Low Blood Pressure

Overview

Low blood pressure is a condition where an individual's blood pressure reading is lower than the typical or normal range. In general, low blood pressure is considered to be below 90 millimeters of mercury (mm Hg) for the top number (systolic) or 60 mm Hg for the bottom number (diastolic). However, what is considered low blood pressure can vary depending on the individual. Low blood pressure might not cause any noticeable symptoms or could lead to dizziness, fainting, and other issues. The causes of low blood pressure can range from dehydration to more serious medical conditions, and it is important to identify and treat the underlying cause when necessary. There are different types of low blood pressure, including orthostatic hypotension, postprandial hypotension, and neurally mediated hypotension. Seek emergency medical help if you experience symptoms of extreme low blood pressure or shock, such as confusion, cold and clammy skin, rapid and shallow breathing, weak and rapid pulse, and decreased skin coloration (pallor).

Understanding the disease

Symptoms

Symptoms of low blood pressure, also known as hypotension, may include:

1. Dizziness or lightheadedness
2. Fainting or near-fainting
3. Weakness or fatigue
4. Confusion, especially in older people
5. Cold, clammy skin
6. Decrease in skin coloration (pallor)
7. Rapid, shallow breathing
8. Weak and rapid pulse It's important to see a health care provider if you have symptoms of extreme low blood pressure or shock. Occasional minor dizziness or lightheadedness can be caused by many things, but if it's affecting your daily life or causing concern, it's a good idea to consult a health care provider.

Risk Factors

Risk factors for low blood pressure (hypotension) include:

1. Age: Drops in blood pressure on standing or after eating primarily occur in adults older than 65. Neurally mediated hypotension primarily affects children and younger adults.
2. Medications: Certain medications, including some blood pressure drugs, can increase the risk of low blood pressure.
3. Certain diseases: Parkinson's disease, diabetes, and some heart conditions may increase the risk of low blood pressure. Remember that low blood pressure might cause no noticeable symptoms or might cause dizziness and fainting. It's important to determine the cause of low blood pressure so it can be treated, if necessary.

Development

The various types of low blood pressure develop due to different factors:

1. Orthostatic hypotension (postural hypotension): This type of low blood pressure occurs when there is a sudden drop in blood pressure when standing from a sitting or lying down position. Causes include dehydration, long-term bed rest, pregnancy, certain medical conditions, and some medications. It is common in older adults.
2. Postprandial hypotension: This type of low blood pressure happens 1 to 2 hours after eating, mostly affecting older adults, especially those with high blood pressure or autonomic nervous system diseases such as Parkinson's disease. Eating small, low-carbohydrate meals, drinking more water, and avoiding alcohol might help reduce symptoms.
3. Neurally mediated hypotension: This type of low blood pressure happens after standing for long periods and is most likely to affect young adults and children. It results from miscommunication between the heart and the brain. In summary, the different types of low blood pressure develop due to various factors such as body position, medical conditions, and medications.

Assessment and Diagnosis

Triage

If you have symptoms of extreme low blood pressure (hypotension) or shock, such as confusion, cold and clammy skin, decreased skin coloration, rapid and shallow breathing, and a weak and rapid pulse, you should seek emergency medical help. It is important to consult a healthcare provider for a correct diagnosis even if you only experience occasional minor dizziness or lightheadedness, as many factors can cause these symptoms. If you consistently have low blood pressure readings but feel fine, your provider may monitor you during routine health checkups and ask you to keep a record of your symptoms, when they occur, and what you're doing at the time.

Diagnosis

To diagnose low blood pressure (hypotension), your health care provider will conduct a physical exam and measure your blood pressure. They may also order additional tests, such as blood tests to check for low blood sugar, high blood sugar, low red blood cell count, or other conditions that could contribute to low blood pressure. Other diagnostic tests may include an electrocardiogram (ECG), which measures the electrical activity of the heart, or a tilt table test, which evaluates how the body reacts to changes in position. If low blood pressure is causing symptoms, the treatment will depend on the underlying cause, and your health care provider may recommend adjusting medications, making lifestyle changes, or using other methods to raise blood pressure and alleviate symptoms.

Management and Treatment

Complications

Potential complications of low blood pressure (hypotension) include dizziness, weakness, fainting, injury from falls, and reduced oxygen levels to the heart and brain, potentially leading to damage. Severe low blood pressure can lead to a condition called shock, which may result in confusion, cold and clammy skin, decreased skin coloration, rapid and shallow breathing, and a weak and rapid pulse. If you experience symptoms of extreme low blood pressure or shock, seek emergency medical help.

Treatment

Treatments for low blood pressure (hypotension) depend on the underlying cause and severity of the condition. Some common treatments include:

1. Addressing underlying causes: Treat the underlying medical condition causing low blood pressure. For example, if dehydration is the cause, rehydration may be sufficient.
2. Medications: In some cases, medications may be prescribed to increase blood pressure. These could include medications like fludrocortisone (Florinef) to increase sodium and water retention in the body, midodrine (Orvaten, Proamatine) to constrict blood vessels and increase blood pressure, or pyridostigmine (Mestinon, Esitrol) to increase acetylcholine and improve blood vessel dilation.
3. Lifestyle changes: Making certain lifestyle changes can help prevent or manage low blood pressure. These may include eating a nutritious, balanced diet, getting regular exercise, avoiding or limiting alcohol consumption, not smoking, and managing stress.
4. Supportive measures: In cases of severe low blood pressure or symptoms like dizziness, fainting, or confusion, supportive measures may be necessary. These could include increasing fluid and salt intake, elevating the feet to improve blood flow, or using compression stockings to support blood circulation. It is important to consult with a healthcare professional to determine the best course of treatment for low blood pressure based on the individual's specific situation.

Preparing for medical consultation

To prepare for an appointment for low blood pressure, make a list of your symptoms, including any that seem unrelated to low blood pressure, and when they occur. Also, gather key personal information, such as a family history of low blood pressure and any major stresses or recent life changes. Prepare a list of all medications, vitamins, or supplements you take, including doses. Write down questions to ask your provider, such as "What is likely causing my symptoms or condition?" and "What's the most appropriate treatment?" It's also helpful to wear a short-sleeved or loose long-sleeved shirt for the appointment, making it easier for the healthcare provider to fit the blood pressure cuff around your arm. Additionally, keep a log of your blood pressure readings taken at home, and bring it with you to your appointment. Take your blood pressure readings first thing in the morning, after eating, when your symptoms are least severe, when they are most severe, when you take your blood pressure medications, and one hour after taking your medications.