Hypotension: Symptoms and Ways to Control

How Do I Know if I Have Hypotension?

Lower blood pressure may or may not be a problem. Your doctor can uncover the cause and diagnose the condition only if you have symptoms characteristic of low blood pressure – also known as hypotension. What is regarded as low blood pressure for someone else may be normal for you. Some medical experts define hypotension as ranges lower than 90 mm Hg systolic or 60 mm Hg diastolic. If either figure is lower than that, your blood pressure can be called lower than normal.

An abrupt drop in blood pressure could be very dangerous. A drop of only 20 mm Hg — a change from 110 Hg systolic to 90 mm Hg systolic, for instance — can trigger dizziness and collapsing when the brain cannot get an adequate blood supply. It goes without saying that bigger plunges, such as those instigated by severe infections, uncontrolled bleeding or allergic reactions, could be potentially life-threatening.

Low blood pressure indicates a problem when it falls rapidly or is accompanied by symptoms such as:

• Lightheadedness or dizziness
• Hypotension syncope (fainting)
• Feeling tired, anxious, nauseated, or weak
• Changes in vision or blurred vision
• Headache or pain in your chest, neck, lower back, buttocks, shoulders, or legs
• Decreased memory, confusion, or inability to concentrate
• Palpitations (forceful, fast heartbeats), increased sweating, a seizure or tremors

Severe hypotension might result in shock, a life-threatening condition.

Signs and symptoms of hypotension shock include:

• Shallow and rapid breathing
• Rapid and weak pulse
• Confusion, especially in senior people
• Clammy, cold, pale skin

Types of Hypotension

Physicians usually break hypotension down into categories, depending on the triggers and further factors.

Some types of hypotension include:

(1) Low blood pressure while standing up (postural or orthostatic hypotension)

As the name suggests, orthostatic hypotension is a sudden plunge in blood pressure in the moment you stand up after lying down or from a sitting position. Gravity makes blood to pool down in your legs while you are in a standing position Normally, your body compensates such pooling by constricting your blood vessels and increasing heart rate, thus ensuring that sufficient amount of blood gets back to your brain. But in patients with postural hypotension, such compensating apparatus fails and blood pressure drops, leading to blurred vision, lightheadedness, dizziness, and even fainting.

Orthostatic hypotension can appear for different reasons, including prolonged bed rest, large varicose veins, dehydration, diabetes, burns, pregnancy, heart problems, excessive heat, and some neurological disorders.

Several medications can trigger postural hypotension, especially drugs used to treat hypertension (high blood pressure) — beta blockers, ACE (angiotensin-converting enzyme) inhibitors, diuretics, calcium channel blockers as well as some antidepressants and medicines used to treat male erectile dysfunction and Parkinson’s disease.

Postural hypotension is particularly common in senior adults, but it may also affect younger, otherwise perfectly healthy people at the moment when they stand up abruptly after sitting crossed-legged for longer periods or after crouching for a while.

A delayed postural hypotension is also possible, with symptoms emerging in 5 to 10 minutes following a pose modification. This is an early stage of postural hypotension or a milder type of the condition.

(2) Low blood pressure after eating a meal (postprandial hypotension)

The sudden plunge in blood pressure after eating a meal affects predominantly senior adults, people with autonomic nervous system conditions such as Parkinson’s disease, as well as people with higher blood pressure.

Blood flows to digestive tract after a person eats. In normal case, a body constricts some blood vessels and increases heart beat rate to help sustain regular blood pressure. However, in some people such mechanism fails, leading to faintness, dizziness, and falls. Eating smaller, low-carb meals and cutting the dosage of blood pressure drugs may help ease the symptoms.

(3) Low blood pressure triggered by flawed signals from the brain (neurally mediated hypotension)

This type of disorder, which instigates a blood pressure to plunge after standing for long intervals, seems to occur due to flawed communication between the brain and the heart. It mostly prevails in children and young adults.

(4) Low blood pressure triggered by nervous system impairment (multiple system atrophy accompanied by orthostatic hypotension).

This rare disorder also known as Shy-Drager syndrome triggers substantial damage to the autonomic nervous system that controls unconscious functions: for example, heart rate, digestion, breathing and blood pressure. Shy-Drager syndrome is also associated with having unusually high blood pressure when lying down.

