Low Blood Pressure

 Low Blood Pressure

Definition

Low blood pressure occurs when blood pressure is much lower than normal. This means the heart, brain, and other parts of the body do not get enough blood. Normal blood pressure is mostly between 90/60 mmHg and 120/80 mmHg.

The medical name for low blood pressure is hypotension.

Alternative Names

Hypotension; Blood pressure - low; Postprandial hypotension; Orthostatic hypotension; Neurally mediated hypotension; NMH

Causes

Blood pressure varies from one person to another. A drop as little as 20 mmHg, can cause problems for some people. There are different types and causes of low blood pressure.

Severe hypotension can be caused by sudden loss of blood (shock), severe infection, heart attack, or severe allergic reaction (anaphylaxis).

Orthostatic hypotension is caused by a sudden change in body position. This occurs most often when you shift from lying down to standing. This type of low blood pressure usually lasts only a few seconds or minutes. If this type of low blood pressure occurs after eating, it is called postprandial orthostatic hypotension. This type most often affects older adults, those with high blood pressure, and people with Parkinson disease.

Neutrally mediated hypotension (NMH) most often affects young adults and children. It can occur when a person has been standing for a long time. Children usually outgrow this type of hypotension.

Certain medicines and substances can lead to low blood pressure, including:

Alcohol

Anti-anxiety medicines

Certain antidepressants

Diuretics

Heart medicines, including those used to treat high blood pressure and coronary heart disease

Medicines used for surgery

Painkillers

Other causes of low blood pressure include:

Nerve damage from diabetes

Changes in heart rhythm (arrhythmias)

Not drinking enough fluids (dehydration)

Heart failure

Symptoms

Symptoms of low blood pressure may include:

Blurry vision

Confusion

Dizziness

Fainting (syncope)

Lightheadedness

Nausea or vomiting

Sleepiness

Weakness

Exams and Tests

The health care provider will examine you to determine the cause of your low blood pressure. Your vital signs (temperature, pulse, rate of breathing, and blood pressure) will be checked frequently. You may need to stay in the hospital for a while.

The provider will ask questions, including:

What is your normal blood pressure?

What medicines do you take?

Have you been eating and drinking normally?

Have you had any recent illness, accident, or injury?

What other symptoms do you have?

Did you faint or become less alert?

Do you feel dizzy or lightheaded when standing or sitting after lying down?

The following tests may be done:

Basic metabolic panel

Blood cultures to check for infection

Complete blood count (CBC), including blood differential

Electrocardiogram (ECG)

Urinalysis

X-ray of the abdomen

X-ray of the chest

Treatment

Lower than normal blood pressure in a healthy person that does not cause any symptoms often does not need treatment. Otherwise, treatment depends on the cause of your low blood pressure and your symptoms.

When you have symptoms from a drop in blood pressure, sit or lie down right away. Then raise your feet above heart level.

Severe hypotension caused by shock is a medical emergency. You may be given:

Blood through a needle (IV)

Medicines to increase blood pressure and improve heart strength

Other medicines, such as antibiotics

Treatments for low blood pressure after standing up too quickly include:

If medicines are the cause, your provider may change the dosage or switch you to a different drug. Do not stop taking any medicines before talking to your provider.

Your provider may suggest drinking more fluids to treat dehydration.

Wearing compression stockings can help keep blood from collecting in the legs. This keeps 

more blood in the upper body.

People with NMH should avoid triggers, such as standing for a long period of time. Other treatments include drinking fluids and increasing salt in your diet. Talk to your provider before trying these measures. In severe cases, medicines may be prescribed.

Outlook (Prognosis)

Low blood pressure can usually be treated with success.

Possible Complications

Falls due to low blood pressure in older adults can lead to a broken hip or spine fracture. These injuries can reduce a person’s health and ability to move about.

Sudden severe drops in your blood pressure starves your body of oxygen. This can lead to damage of the heart, brain, and other organs. This type of low blood pressure can be life threatening if not treated right away.

