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HYPOTENSION
IN THE
ELDERLY
Although most patients with blood
pressure
below
100/60 mmHg
are
aparently
normal
and
many actually
have a greater life
expectancy than
those
with
higher pressure, many of
them have
been
treated
for
chronic "low
blood
pressure".
Patients with
true
chronic hypotension
may
complain of
lethargy, weakness, easy fatigability,
and dizziness
or
faintness, especially
if
arterial pressure
is
lowered further
when
the
erect
position
is assumed.
These
symptoms are presumably due
to
a
decrease in perfusion
of
the brain,
heart, skeletal
muscle
and other
organs.
ln
an elderly person a
sudden
faint, without
obvious cause, should
arouse the suspicion of complete heart
block, even though
all
findings
are
negative
when
the
physician
sees
the
patient.
ln addition to the underlying
disease,
the chief
hazard
of
hypotension with
a
faint in most elderly
persons
is
bone
fracture
or other
trauma
due to
a
lall.
Chronic hypotension occasionally
results from severe reductions of the
cardiac
output.
The major endocrine
causes are associated with deficient
gluco and mineralocorticoid
secretion
and resultant
reductions
of
the
intravascular and
interstitial
lluid
volume.
Malnutrition, cachexia due
to
cancer
or
other severe
diseases,
chronic bed rest, and a variety
of
neurologic disorders may also result
in
chronic hypotension, especially
in
the
standing position.
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