Low Blood Pressure: Recognizing Dangers & When to Seek Help

Understanding Low Blood Pressure

Blood pressure is the force exerted by blood against the walls of the arteries as it is pumped through the body by the heart. It is measured in millimeters of mercury (mmHg) and is recorded as two numbers - systolic pressure (when the heart beats and pushes blood into the arteries) and diastolic pressure (when the heart relaxes between beats).

Normal blood pressure levels are less than 120 mmHg systolic and less than 80 mmHg diastolic. However, what is considered normal can vary slightly from person to person. When blood pressure is lower than 90/60 mmHg, it is considered low blood pressure or hypotension.

Causes of Low Blood Pressure

There are many potential causes of low blood pressure, including:

• Pregnancy - Blood pressure often drops during the first 24 weeks of pregnancy.
• Heart conditions - Issues with heart rate, heart valve function, and heart structure can affect blood pressure.
• Endocrine problems - Thyroid disorders, adrenal insufficiency, and low blood sugar can cause hypotension.
• Dehydration - Loss of body fluids through vomiting, diarrhea, or excessive sweating may lead to low blood volume and pressure.
• Nutritional deficiencies - Lack of nutrients like vitamin B12, folate, and iron can affect blood pressure.
• Medications - Certain prescription drugs, such as diuretics, beta-blockers, and antidepressants, may lower blood pressure.
• Anemia - Having a low red blood cell count reduces the ability of blood to carry oxygen and can cause hypotension.
• Sepsis - A severe infection in the body that leads to widespread inflammation can dramatically reduce blood pressure.
• Neurogenic conditions - Parkinson's disease, multiple system atrophy, and certain neurological disorders can interfere with blood pressure regulation.

Underlying Health Conditions Linked to Low Blood Pressure

For some people, persistent low blood pressure may be due to an underlying chronic health condition. Some examples include:

• Diabetes - About 10-20% of people with diabetes experience low blood pressure due to diabetic neuropathy affecting the autonomic nervous system.
• Parkinson's disease - The autonomic dysfunction associated with Parkinson's often leads to orthostatic hypotension.
• Amyloidosis - This condition causes abnormal protein deposits that interfere with regulatory systems like blood pressure.
• Sleep apnea - Interruptions in breathing during sleep can activate nerve responses that lower blood pressure.
• Pheochromocytoma - This adrenal gland tumor can sporadically release adrenaline and lead to plummeting blood pressure.
• Sepsis - Widespread infection and inflammation severely impairs the body's ability to maintain adequate blood pressure.
• Dehydration - Fluid loss from vomiting, diarrhea or sweating reduces blood volume, which directly lowers blood pressure.

Hypotension Symptoms

In many cases, low blood pressure itself does not cause any noticeable symptoms. However, some of the more common symptoms of hypotension can include:

• Dizziness or lightheadedness
• Fainting (syncope)
• Decreased concentration and focus
• Blurred vision
• Nausea
• Fatigue
• Depression
• Thirst and dry mouth

These symptoms are often more apparent when moving from a lying or sitting position to standing. This is known as orthostatic hypotension.

Risks of Low Blood Pressure

While not inherently dangerous in all cases, very low blood pressure can potentially lead to:

• Reduced blood flow to vital organs like the brain, heart and kidneys
• Syncope or fainting
• Injuries from falls caused by dizziness or fainting
• Strokes or heart attacks if blood flow is chronically reduced
• Kidney problems or failure
• Cognitive impairment

The risks associated with hypotension are greater in older adults due to atherosclerosis and other age-related circulatory system changes. Pregnant women with hypotension also face higher risks of poor fetal growth and other complications.

Diagnosing the Cause of Low Blood Pressure

Determining the underlying cause of low blood pressure allows appropriate treatment measures to be taken. Diagnosis typically involves:

• Medical history assessment - Existing conditions, family history, medications taken and symptoms are reviewed.
• Physical exam - Heart rate, heart sounds, and blood pressure response are evaluated.
• Blood tests - Complete blood count, electrolytes, thyroid and kidney function are analyzed.
• Electrocardiogram (EKG) - Checks for heart rhythm and structural issues.
• Tilt table test - Blood pressure and heart rate measured while body position is shifted from lying to standing.
• Echocardiogram - Uses ultrasound to examine the heart's structure and function.
• Valsalva maneuver - Blood pressure response measured during forced exhalation against closed airway.

Based on the exam findings and test results, potential causes can be identified and targeted treatment approaches determined.

Treating and Managing Chronic Low Blood Pressure

If hypotension is due to an underlying medical condition, treating the root cause can help normalize blood pressure. For chronic low blood pressure, general management strategies include:

• Increasing fluid and salt intake - Boosts blood volume to help raise blood pressure.
• Raising head of bed - Allows gravity to help blood flow and maintain pressure while lying down.
• Wearing compression garments - Specially fitted stockings or abdominal bands can help prevent blood from pooling in extremities.
• Changing medications - Adjusting or changing dosage of drugs causing hypotension.
• Taking fludrocortisone - This medication helps the body retain salt and boost fluid volume.
• Taking midodrine - Helps constrict blood vessels and improve standing blood pressure.
• