is:

(1) dizziness after excessive physical or mental work, often aggravated by changing body position.

② blurred vision, dizziness, blackness, etc. It appeared soon after dizziness.

③ There may be slight hearing loss or tinnitus.

(4) weak, unstable, and have a sense of dumping.

(5) pale face, nervous, difficult to speak, and even unable to open his mouth.

⑥ It may be accompanied by gastrointestinal symptoms such as nausea and vomiting.

⑦ Most patients have no time to support or take a lying or sitting position immediately, and then they will faint and fall.

Many patients fainted in the absence of others. Some patients may have facial or head skin abrasions, the elderly may have fractures due to falls, or they may be complicated by cerebrovascular accidents or acute myocardial infarction due to a sudden and obvious drop in blood pressure, and some elderly people may be complicated by pneumonia after fainting for a long time. Except cardiogenic and neurogenic (central) patients, there is no obvious change in breathing, the heart rate can be slow or fast, and the heart sound is low and weak; Both deep and shallow nerve reflexes exist (different from coma). Most patients can clearly describe the scene or environment before syncope. Generally, the attack lasts for more than ten seconds to ten minutes, rarely more than 20min minutes. After the patient wakes up, he can still see pale face, sweating profusely, cold hands and feet, and can't speak. A few people who fainted for a short time without serious trauma or complications can go to a nearby medical unit by themselves or with the support of others. No obvious abnormality has been found at this time. Only those who have primary organic diseases that cause syncope can also detect the corresponding positive signs.