My wife Linda and I are on separate ends of the blood pressure spectrum. She is struggling with high blood pressure while I am at the other end with chronically low. While she has received specific guidelines from her GP on what her upper normal target should be, 135 over 85, nothing is ever mentioned about hypotension, that is, low blood pressure. We don’t even see the term, hypotension, to any extent when blood pressure is discussed. As a society, we seem to be fixated on hypertension. My first approved disability with the US Veteran’s Association was for “Diabetes with Hypertension.”
There seem to be philosophical differences between medical professionals as to what constitutes hypertension. For instance, my current dentist takes my blood pressure before opening my mouth for any dental procedure. By current guidelines, in the past, I have been hypertensive but nothing was ever said or done about it. Compounding this are definitional concepts like who are the “elderly” that have different parameters than the “normal” population. To illustrate this point, I queried Poe as to what the definition of “elderly” is in the USA with the following results:
“In the USA, the term “elderly” generally refers to individuals who are considered to be advanced in age or the later stages of life. However, it’s important to note that there isn’t a universally agreed-upon definition of when someone is considered elderly. The perception of old age can vary depending on cultural, social, and individual factors. In many contexts, the term “elderly” is often used to describe individuals who are around 65 years of age or older, which is the age at which many people become eligible for certain government benefits and programs such as Medicare. However, it’s worth mentioning that this age threshold is not fixed or definitive, and some organizations or researchers may utilize different age ranges or criteria when discussing the elderly population. Additionally, it’s important to recognize that the term “elderly” can be subjective and may carry different connotations for different people. Some individuals may consider themselves elderly at a younger age, while others may not identify as elderly even at an older age. It’s always best to consider individual preferences and perspectives when discussing age-related topics.” (Emphasis provided.)
Since I am interested in specific guidelines for my particular case, an 85-year-old male on peritoneal dialysis, I went back to Perplexity to ascertain what current research indicates for my particular case with the following Prompt and results:
What are the most recent guidelines for both high and low limits on blood pressure for an 85-year-old male on peritoneal dialysis?
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Answer
The most recent guidelines for blood pressure management in elderly patients with chronic kidney disease (CKD) on peritoneal dialysis are not explicitly detailed in the search results provided. However, the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines suggest a target blood pressure of less than or equal to 140/90 mmHg if albuminuria is present
2. Additionally, the 2015 International Society of Peritoneal Dialysis (ISPD) guidelines recommend that persistently high blood pressure in peritoneal dialysis patients should be corrected to levels below 140/90 mmHg5.For patients with CKD not receiving dialysis, the KDIGO 2021 Clinical Practice Guideline suggests a target systolic blood pressure (SBP) of less than 120 mm Hg3. However, this target may not be directly applicable to patients on peritoneal dialysis, such as the 85-year-old male in question. It is important to note that individual patient factors, such as the presence of other comorbidities, should be considered when determining the appropriate blood pressure targets. Therefore, the patient should consult with their healthcare provider to determine the most appropriate blood pressure goals based on their specific health status and the latest clinical guidelines.
So although I specifically requested a lower limit, Perplexity aka a smart Google did not provide any, just the 140 number for an upper limit. I went one step further and quizzed Perplexity about my potential problems related to blood pressure while on PD with the following Prompt and results:
Prompt:
What are the most recent guidelines for both high and low limits on blood pressure for a 85 year old male on peritoneal dialysis?
Answer
The most recent guidelines for blood pressure management in elderly patients with chronic kidney disease (CKD) on peritoneal dialysis are not explicitly detailed in the search results provided. However, the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines suggest a target blood pressure of less than or equal to 140/90 mmHg if albuminuria is present
2. Additionally, the 2015 International Society of Peritoneal Dialysis (ISPD) guidelines recommend that persistently high blood pressure in peritoneal dialysis patients should be corrected to levels below 140/90 mmHg5.For patients with CKD not receiving dialysis, the KDIGO 2021 Clinical Practice Guideline suggests a target systolic blood pressure (SBP) of less than 120 mm Hg3. However, this target may not be directly applicable to patients on peritoneal dialysis, such as the 85-year-old male in question.It is important to note that individual patient factors, such as the presence of other comorbidities, should be considered when determining the appropriate blood pressure targets. Therefore, it is advisable for the patient to consult with their healthcare provider to determine the most appropriate blood pressure goals based on their specific health status and the latest clinical guidelines.
what are the risks of low blood pressure for elderly patients on peritoneal dialysis?
Low blood pressure in elderly patients on peritoneal dialysis can pose several risks, including an increased risk of clots during dialysis. A study led by researchers at Stanford University School of Medicine reported an elevated risk of clots associated with a fall in blood pressure during dialysis, emphasizing the importance of blood pressure management in this patient population
1. Additionally, low blood pressure during dialysis can lead to various short-term symptoms such as nausea, dizziness, and gastrointestinal, muscular, and neurologic symptoms13. Furthermore, the 2015 International Society of Peritoneal Dialysis (ISPD) guidelines recommend that persistently high blood pressure in peritoneal dialysis patients should be corrected to levels below 140/90 mmHg, highlighting the significance of blood pressure control in this population4. Therefore, it is essential to monitor and manage blood pressure carefully in elderly patients on peritoneal dialysis to mitigate these potential risks.
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