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Low Blood Pressure (Hypotension)

Low Blood Pressure (Hypotension) Treatment in Delhi, India

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Overview

Hypotension is the medical term used for low blood pressure among certain individuals. The normal blood pressure recorded is 120/80mm Hg (systolic/diastolic). In healthy individuals, low blood pressure without any symptoms is not usually a concern and does not need to be treated.

However, low blood pressure can be a sign of some underlying problem, especially in the elderly, because of inadequate blood flow to the heart, brain, and other vital organs. It can occur either as a condition on its own or as a symptom resulting from plenty of conditions. It generally doesn't cause symptoms, but when it produces, it requires immediate medical attention. 

Hypotension has two definitions:

  1. Absolute hypotension: When the resting blood pressure level is below 90/60 mmHg (millimetres of mercury).
  2. Orthostatic hypotension: The blood pressure level drops within three minutes of standing up from a sitting position. The drop level must be 20 mmHg or more for the systolic pressure and ten mmHg or more for the diastolic pressure. Another term used for this is postural hypotension because it occurs with posture changes.

A blood pressure level lower than 90 millimetres of mercury (mm Hg) for the systolic or 60 mm Hg for the diastolic is generally considered low blood pressure.

Under normal circumstances, the body manages to control blood pressure and keep it from dropping too much. If it starts to drop, the body tries to compensate for that by accelerating the heart rate or compressing blood vessels to narrow them. Symptoms of hypotension appear when the body can't compensate enough to accommodate the drop in blood pressure.

Slight decreases in blood pressure normally occur, so hypotension becomes more common as people get older. A rapid decrease in blood pressure indicates that certain body parts aren't getting the sufficient amount of blood flow required. That can result in unpleasant, disruptive, or even dangerous effects.

Symptoms of Low blood pressure

For some people, low blood pressure levels indicate underlying pathology, especially when it goes down all of a sudden or is followed by signs and symptoms such as:

  • Dizziness or lightheadedness
  • Fainting
  • Blurred or fading vision
  • Nausea
  • Fatigue
  • Lack of concentration
  • Lethargy

Shock of hypotension

Extreme hypotension can result in this condition which can be life-threatening. Signs and symptoms include:

  • Confusion, especially in older people
  • Cold, clammy, pale skin
  • Rapid, shallow breathing
  • Weak and rapid pulse

Causes of Low blood pressure

Medical conditions that are responsible for causing low blood pressure are as follows:

  • Pregnancy. Since the circulatory system expands rapidly during pregnancy, blood pressure level is most likely to go down. This is normally expected, and blood pressure usually returns to the pre-pregnancy level after conceiving.
  • Heart problems. Certain heart conditions that can lead to low blood pressure include extremely low heart rate (bradycardia), issues in the heart valve, heart attack, and sudden heart collapse.
  • Endocrine problems. Parathyroid disease, adrenal insufficiency (Addison's disease), hypoglycaemia and, in some cases, diabetes can trigger low blood pressure.
  • Dehydration. When the body loses more fluids than it consumes, it results in weakness, dizziness and fatigue. Other factors like fever, vomiting, severe diarrhoea, overuse of diuretics, and strenuous exercise can also lead to dehydration.
  • Blood loss. Losing a lot of blood from a major injury or internal bleeding reduces a considerable amount of blood in the body, leading to a severe drop in blood pressure levels.
  • Severe infection (septicemia). When an infection present in the body enters the bloodstream, it can result in a life-threatening drop in blood pressure termed septic shock.
  • Severe allergic reaction (anaphylaxis). A common trigger of this severe and potentially life-threatening reaction comprises various foods, certain specific medications, insect bites, and latex. It can also result in breathing problems, itching, inflamed throat, and a severe drop in blood pressure levels.
  • Lack of nutrients in the diet. The absence of vitamin B-12, folate, and iron can prevent the body from making enough RBCs, causing low blood pressure.

Medications that Result in Low Blood Pressure

Certain medications result in low blood pressure. These are as follows:

  • Diuretics, like furosemide (Lasix) and hydrochlorothiazide (Microzide)
  • Alpha blockers i.e. prazosin (Minipress)
  • Beta-blockers like atenolol (Tenormin) and propranolol (Inderal, Innopran XL)
  • Drugs for Parkinson's disease, i.e. pramipexole (Mirapex) or drugs containing levodopa
  • Certain forms of antidepressants (tricyclic antidepressants), doxepin (Silenor), and imipramine (Tofranil)
  • Drugs prescribed for erectile dysfunction like sildenafil (Revatio, Viagra) or tadalafil (Adcirca, Alyq, Cialis), particularly when given with the heart medication nitroglycerin (Nitrostat, others)

Diagnosis of Low blood pressure

The goal of testing for low blood pressure is to find the exact cause involved. Apart from taking the medical history, doing a physical exam, and measuring the blood pressure, the doctor might recommend the following:

  • Blood tests. These can provide details about the overall health as well as whether the individuals have low blood sugar levels (hypoglycemia), high blood sugar (hyperglycemia or diabetes), or a low RBC count (anaemia), all of which result in lower than normal blood pressure.
  • Electrocardiogram (ECG). An ECG detects irregularities in the heart rhythm, structural problems in the heart, and issues with the blood and oxygen supply to the cardiac muscle. It can also tell if the patient is susceptible to having a heart attack or has had one in the past.
  • Tilt table test. During the test, individuals lie on a table that's tilted to raise the upper part of the body, simulating the movement from a horizontal to a standing position.

Treatment of Low blood pressure

Treating hypotension directly usually happens in the following ways:

  • Increasing blood volume. This method, also called fluid resuscitation, includes the administration of infusing fluids into the blood. Examples include intravenous (IV) fluids, plasma, or blood transfusions.
  • Making blood vessels constrict. Just as there are medications that lower blood pressure by relaxing blood vessels in the body, there are also certain medications that do the reverse effect.
  • Change how the body handles fluids. The kidneys play a vital role in maintaining fluid balance in the body. Certain medications can make the kidneys maintain fluid and salt in the body, which can help with low blood pressure.
  • Use more salt. Doctors usually recommend restricting salt intake in the diet because sodium can sometimes raise blood pressure levels. For people with low blood pressure levels, it turns out to be a good remedy. However, excess sodium can lead to heart failure, especially in older adults; it's important to check with the doctor before increasing the salt in the dietary intake.
  • Drink more water. Fluids increase blood volume and help prevent dehydration, which is important in treating hypotension.

Risk factors of Low blood pressure

Low blood pressure can occur in anyone; though certain types of low blood pressure are more common depending on age or other associated factors:

  • Age. Decrease in blood pressure on standing or after eating occur primarily in adults older than 65. It mainly affects children and younger adults.
  • Medications. People who consume certain medications like high blood pressure drugs such as alpha-blockers have a higher risk of having low blood pressure levels.
  • Certain diseases. Parkinson's disease, diabetes, and a few heart conditions increase your risk of developing low blood pressure.

Complications of Low blood pressure

Even moderate kinds of low blood pressure levels can result in complications like dizziness, weakness, fainting, and risk of injury resulting from falls. And severely low blood pressure can deprive the body of enough supply of oxygen to carry out its functions, leading to damage to the heart and brain.

Outlook

If a person has low blood pressure levels but doesn't have symptoms, this condition usually isn't harmful and shouldn't impact the quality of life. If individuals have symptoms, the underlying cause determines the outlook or prognosis for this condition. The doctor is, however, the best person to tell the person what to expect from this condition and what all they can do to manage those effects.

Last Update

Reviewed by Dr. Yogendra Singh, Associate Director – Interventional Cardiology, Cardiology, Cardiac Sciences on 03-Nov-2022.

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