Hypotension or low blood pressure is when a person’s blood pressure is lower than 90/60 mmHg (millimeters of mercury). Hypotension may also mean that only one value is low, either the systolic or diastolic, or both are low. Hypotension is not considered a disease, but a syndrome. Hypotension occurs equally in all genders and all ages, from newborns to the elderly.

Types of Hypotension
  1. Orthostatic or postural hypotension: Hypotension when standing up or when suddenly changing position (acute hypotension due to sudden position change) occurs about 5-10 minutes after you change position and can cause dizziness, blurry vision, and even loss of consciousness.
  2. Postprandial hypotension: Hypotension after eating is more common in the elderly. When you eat too much, a larger than normal amount of blood is sent to the digestive system. This can cause dizziness and fainting.
  3. Neurally mediated hypotension: Hypotension from faulty brain signals causes a blood pressure drop after standing for long periods, mostly affects young adults and children. It seems to occur because of a miscommunication between the heart and the brain.
  4. Multiple system atrophy with orthostatic hypotension: Hypotension due to nervous system damage is rare, but it causes damage can occur to the autonomic nervous system, which controls involuntary functions such as blood pressure, heart rate, breathing and digestion. It is associated with having high blood pressure when lying down and low blood pressure when getting up. 

Hypotension has many causes, from lifestyle to medications to health problems. The most common causes of hypotension include:

  • The main cause of hypotension is lack of nutrients, especially protein and vitamins B and C, causing the walls of arteries to weaken and become too relaxed.
  • Sudden loss of blood, such as in an accident, or chronic loss of blood, such as with ulcers in the stomach, intestines, or kidneys
  • Dehydration due to excessive sweating or diarrhea
  • Severe infection
  • Heart disease
  • Pregnancy
  • Depression
  • Dizziness, lightheadedness, fainting, loss of balance
  • Blurry vision
  • Heart palpitations, racing heart
  • Confusion
  • Nausea
  • Fatigue, easily tired
  • Shallow, rapid breathing
  • Thirst
  • Clammy skin, pale skin, shivering

Normally the doctor will ask about the patient’s medical history and their symptoms. A general check-up will be done. Blood pressure will be measured to see if it is in the normal range and the doctor will look for any signs of shock, which can be life-threatening. Other tests may include:

  • Blood tests are simple to do and don’t take very long. They can be done with the patient sitting or lying down. Blood tests give more information about the components of blood and can tell if the patient is anemic or has low blood sugar, and both can cause hypotension.
  • A tilt table test involves the patient lying on an examination table specially designed to tilt to different angles and the patient’s blood pressure can be measured as the table moves.
  • Electrocardiogram (EKG) tests the heart’s electrical activity as it beats to detect any abnormalities.
  • 24-hour Holter monitoring records the heart’s activity over 24 hours with a small, portable instrument that allows the patient to continue normal activities. This makes it easy to detect any problems.
  • An exercise stress test assesses the heart’s function while exercising as some heart abnormalities are easier to detect when the heart is working hard and is pumping more, which are triggered by exercise.
  • Assessment of the autonomic nervous system checks the changes in heart rate during certain activities to measure blood pressure, such as when the patient breathes deeply or places their hand in cold water.
  • In a 24-hour urine test the patient will be asked to collect their urine over 24 hours in a prepared container that they will take home. The urine will then be tested in the laboratory. (During collection the urine should be kept in a cold place.)

Treatment focuses on the patient being able to control their blood pressure and bring it back to normal as well as alleviate symptoms. When hypotension is mild and the patient is in good health, the condition can be managed in the following ways:

  • If hypotension is caused by dehydration, lack of electrolytes, blood loss, or infection in the bloodstream, intravenous fluids can help increase blood pressure.
  • Treat the cause of hypotension. For example, if the doctor believes hypotension is caused by an abnormality or disease, the doctor may order additional tests and specific treatment for that condition. If a patient experiences hypotension due to hormonal problems, a specialist may need to examine the patient and treat hypotension with hormone replacement therapy.
  • Medication may be used if lifestyle changes and intravenous fluids don’t alleviate systems. The doctor will decide which medications are best for the patient depending on the cause of the hypotension. There are many types of medications that may be used, such as alpha adrenergic receptor agonists, which can increase blood pressure and alleviate symptoms caused by hypotension, steroids that can prevent the loss of electrolytes, increase fluids, and increase blood pressure, and vasopressors, which increase blood pressure.
  • Get adequate rest as lack of sleep can cause low blood pressure. Avoid overworking and staying up late. Use a supportive pillow when you sleep.
  • Avoid standing too long; avoid changing positions suddenly.
  • Exercise regularly to balance the nervous system, strengthen the heart’s vessels, and maintain healthy blood pressure.
  • Eat nutritious foods as hypotension can be caused by lack of nutrition.
  • Take medication carefully and always see a doctor when you are unwell. Let your doctor know if you have hypotension to avoid medication that can make the condition worse.
Hypotension can cause minor accidents or severe health problems. A person with low blood pressure is prone to accidents, such as falling due to dizziness, headache, or fainting. Severe hypotension can limit oxygen to the body, causing damage to the heart, brain, and other organs in the body, and this can lead to death without timely treatment.

There are different causes of hypotension so complete prevention is not possible, but risks can be minimized in the following ways:

  • Drink plenty of clean water each day to prevent dehydration and loss of electrolytes as well as increase amount of blood.
  • Avoid alcohol as it can lead to dehydration.
  • Eat nutritious foods that provide all the nutrients the body needs and focus on vegetables, fruit, grains, and lean meat.
  • Change positions (from sitting to standing or vice versa) slowly.
  • Check your blood pressure regularly.
  • Eat an adequate amount of food at each meal or eat small, frequent meals and avoid foods high in carbohydrates, such as potatoes, rice, pasta, and bread, to prevent blood pressure from decreasing too quickly after eating.

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