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Low blood pressure

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Blood Pressure (BP) is the pressure applied by the blood on the arteries while the heart pumps blood. This pressure is described in two numbers, systolic BP, which is the pressure while your heart beats or contracts, and diastolic BP, which is the pressure while your heart relaxes between two beats.

Low BP is medically known as hypotension. Technically, you are said to have low BP when your systolic pressure (upper reading) falls below 120 mmHg, and the diastolic pressure (lower reading) is less than 80 mmHg. However, according to doctors’ systolic pressure of 90 mmHg or a lower and diastolic pressure of 60 mmHg or lower characterize low BP. If your BP falls below these levels, it may restrict blood flow to the brain and other vital organs, leading to various health complications.

There is no lower limit for low BP that is not healthy. Few individuals have low BP all the time, which is completely normal, while some might experience a sudden decrease in BP. Body position and various organs, hormones, and nerves play an important role in regulating BP. When an individual moves from a resting position to a standing position, a larger blood volume is displaced to the legs and abdominal area, which can affect BP. However, most of the time, various bodily systems’ rapid actions adapt to the changes and restores BP to normal.

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Types

Low BP can be a temporary or long-lasting condition. Here are the main types of low BP:


  • Orthostatic hypotension: This type of hypotension occurs when there is a decrease in systolic BP by 20 mmHg and/or diastolic BP by 10 mmHg within three minutes of standing. It is common in pregnant women and older adults, or in conditions causing dehydration.

  • Constitutional hypotension: In this type of hypotension, the patient constantly has low figures. It is seen frequently in younger patients.

  • Postprandial hypotension: In this type of hypotension, the individual feel dizzy or light-headed after having a meal. It is common in older adults.

  • Naturally mediated hypotension: In this type of hypotension, the individuals feel dizzy, nauseous, or faint after exercising or standing for a long time.

  • Severe hypotension causing shock: In this type of hypotension, the BP drops to dangerously low levels. The essential organs do not get enough oxygen and nutrients to function, and the patient may succumb if not treated quickly.

Symptoms

Many individuals do not experience any symptoms of low BP. However, some may experience several symptoms. The common signs and symptoms you may experience if suffering from low BP are:


  • Nausea

  • Vomiting

  • Fatigue

  • Dizziness

  • Weakness

  • Fainting

  • Excessive thirst

  • Constant palpitation

  • Blurred vision

  • Confusion

  • Light-headedness

  • Lack of concentration

  • Cold and pale skin

  • Sweating

  • Chills

  • Rapid breathing

  • Depression


Signs of shock due to extremely low BP include:

  • Cold skin

  • Sweaty skin

  • Blue skin

  • Rapid breathing

  • Weak or a rapid pulse


This is a serious condition, and the patient requires immediate medical attention.

Causes And Risk Factors

Causes

Some of the common causes of low BP are:


  • A sudden change in body position such as standing from a sitting or lying down position.

  • A sudden decrease in BP post eating is more common in older adults. This occurs one to two hours after having a high-carbohydrate meal. Alcohol consumption, along with a high carbohydrate meal, can make this condition worse.

  • A sudden decrease in BP if an individual is standing for a long time.

  • Few individuals may naturally have low BP due to genetics.

  • Intense emotions, such as pain or fear.


In many cases, medical conditions occur along with low BP. Some of these medical conditions that cause low BP are:

  • Heart diseases (heart attack, coronary heart disease, arrhythmias, and heart failure)

  • Thyroid problems

  • Addison’s disease

  • Parkinson’s’ disease

  • Neurological syndromes

  • Autonomic failure

  • Multiple organ failure

  • Diabetes and hypoglycemia

  • Nerve damage due to diabetes

  • Dehydration

  • Severe allergic reaction

  • Severe infections

  • Severe anaemia caused by iron, vitamin B-12 and folic acid deficiency.

  • Pregnancy

  • Blood loss (through external bleeding or internal bleeding)

  • Auto-immune systemic diseases


Following medications can also lead to low BP:

  • Anti-anxiety medicines

  • Antidepressants

  • Anti-hypertensives (diuretics)

  • Some over-the-counter medicines if taken with antihypertensives

  • Painkillers

  • Cancer chemotherapy

  • Medications for coronary heart disease

  • Medications used during surgery

  • Medications used for erectile dysfunction or prostate conditions.


Risk Factors

Patients with orthostatic hypotension are sensitive to hot temperature and changes in blood volume. Such patients need to take extra precautions, but they often forget, for example, standing up immediately to visit the toilet. Individuals with hormonal imbalance or vitamin deficiencies are at a greater risk for low BP.