How is Hypotension Diagnosed?

Your doctor will inquire about your symptoms, how often you have them and whether they change throughout the day, as well as existing health conditions, and the medicines you take. Inform your physician if you recently experienced blood loss, vomiting, or diarrhea. Your doctor will examine you, check your eyes and listen to your heart.

He or she will also check your body sensations (ability to feel tactile sensations) and suggest the following medical tests:

• Blood pressure tests: This will be done while you sit, lie down, and stand. You may be required to wear a blood pressure monitor to record your blood pressure for a full day of 24 hours.
• Tilt table test: Some forms of orthostatic hypotension may require this test that estimates the body’s reaction to modifications in position. The patient lies on a special table, is carefully strapped in, and this table is then raised to a vertical position for an hour or so. Heart rate, blood pressure, and symptoms of hypotension are recorded.

What Tests Can Detect the Cause of Hypotension?

In many cases, hypotension is a indication of another underlying condition.

You may need some of the ensuing tests to locate the original cause of your hypotension:

• EKG (electrocardiogram): this test records your hearts` electrical activity. EKG is used to examine for damage or further heart disorders that might be triggering your low blood pressure problem.
• Blood and urine lab tests: Your blood or urine sample may be tested for anemia or alternative conditions instigating your low blood pressure problem.
• Tests of autonomic nervous system: Your doctor may examine changes in how fast your heart is beating when you are taking deep breaths. He or she may also monitor the changes in your blood pressure while you submerge your hands into ice cold water.
• ECG (echocardiogram): A sophisticated type of ultrasound, known as a Holter monitor may be needed to check for irregular heart beat that can make your blood pressure plunge suddenly, as well as heart hitches that come and go.
• 24-hour urine test: As the name of the test implies, you will be asked to collect all your urine for a full day. A patient urinates into a container and then the urine is placed into a jug that must be maintained cold. Should you also urinate during the night time, you will be asked to save that urine as well. Nurses will record and measure how much you have urinated. At the end of 24-hour period, the urine sample will be sent for a lab tests.
• An exercise stress test or, less frequently, EP (electrophysiology) test might also provide additional insights.

Conditions That Can Instigate Low Blood Pressure

A wide variety of existing underlying conditions might trigger the symptoms of low blood pressure. Identifying the cause of hypotension is essential for prescribing an appropriate treatment.

Some of the medical conditions that may be hypotension causes include:

• Blood loss. Losing a significant amount of blood, for example, from internal bleeding or a major injury decreases the amount of blood in a circulatory system, leading to a harsh plunge in blood pressure.
• Heart problems. Bradycardia (very low heart beat rate), heart valve problems, heart attack, and heart failure are some of the conditions that may lead to hypotension.
• Pregnancy. Blood pressure is expected to lower during pregnancy since the circulatory system tends to expand rapidly in pregnant women. This is entirely normal, with blood pressure readings returning to a pre-pregnancy level after child delivery.
• Dehydration. Severe diarrhea, fever, vomiting, abuse of strenuous exercise and diuretics can lead to dehydration, when your body takes in less water than it loses, which might cause dizziness, weakness, and fatigue.
• Endocrine disorders. Thyroid conditions such as Addison’s disease (adrenal insufficiency), parathyroid disease, hypoglycemia (low blood sugar levels) and, in certain cases, diabetes might trigger hypotension.
• Septicemia (severe infection). Septic shock, a life-threatening plunge in blood pressure, can strike when an infection in the body gets into the bloodstream.
• Deficiency in dietary nutrients. A deficit of folate and the vitamin B-12 can hinder creation of red blood cells – a condition known as anemia, which causes low blood pressure in turn.
• Anaphylaxis (severe allergic reaction). This dangerous and potentially life-threatening condition can be triggered by certain foods, medications, latex and insect venoms. Anaphylaxis can instigate hives, breathing problems, a swollen throat, itching, and a harsh decrease of blood pressure.

What Amplifies my Risk for Hypotension?

