Hypotension is the medical term for low blood pressure (less than 90/60).
A blood pressure reading appears as two numbers. The first and higher of the two is a measure of systolic pressure, or the pressure in the arteries when the heart beats and fills them with blood. The second number measures diastolic pressure, or the pressure in the arteries when the heart rests between beats.
Optimal blood pressure is less than 120/80 (systolic/diastolic). In healthy people, low blood pressure without any symptoms is not usually a concern and does not need to be treated. But low blood pressure can be a sign of an underlying problem -- especially in the elderly -- where it may cause inadequate blood flow to the heart, brain, and other vital organs.
Conditions that can cause low blood pressure
Medical conditions that can cause low blood pressure include:
- Pregnancy. Because the circulatory system expands rapidly during pregnancy, blood pressure is likely to drop. This is normal, and blood pressure usually returns to your pre-pregnancy level after you've given birth.
- Heart problems. Some heart conditions that can lead to low blood pressure include extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure.
- Endocrine problems. Parathyroid disease, adrenal insufficiency (Addison's disease), low blood sugar (hypoglycemia), and, in some cases, diabetes can trigger low blood pressure.
- Dehydration. When your body loses more water than it takes in, it can cause weakness, dizziness, and fatigue. Fever, vomiting, severe diarrhea, overuse of diuretics, and strenuous exercise can lead to dehydration.
- Blood loss. Losing a lot of blood, such as from a major injury or internal bleeding, reduces the amount of blood in your body, leading to a severe drop in blood pressure.
- Severe infection (septicemia). When an infection in the body enters the bloodstream, it can lead to a life-threatening drop in blood pressure called septic shock.
- Severe allergic reaction (anaphylaxis). Common triggers of this severe and potentially life-threatening reaction include foods, certain medications, insect venoms, and latex. Anaphylaxis can cause breathing problems, hives, itching, a swollen throat, and a dangerous drop in blood pressure.
- Lack of nutrients in your diet. A lack of vitamin B-12, folate, and iron can keep your body from producing enough red blood cells (anemia), causing low blood pressure.
- Liver disease
- infections of the bloodstream
Medications that can cause low blood pressure
Some medications can cause low blood pressure, including:
- Water pills (diuretics), such as furosemide (Lasix) and hydrochlorothiazide (Microzide, others)
- Alpha blockers, such as prazosin (Minipress)
- Beta-blockers, such as atenolol (Tenormin) and propranolol (Inderal, Innopran XL, others)
- Drugs for Parkinson's disease, such as pramipexole (Mirapex) or those containing levodopa
- Certain types of antidepressants (tricyclic antidepressants), including doxepin (Silenor) and imipramine (Tofranil)
- Drugs for erectile dysfunction, including sildenafil (Revatio, Viagra) or tadalafil (Adcirca, Alyq, Cialis), particularly when taken with the heart medication nitroglycerin (Nitrostat, others)
Risk factors
Low blood pressure (hypotension) can occur in anyone, though certain types of low blood pressure are more common depending on your age or other factors:
- Age. Drops in blood pressure on standing or after eating occur primarily in adults older than 65. Neurally mediated hypotension primarily affects children and younger adults.
- Medications. People who take certain medications, for example, high blood pressure medications such as alpha-blockers, have a greater risk of low blood pressure.
- Certain diseases. Parkinson's disease, diabetes, and some heart conditions put you at a greater risk of developing low blood pressure.
What Causes a Sudden Drop in Blood Pressure?
Sudden drops in blood pressure can be life-threatening. Causes of this type of hypotension include:
- Loss of blood from bleeding
- Low body temperature
- High body temperature
- Heart muscle disease causing heart failure
- Sepsis, a severe blood infection
- Severe dehydration from vomiting, diarrhea, or fever
- A reaction to medication or alcohol
- A severe allergic reaction called anaphylaxis that causes an irregular heartbeat.
People with hypotension may experience symptoms when their blood pressure drops below 90/60. Symptoms of hypotension can include:
- fatigue
- lightheadedness
- dizziness
- nausea
- clammy skin
- depression
- loss of consciousness
- blurry vision
Symptoms can range in severity. Some people may be slightly uncomfortable, while others may feel quite ill.
Hypotension is divided into several different classifications according to when your blood pressure drops.