Prevention

Apart from medication and other pharmacological ways to treat hypotension, you can try these expert tips to prevent low BP in future:


  • Drink plenty of fluids

  • Drink ice-cold water before going to bed; this increases blood flow to the heart

  • Eat small, frequent meals

  • Include plenty of whole grains, fruit, and vegetables in your diet

  • Lie down with your head elevated; this is more effective in orthostatic hypotension patients, who generally have high BP throughout the day

  • Be careful while standing

  • Exercise regularly

  • Optimize salt intake


If an individual experiences any symptoms listed above for low BP, they can sit or lie down right away in a cool room and raise their feet above heart level. Individuals can reduce light-headedness by gradually moving from lying to standing position. You can first sit on the edge, move your legs to increase blood flow to the heart, and then stand up. Focus on breathing before you stand up.

Diagnosis

The only way to know whether you have low BP is to get it measured. The physician will measure your BP with an instrument called a sphygmomanometer. The normal BP reading is 120/80 mmHg. In some cases, individuals recover rapidly from a sudden drop in BP, making it difficult for a doctor to record with regular BP monitors. The doctor may also check body temperature, pulse rate, and breathing rate, which are vital signs for low BP. The doctor may ask the patient about their normal BP, current medications, current diet, recent illness, injury and accident, and symptoms such as fainting, dizziness, or light-headedness.  The doctor will conduct several tests like basic metabolic panel, blood tests to check infection, complete blood count, stress test, echocardiogram, electrocardiogram (ECG), urine test, and X-ray of abdomen and chest.

Treatment

Low BP in healthy individuals may not require treatment, but if it is associated with any other disorder, your doctor will address that condition as the first line of treatment. If ongoing medication is a cause for the low BP, the doctor may suggest reducing the medicines’ doses or changing the prescription. The doctor may prescribe drugs for low BP. Severe low BP caused by shock can be treated by:


  • Intravenous fluids or blood

  • Medicines like fludrocortisone and midodrine

  • Antibiotics to reduce bacterial infection


In patients with orthostatic hypotension, fludrocortisone acetate is prescribed to maintain salt and potassium balance and increase blood volume. Other drugs, such as ephedrine, caffeine, dihydroergotamine, etilefrine, droxidopa and midodrine can also be prescribed. 

Lifestyle/management

In general, you can raise your BP to normal levels by:


  • Using more salt in your diet to increase sodium intake (but check with your doctor first)

  • Drinking more water to prevent dehydration

  • Limiting alcohol and caffeine intake, especially at night

  • Eating small, frequent meals

  • Getting out of bed or getting up from a chair slowly

  • Avoiding going out in extreme heat conditions

  • Avoid taking hot baths or showers

  • Being physically active

  • Using compression stockings to prevent the accumulation of blood in the lower body. Patients with an advanced level of low BP are required to wear compression stockings for the abdomen

  • Avoiding standing for a long time (especially if you have naturally mediated hypotension)

  • Including plenty of fruits, vegetables, and whole grains in your diet

Prognosis And Complications

Prognosis

Usually, doctors can successfully treat low BP in patients. Drugs like fludrocortisone may worsen certain infections and cause difficulty sleeping, dizziness, and stomach problems. Midodrine may cause a tingling sensation, numbness, itching, goosebumps, and chills. However, if treated and monitored properly, low BP will not cause any serious health effects. Also, most of the patients learn to control low BP with lifestyle changes.

Complications

The risk of falling is increased in patients with orthostatic hypotension. Low BP in older adults can lead to falls which may ultimately cause broken bones or fractures. Just like any other disease, if low BP is not treated in time it can cause complications. A severe drop in BP can lead to an insufficient supply of oxygen in the body. Long term damage to the brain, heart and other organs can occur if low BP is severe and untreated. Hypotension in pregnancy can cause complications such as stillbirth.

Alternative Treatments

There are alternative therapies to normalize your BP such as:


  • Yoga techniques such as Ardha Matsyendrasana, Paschimotasana, and Bhastrika Pranayam are good for managing BP irregularities, especially hypotension issues.

  • Acupressure is believed to be a holistic approach to heal low BP. Gentle massaging of the reflex points in your hands and feet by a certified reflexologist can raise low BP.

  • Herbs such as turmeric, cinnamon, ginger, pepper, Ashwagandha, ginkgo and garlic may also help in normalizing BP. There are homoeopathic remedies for low BP too, but remember to consult only a registered homoeopathic doctor for treatment.

References


  1. Low blood pressure. NIH. Available at: https://www.nhlbi.nih.gov/health-topics/low-blood-pressure. Accessed on: March 24, 2021.

  2. The lowdown on low blood pressure. University of Rochester Medical Center. Available at: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=56&contentid=2949. Accessed on: March 24, 2021.

  3. Low blood pressure. European Society of Cardiology. Available at: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-17/low-blood-pressure. Accessed on: March 24, 2021.

  4. Low blood pressure (hypotension). Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/21156-low-blood-pressure-hypotension. Accessed on: March 24, 2021.

  5. Low blood pressure. MedlinePlus. Available at: https://medlineplus.gov/ency/article/007278.htm. Accessed on: March 24, 2021.

  6. Low blood pressure (hypotension). Breastcancer.org. Available at: https://www.breastcancer.org/treatment/side_effects/low_blood_press. Accessed on: March 24, 2021.

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