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Low Blood Pressure-Hypotension

by | Jan 23, 2023 | Info | 0 comments

Low Blood Pressure (Hypotension) Overview

Low blood pressure, or hypotension, can lead to dizziness and faintness. It is less likely than high blood pressure to be problematic, but it can sometimes indicate an underlying health issue.

Blood pressure readings include two numbers. The top number shows the systolic pressure, which is the pressure when the heart is contracting, and the bottom number gives the diastolic pressure, which is the pressure between heartbeats. An adult with low blood pressure will have a reading of less than 90/60 millimeters of mercury (mm Hg).

According to the American Heart Association (AHA), doctors do not usually consider low blood pressure a problem unless it causes noticeable signs and symptoms.

Very low blood pressure can be a sign of an allergic reaction or internal bleeding. It can be life threatening if oxygen and nutrients are unable to reach the brain, heart, and other vital organs.

However, it is generally better to have persistently low blood pressure than high blood pressure, as it poses a lower risk of various health problems.

What is Blood Pressure (Hypotension)?

The heart is a muscle that pumps blood continuously, delivering oxygen and nutrients to all parts of the body, including the vital organs.

This pumping action and the pressure of blood against the blood vessels create blood pressure.

Blood pressure can vary during the day. It is lowest while a person is sleeping or resting. It can be much higher during physical activity and times of stress and anxiety.

Types of Low Blood Pressure (Hypotension)

Following are different types of low blood pressure:

  • Orthostatic Hypotension (postural hypotension): This is a sudden drop in blood pressure when standing from a sitting position or after lying down. Causes include dehydration, long-term bed rest, pregnancy, certain medical conditions and some medications. This type of low blood pressure is common in older adults.
  • Postprandial Hypotension: This drop in blood pressure occurs 1 to 2 hours after eating. It’s most likely to affect older adults, especially those with high blood pressure or autonomic nervous system diseases such as Parkison’s disease.
  • Neurally Mediated Hypotension: This type of blood pressure drop happens after standing for long periods. It mostly affects young adults and children. It may result from miscommunication between the heart and the brain.
  • Multiple System Atrophy with Orthostatic Hypotension: Also called Shy-Drager syndrome, this rare disorder affects the nervous system that controls involuntary functions such as blood pressure, heart rate, breathing and digestion. It’s associated with having very high blood pressure while lying down.


Signs and Symptoms of Low Blood Pressure (Hypotension)

Most patients with low blood pressure have no symptoms. Those who are very fit with low blood pressure may have excellent health.

However, hypotension can also indicate a chronic problem, such as a hormone imbalance, or an acute condition, such as anaphylaxis.

Common symptoms of Low blood pressure (hypotension) may include the following:

Symptoms that can result from an underlying cause include the following:

For some patients, low blood pressure may be a sign of an underlying health condition, especially when it drops suddenly or occurs with symptoms.

A sudden fall in blood pressure can be dangerous. A change of just 20 mm Hg, a drop from 110 mm Hg systolic to 90 mm Hg systolic, for example, can cause dizziness and fainting. And big drops, such as those caused by uncontrolled bleeding, severe infections or allergic reactions, can be life-threatening.

Extreme low blood pressure can lead to a condition known as shock. Symptoms of shock may include the following:

  • Confusion, especially in older people
  • Cold, clammy skin
  • Decrease in skin coloration (pallor)
  • Rapid, shallow breathing
  • Weak and rapid pulse


Causes of Low Blood Pressure (Hypotension)

Blood pressure depends on two main mechanisms: the functioning of the heart and the resistance of the blood vessels.

In combination with the effects of neurological and hormonal factors, these mechanisms determine the extent to which blood pressure will be high or low.

Possible causes of low blood pressure (hypotension) include the following:

After Eating

Blood pressure sometimes falls after eating, as the intestines need an increased blood supply for digestion. Hypotension after eating is more common among older people, especially those with high blood pressure, diabetes, or Parkinson’s disease.

Dietary Deficiencies

Low levels of vitamin B12 and folic acid can lead to anemia, which can, in turn, lead to low blood pressure.

Eating Disorders

In patients suffering with anorexia nervosa, a low-calorie diet intake can affect the structure of the heart, reducing blood pressure. Bulimia nervosa can lead to an electrolyte imbalance, increasing the risk of irregular heartbeats (arrhythmia) and heart failure.