Orthostatic
Orthostatic hypotension is the drop in blood pressure that occurs when you transition from sitting or lying down to standing. It is common in people of all ages.
As the body adjusts to the position change there may be a brief period of dizziness. This is what some people refer to as “seeing stars” when they get up.
Postprandial
Postprandial hypotension is a drop in blood pressure that occurs right after eating. It is a type of orthostatic hypotension. Older adults, especially those with Parkinson’s disease, are more likely to develop postprandial hypotension.
Neurally mediated
Neurally mediated hypotension happens after you stand for a long time. Children experience this form of hypotension more often than adults. Emotionally upsetting events can also cause this drop in blood pressure.
Severe
Severe hypotension is related to shock. Shock occurs when your organs do not get the blood and oxygen they need to function properly. Severe hypotension can be life-threatening if not treated promptly.
Diagnosis
The goal in testing for low blood pressure is to find the cause. Besides taking your medical history, doing a physical exam, and measuring your blood pressure, your doctor might recommend the following:
- Blood tests. These can provide information about your overall health as well as whether you have low blood sugar (hypoglycemia), high blood sugar (hyperglycemia or diabetes), or a low red blood cell count (anemia), all of which can cause lower than normal blood pressure.
Electrocardiogram (ECG). During this painless, noninvasive test, soft, sticky patches (electrodes) are attached to the skin of your chest, arms, and legs. The patches detect your heart's electrical signals while a machine records them on graph paper or displays them on a screen.
An ECG, which can be performed in your doctor's office, detects irregularities in your heart rhythm, structural problems in your heart, and problems with the supply of blood and oxygen to your heart muscle. It can also tell if you're having a heart attack or have had one in the past.
treatment
Low blood pressure that either doesn't cause signs or symptoms or causes only mild symptoms rarely requires treatment.
If you have symptoms, treatment depends on the cause. For instance, when medication causes low blood pressure, treatment usually involves changing or stopping the medication or lowering the dose.
If it's not clear what's causing low blood pressure or no treatment exists, the goal is to raise your blood pressure and reduce signs and symptoms. Depending on your age, health, and the type of low blood pressure you have, you can do this in several ways:
Use more salt. Experts usually recommend limiting salt in your diet because sodium can raise blood pressure, sometimes dramatically. For people with low blood pressure, that can be a good thing.
But because excess sodium can lead to heart failure, especially in older adults, it's important to check with your doctor before increasing the salt in your diet.
- Drink more water. Fluids increase blood volume and help prevent dehydration, both of which are important in treating hypotension.
Wear compression stockings. The elastic stockings commonly used to relieve the pain and swelling of varicose veins can help reduce the pooling of blood in your legs.
Some people tolerate elastic abdominal binders better than they do compression stockings.
Medications. Several medications can be used to treat low blood pressure that occurs when you stand up (orthostatic hypotension). For example, the drug fludrocortisone, which boosts your blood volume, is often used to treat this form of low blood pressure.
Doctors often use the drug midodrine (Orvaten) to raise standing blood pressure levels in people with chronic orthostatic hypotension. It works by restricting the ability of your blood vessels to expand, which raises blood pressure.
Lifestyle and home remedies
Depending on the reason for your low blood pressure, you might be able to reduce or prevent symptoms.
- Drink more water, less alcohol. Alcohol is dehydrating and can lower blood pressure, even if you drink in moderation. Water, on the other hand, fights dehydration and increases blood volume.
Pay attention to your body positions. Gently move from a prone or squatting to a standing position. Don't sit with your legs crossed.
If you begin to get symptoms while standing, cross your thighs in a scissors fashion and squeeze, or put one foot on a ledge or chair and lean as far forward as possible. These moves encourage blood flow from your legs to your heart.
Eat small, low-carb meals. To help prevent blood pressure from dropping sharply after meals, eat small portions several times a day and limit high-carbohydrate foods such as potatoes, rice, pasta, and bread.
Your doctor also might recommend drinking one or two strong cups of caffeinated coffee or tea with breakfast. Don't drink caffeine throughout the day because you will become less sensitive to caffeine, and caffeine can cause dehydration.
- Exercise regularly. Aim for 30 to 60 minutes a day of exercise that raises your heart rate and resistance exercises two or three days a week. Avoid exercising in hot, humid conditions.
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