• Advanced age
• Being bedbound for a longer intervals of time
• Drug and alcohol use
• Hemodialysis
• Low body weight
• Medical conditions such as Parkinson disease, diabetes, and Alzheimer disease.

Medications That Might Trigger Hypotension

Selected drugs can cause hypotension, including:

• Alpha blockers, such as prazosin
• Beta blockers, such as propranolol and atenolol
• Diuretics, such as hydrochlorothiazide and furosemide
• Tricyclic antidepressants, such as doxepin and imipramine
• Drugs for male erectile dysfunction, including sildenafil or tadalafil, particularly when taken concurrently with the heart remedy nitroglycerin
• Drugs for treating Parkinson’s disease, for example pramipexole or levodopa-containing drugs

What Are the Ways to Control Hypotension?

For most people, chronic hypotension can be successfully addressed with lifestyle changes and special diet to control hypotension.

Depending on your symptoms and their causes, your physician may recommend you boost your blood pressure by making some of the following changes:

• Be careful while rising from sitting or lying down. To help boost circulation, pump your ankles and feet a few times before you stand up. Proceed gently. Before getting out of your bed in the morning, sit straight on the edge of the bed for a couple of minutes.
• Drink more fluids while sick with a viral infection and during hot weather.
• Cut down your consumption of alcoholic beverages.
• Add more salt to your diet.
• Avoid standing still in one place for a long time.
• Avoid lifting heavy objects.
• Stay away from lengthy exposure to hot water. Sit down if you get dizzy. It might be helpful to have a nonslip stool in your shower for the case you need to sit.
• Have your doctor check your prescription drugs and over-the-counter medicines alike to make sure none of them are triggering your hypotension symptoms.
• Exercise regularly to promote blood circulation.
• Put your head in elevated position at night.
• Avoid straining efforts while on the toilet.
• Try eating frequent smaller meals to avoid problems with postprandial hypotension and lessen incidents of lightheadedness after eating. Cut back on carbs. Avoid taking drugs that lower blood pressure before eating. Take rest after you eat.
• If needed, use compression stockings covering calf and thigh to help restrict blood flow in the lower body, therefore encouraging better blood flow in the upper body.

What Are the Risks of Untreated Hypotension?

When left unaddressed, your hypotension symptoms may grow worse. You may faint or collapse repeatedly, which may result in injuries, such as bone fractures. Sepsis-related hypotension is life-threatening when ignored. You might be at bigger risk for confusion, depression, and memory glitches. Hypotension may decrease blood circulation in your heart and brain. This may ultimately lead to a heart attack or stroke and could be life-threatening.

When You Should Contact Your Doctor

• You have diarrhea and vomit several times, and you cannot swallow liquids.
• Your feet, ankles, and legs are swollen, or you have gained weight for unclear reason.
• You have increased symptoms of weakness, dizziness, or fainting.

When You Should Seek Immediate Care

• You have seizures.
• You experience changes in vision that do not go away or you cannot see.
• You are confused or unable to speak.
• You have trouble breathing or chest pain.
• You do not urinate at all (or very little).

Drugs to Control Hypotension

Only a small share of patients are prescribed medications to tackle their low blood pressure problems. The symptoms of hypotension may normally be lessened by making the above lifestyle changes and by increasing your sodium and fluid intake.

If drug is required, it will typically be a type of drug that expands the volume of the blood or narrows the arteries. Blood pressure will go up since there will be slightly more blood circulating through a smaller space. Fludrocortisone and midodrine are standard drugs used in hypotension treatment.

Midodrine stimulates receptors on veins and the smallest arteries to make an increase in blood pressure. Midodrine is used for boosting standing blood pressure in patients with postural hypotension caused by nervous system disorders. Midodrine works by curbing the ability of the blood vessels to expand, thus raising the blood pressure.

Fludrocortisone is a hypotension medication that appears to help most types of hypotension. It works by stimulating sodium retention in the kidney, thus causing fluid preservation and some amount of swelling necessary to boost blood pressure. On the downside, sodium retention causes a deficit of potassium. When you take fludrocortisone, it’s essential to get enough potassium supplements each day. Fludrocortisone does not build muscle similar to anabolic steroids and has none of the anti-inflammatory capabilities of prednisone or cortisone.