Call your provider right away if you have any of the following symptoms:

Black or maroon stools

Chest pain

Dizziness, lightheadedness

Fainting

Fever higher than 101°F (38.3°C)

Irregular heartbeat

Shortness of breath

Prevention

Your provider may recommend certain steps to prevent or reduce your symptoms including:

Drinking more fluids

Getting up slowly after sitting or lying down

Not drinking alcohol

Not standing for a long time (if you have NMH)

Using compression stockings so blood does not collect in the legs

Medicine

• Fludrocortisone. Fludrocortisone is a medication that seems to help some types of low blood pressure. ...
• Midodrine. Midodrine activates receptors on the smallest arteries and veins to produce an increase in blood pressure.
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• Clinical Medication 

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• Norepinephrine injection is used to raise blood pressure in patients with severe, acute hypotension (short-term low blood pressure).

During a treatment, if your blood pressure drops, the nurse or tech may give you saline (salt water) through your blood tubing. Normal saline has the same amount of salt as your blood. It replaces blood volume, which improves your blood pressure. In some centers, hypertonic saline may be given.

Home Remedies to Improve Low Blood Pressure

Hypotension, or extremely low blood pressure, can cause different health problems. Generally, low blood pressure can be corrected with lifestyle changes, such as increasing your intake of fluids, changing your medications, and raising your legs.

1. Increase your water intake

Dehydration can cause an electrolyte imbalance and, eventually, low blood pressure. Therefore, hydrate your body adequately, especially in hot weather or during diarrhea or fevers.

2. Try ORS for immediate relief

ORS stands for oral rehydration solution which helps restore lost electrolytes in the body to avoid dehydration and low blood pressure. It is recommended as the first-line treatment for diarrhea by WHO.

It is sold as a packaged powder containing a number of essential salts like sodium and potassium and a bit of sugar, which has to be mixed into distilled water for consumption.

3. Consume more sodium

Eating high-sodium foods, such as cheeses, meals containing soy sauce, salted nuts, and cured meats and fish, can help raise blood pressure. However, it is important to limit your salt intake between 10 g and 20 g per day, (2) since an excess can lead to hypertension.

4. Avoid alcohol

Although alcohol usually causes high blood pressure, it can occasionally lead to an arrhythmia called atrial fibrillation, which may result in low blood pressure.

5. Stay active

Performing light exercises aids blood circulation throughout the body. Doing simple leg exercises before getting up can help blood movement.

6. Wear compression stockings

This prevents the pooling of blood in the legs, thereby keeping the blood in the upper body. Elastic compression stockings are found to be effective in preventing hypotension for patients having hemodialysis.

7. Avoid staying in the heat for long

Prolonged exposure to heat, including hot showers or baths, can lower your blood pressure by causing your blood vessels to dilate.

8. Don’t stand up too quickly

Sudden or rapid movements or postural changes after an extended period of rest can often trigger low blood pressure and even dizziness. This is particularly noticeable when you get out of bed after sleep or stand up after sitting for too long.

People who are prone to hypotension should, therefore, be mindful about changing their position gradually rather than abruptly. Take your time in getting out of bed by first slowly turning on the side, sitting up and then getting on your feet.

9. Eat small portions but eat frequently

Eating too much in one sitting can sink your blood pressure sharply after the meal, but starving yourself by not eating sufficiently can also make you go weak. Instead of consuming the standard three large meals a day, people with hypotension are advised to eat several small meals at short intervals distributed throughout the day.

10. Limit your carbohydrate intake

Another dietary change recommended for managing low blood pressure is to cut down on high-carb foods like bread, pasta, potatoes and rice.

11. Use extra pillows

When lying down, elevate your head with pillows to prevent orthostatic hypotension from getting up.

12. Include caffeine in your diet

It is seen that caffeine intake via coffee and black tea helps improve blood pressure in elderly patients with postprandial hypotension. However, further studies are needed to establish this claim. (4)(5)

13. Consume a healthy diet

Include fresh fruits, vegetables, and whole grains in your diet. Eat small meals throughout the day with healthy snacks in between, and reduce your carbohydrate intake.

14. Consult your doctor

Seek medical advice if you have diabetes or heart, liver, or kidney problems and are having low blood pressure.