Heart Disease

If the heart does not work correctly, it may not pump enough blood to keep blood pressure within the normal range.

Hormonal Problems

The thyroid gland makes and stores hormones that help manage various bodily functions, including heart rate and blood pressure. The adrenal glands regulate the stress response. Problems with either type of gland can lead to hypotension.

Medications

Beta blockers, calcium channel blockers, and diuretics can reduce blood pressure. During surgery, healthcare professionals may lower blood pressure deliberately to reduce the risk of blood loss.


Neurally Mediated Hypotension

Faulty signals between the heart and brain can lead to low blood pressure.

Orthostatic Hypotension (postural hypotension)

Standing up from a sitting or lying position can lead to a drop in blood pressure alongside dizziness or faintness.

Pregnancy

The circulatory system expands during gestation, and this often results in low blood pressure. Hypotension during pregnancy is rarely a cause for concern.


Straining

Blood pressure can drop when using the bathroom, swallowing, or coughing. These actions all stimulate the vagus nerve, which reduces blood pressure.


Low Blood Pressure (Hypotension) and Shock

Severe hypotension can lead to hypotensive shock. There are different ways of describing shock, depending on the cause.

  • Hypovolemic Shock: The total volume of blood falls, and the heart can no longer pump effectively. Possible causes include severe internal or external bleeding or severe dehydration. This can result from a high urine output, for example, due to a hormone imbalance or the overuse of diuretics or a loss of fluid due to diarrhea and vomiting.
  • Cardiogenic Shock: The heart is unable to function effectively due to cardiovascular problems. A patient may have a low heart rate and cool, dry extremities and skin.
  • Distributive Shock: The vascular system loses resistance, and the heart is unable to pump fast enough to compensate. Causes include an allergic reaction (anaphylactic shock) and septic shock, which is a possible complication of an infection.
  • Obstructive Shock: An obstruction in the cardiovascular system stops the heart from pumping effectively or prevents the blood from flowing. Causes include pulmonary embolism. A person’s jugular veins may be distended, and they may have quiet heart sounds.

Any combination of these is called hypotensive shock. Whatever the cause, a person with shock will need urgent medical attention.


Diagnosis of Low Blood Pressure (Hypotension)

Blood pressure is measure by a blood pressure monitor, there are different types of monitors available. Monitors for home use are usually digital devices. It is best to take several readings to check whether the problem is ongoing.

Devices that healthcare professionals use in a healthcare setting may require them to listen for changes in pressure with a stethoscope while reading a mercury gauge.

A doctor will also ask the person about their medical history and other symptoms. They may carry out other tests to rule out an underlying problem.


Treatment of Low Blood Pressure (Hypotension)

Most patients with low blood pressure do not need treatment. However, if hypotension starts suddenly or results from an underlying condition, a doctor will provide appropriate treatment. The treatment options will depend on the cause.

Treatment may involve the following:

  • Changing the patient’s medication or dosage, if the doctor suspect that either of these are responsible.
  • Prescribing medication to help resolve low blood pressure.
  • Suggesting dietary changes, such as increasing the intake of salt or fluids

Patients should always consult with their doctor before making any significant changes to their diet or medication use.


Prevention of Low Blood Pressure (Hypotension)

A range of lifestyle measures can help prevent low blood pressure.

These include the following:

  • Avoiding long periods of sitting or standing still
  • Eating small meals frequently and resting after eating
  • Avoiding suddenly changing posture or position
  • Increasing fluid intake
  • Moderating alcohol intake
  • Refraining from drinking caffeinated beverages late in the day
  • Taking time to stand up from a sitting or lying position.
  • Using blocks to raise the head of the bed by 6 inches.
  • Wearing support stockings


Summary

Low blood pressure is not usually a cause for concern. However, the patient may need medical attention if their symptoms are severe or lead to other problems, such as frequent falls.

If blood pressure falls suddenly, emergency medical treatment might be necessary. Examples of when this might happen include:

  • A trauma leading to external or possible internal bleeding.
  • Exposure to an allergen, such as an insect sting
  • Severe dehydration
  • An infection that may have spread to another part of the body.

In these cases, the patient may need treatment for shock and to prevent damage to the brain and other organs due to a lack of oxygen.

 

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