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For people with Down syndrome, family members, caregivers and professionals.

Hypertension and Hypotension

May 2010 | Brian Chicoine, MD - Medical Director, Adult Down Syndrome Center

Hypertension (high blood pressure) is a major health problem – except not for people with Down syndrome. There has recently been much discussion about reducing the salt consumption of the United States population. Hypertension is one of the negative outcomes of eating too much salt.

However, people with Down syndrome rarely have high blood pressure. This may have to do with the function of the autonomic nervous system (the part of the nervous system that we don’t think about – it works automatically). The autonomic nervous system helps control our blood pressure, heart rate, function of our intestines, etc. People with DS also tend to have a lower heart rate. This is also partly controlled by the autonomic nervous system.

The combination of lower blood pressure and lower heart rate sometimes contributes to syncope (passing out). Blood pressure that is low and causing problems (like passing out) is hypotension. We tend to see this with factors that stimulate the autonomic nervous system such as fear, pain, and anxiety. Standing up quickly may also contribute to this problem.

For our patients with hypotension, we often end up recommending the opposite of the recent recommendation to reduce salt. For our patients who have more of a tendency to pass out, we often recommend increasing salt and water consumption. For some of our patients, we recommend putting a few saltine crackers and glass of water next to the bed and eating the crackers and drinking the water before rising out of bed. We also recommend getting up slowly and quickly sitting down if they begin to get dizzy.

Adequate fluid consumption is a challenge for many of our patients. Regular encouragement or reminders, use of daily checklists, and other ways to help individuals with DS to drink at least 6-8 cups of water daily can help some individuals avoid dizziness.

(When I mention that people with DS rarely have hypertension, often someone says it is because they don’t have any stress. Stress is in the eye of the beholder and people with DS do have stress in their lives. It may not be paying the mortgage, battling rush hour traffic on the Kennedy expressway, or some of the other stresses of daily life. However, there are stressful issues for people with DS. We believe that the lower incidence of hypertension in people with DS is not related to their level of stress.)

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