DEAR DR. ROACH: I am an 86-year-old woman, and my sister is 91. We are both in good health, with normal health issues for people our age. My question is that we both have contracts with crematory companies, but we also intend to be organ donors. Will they really use organs from people our age? We both have some health issues. How should we handle this if our organs are useful?
ANSWER: I honor your desire to help others after you are gone. We need more organ donors. Yes, people of any age may be organ donors (liver donors have been over 90 years old), and physicians will evaluate what organs might be usable. Funeral homes are very experienced with working with organ donors. It would be wise to register with your local organ transplant program (start at www.organdonor.gov) as well as discussing your wishes with the funeral director you have a contract with, if you have not done so already.
DEAR DR. ROACH: So much is written about the dangers of high blood pressure — “the silent killer” — but very little about low blood pressure. Low blood pressure is not silent. It can make life miserable. Is there a way to safely raise one’s BP?
ANSWER: Physicians may not seem to care as much about low blood pressure readings than high, partially because healthy people with low blood pressure have a lower risk of heart disease. However, there are many medical conditions where a low blood pressure is a cause for great concern — sepsis in particular is exceedingly dangerous when accompanied by a lower blood pressure than the person’s normal. Heart failure with low blood pressure is concerning. I’m going to assume that you mean low blood pressure that has been persistent and not as a result of other medical illness.
High blood pressure often does not have any warning signs (some people will have headache or other symptoms), but low blood pressure can cause lightheadedness or fatigue. Although some people have symptomatic low blood pressure at any time, for most people, symptoms are worst when changing position, particularly when going from laying down to sitting or standing, but also from sitting to standing. This situation is called orthostatic hypotension (which literally means “upright posture low blood pressure”). Others may develop symptoms after prolonged standing, a situation sometimes called chronic orthostatic intolerance.
Orthostatic hypotension is common (20% or more) in healthy older adults. It may also be due to medication, especially blood pressure medications. There are common and uncommon neurological syndromes that can cause orthostatic hypotension, and these are part of what a physician considers in a patient with symptomatic low blood pressure.
Many people, even after extensive evaluation, will not have an identifiable cause of low blood pressure. In this case, first-line treatment is changing behavior; specifically, getting up slowly, along with taking in extra salt and water. Those who don’t respond adequately may benefit from medication treatment. Fludrocortisone promotes retention of salt and water.
There are additional treatments, but these run the risk of making blood pressure too high when someone is sitting or lying down, so treatment must be individualized. Cardiologists and hypertension specialists often have expertise in conditions of too-low blood pressure.