HYPOTENSION - Low Blood Pressure

The heart is a muscle that pumps blood around the body continuously through the blood vessels. Blood pressure is the amount of force exerted on the artery walls by the pumping blood. It varies according to environmental demands. For example, it rises during physical exertion and drops in extreme heat.
Measures of blood pressure include two different types of pressure:
·        Systolic pressure is the pressure when the heart contracts. It is measured at the moment of maximum force of the contraction, when the left ventricle of the heart contracts.
·        Diastolic pressure is the pressure measured between heartbeats, when the heart is resting and opening up, or dilating.
A blood pressure reading measures both the systolic and diastolic pressures. The figures usually appear with a larger number first, which is the systolic pressure, and then a smaller number, the diastolic pressure.
If a person's BP is 120 over 80, or 120/80 mmHg, the systolic pressure is 120mmHg, and the diastolic pressure is 80mmHg. The abbreviation mmHg means millimeters of mercury. Levels of BP can fluctuate by up to 30 or 40 mmHg during the day. BP is lowest while sleeping or resting. Physical activity, high levels of stress and anxiety causes blood pressure to rise. BP must be taken under similar circumstances each time, so that when the readings are compared, they refer to the same state of physical activity.

What is HYPOTENSION?

Hypotension, or low blood pressure, means that the pressure of blood circulating around the body is lower than normal, or lower than expected given the environmental conditions. However, ‘hypotension’ is a relative term – one person may have low blood pressure compared to others of similar physical characteristics, but may be perfectly healthy. An adult with a reading of 90/60 mmHg or lower can be regarded as having hypotension, or low blood pressure.
Having a lower blood pressure is good in most cases (less than 120/80). But low blood pressure can sometimes make you feel tired or dizzy. In those cases, hypotension can be a sign of an underlying condition that should be treated. For some people who exercise and are in top physical condition, low blood pressure is a sign of good health and fitness. A single session of exercise can induce hypotension and water-based exercise can induce important hypotension response.

Low Blood Pressure (Hypotension) FACTS

·        Low blood pressure, also called hypotension, is blood pressure low enough that the flow of blood to the organs of the body is inadequate and symptoms and/or signs of low blood flow develop.
·        Low pressure alone, without symptoms or signs, usually is not unhealthy.
·        The symptoms of low blood pressure include lightheadedness, dizziness, and fainting. These symptoms are most prominent when individuals go from the lying or sitting position to the standing position (orthostatic hypotension).
·        Low blood pressure that causes an inadequate flow of blood to the body's organs can cause strokes, heart attacks, and kidney failure. The most severe form is shock.
·        Common causes of low blood pressure include a reduced volume of blood, heart disease, and medications.
·        The cause of low blood pressure can be determined with blood tests, radiologic studies, and cardiac testing to look for heart failure and arrhythmias.
·        Treatment of low blood pressure is determined by the cause of the low pressure.

SIGNS & SYMPTOMS of Hypotension

When blood pressure is not sufficient to deliver enough blood to the organs of the body, the organs do not work properly and can be temporarily or permanently damaged. Symptoms of low blood pressure caused by conditions or diseases depend upon the specific cause of the low blood pressure. For example, if insufficient blood flows to the brain, brain cells do not receive enough oxygen and nutrients, and a person can feel lightheaded, dizzy, or even faint.
Low blood pressure is sometimes associated with certain symptoms, many of which are related to causes rather than effects of hypotension:
·        chest pain ; shortness of breath
·        irregular heartbeat ; fever higher than 38.3 °C (101 °F)
·        headache ; stiff neck
·        severe upper back pain ; cough with sputum
·        prolonged diarrhea or vomiting ; dyspepsia (indigestion)
·        dysuria (painful urination) ; acute, life-threatening allergic reaction
·        seizures ; loss of consciousness
·        profound fatigue ; temporary blurring or loss of vision
·        black tarry stools ; light-headedness (when standing from a sitting or lying position)
·        unsteadiness ; dizziness
·        fainting ; cold, clammy, pale skin
·        depression ; palpitations
·        rapid, shallow breathing ; thirst
·        nausea ; feeling sick
·        confusion

CAUSES of Hypotension

Everyone’s blood pressure drops at one time or another. And, it often doesn’t cause any noticeable symptoms. Certain conditions can cause prolonged periods of hypotension that can become dangerous if left untreated. Low blood pressure can be caused by low blood volume, hormonal changes, widening of blood vessels, medicine side effects, anemia, heart problems or endocrine problems.
Low blood pressure has many different causes including:
·        Emotional stress, fear, insecurity or pain (the most common causes of fainting)
·        Dehydration, which reduces blood volume
·        The body’s reaction to heat, which is to shunt blood into the vessels of the skin, leading to dehydration
·        Blood donation
·        Internal bleeding, such as a perforated stomach ulcer
·        Blood loss from trauma, such as a road accident or deep cut
·        Diuretics, which produce fluid loss
·        Medications for depression
·        Medications for certain heart conditions
·        Allergic reaction to certain drugs or chemicals
·        Some forms of infection, such as toxic shock syndrome
·        Heart disease, which can hamper the pumping action of the heart muscle
·        Some nervous system disorders, such as Parkinson’s disease
·        Addison’s disease (where the adrenal glands fail to produce sufficient blood-pressure-maintaining hormones).
·        Pregnancy, due to an increase in demand for blood from both mother and the growing fetus
·        Impaired circulation caused by heart attacks or faulty heart valves
·        Weakness and a state of shock that sometimes accompanies dehydration
·        Anaphylactic shock, a severe form of allergic reaction
·        Infections of the bloodstream
·        Endocrine disorders such as diabetes, adrenal insufficiency, and thyroid disease
·        Some over-the-counter medications
·        Heart arrhythmias (abnormal heart rhythms)
·        Widening, or dilation, of the blood vessels
·        Heat exhaustion or heat stroke
·        Liver disease

TREATMENT for Hypotension

The treatment for hypotension depends on its cause. Chronic hypotension rarely exists as more than a symptom. Asymptomatic hypotension in healthy people usually does not require treatment. Adding electrolytes to a diet can relieve symptoms of mild hypotension. A morning dose of caffeine can also be effective. In mild cases, where the patient is still responsive, laying the person in dorsal decubitus (lying on the back) position and lifting the legs increases venous return, thus making more blood available to critical organs in the chest and head. The Trendelenburg position, though used historically, is no longer recommended.
·        Drink plenty of water to avoid hypotension due to dehydration, especially if we are vomiting or have diarrhea. Staying hydrated can also help treat and prevent the symptoms of neurally mediated hypotension.
·        If we experience low blood pressure when standing for long periods, be sure to take a break to sit down. And try to reduce the stress levels to avoid emotional trauma.
·        Treat orthostatic hypotension with slow, gradual movements. Instead of standing up quickly, work our way into a sitting or standing position using small movements. We can also avoid orthostatic hypotension by not crossing our legs when we sit.
·        Shock-induced hypotension is the most serious form of the condition. Severe hypotension must be treated immediately. Emergency personnel will give us fluids and possibly blood products to increase our blood pressure and stabilize our vital signs.
·        Changing medicines or altering our dose, if this is the cause.
·        Wearing support stockings can improve circulation and increase blood pressure.
·        Blood loss can be treated by treating the cause of the bleeding, and with intravenous fluids and blood transfusions. Continuous and severe bleeding needs to be treated immediately.
·        Septic shock is a medical emergency and is treated with intravenous fluids and antibiotics.
·        Blood pressure medications or diuretics are adjusted, changed, or stopped by the doctor if they are causing low blood pressure symptoms.
·        Bradycardia may be due to a medication. The doctor may reduce, change, or stop the medication. Bradycardia due to sick sinus syndrome or heart block is treated with an implantable pacemaker.
·        Pulmonary embolism and deep vein thrombosis is treated with blood thinners, initially with types of heparin. Later, oral warfarin (Coumadin) or other oral medications are substituted for heparin.
·        Postural hypotension can be treated with changes in diet such as increasing water and salt intake, increasing intake of caffeinated beverages (because caffeine constricts blood vessels), using compression stockings to compress the leg veins and reduce the pooling of blood in the leg veins, and in some patients, the use of a medication called midodrine (ProAmatine).
·        Postprandial hypotension refers to low blood pressure occurring after meals. Ibuprofen (Motrin) or indomethacin (Indocin) may be beneficial.
·        Raising the head of the bed by 6 inches.
·        Increasing salt and fluid intake may improve the symptoms of hypotension. Salt levels can be boosted by taking salt tablets or adding more salt to food. Fluids increase blood volume and prevent dehydration, and this can impact blood pressure levels.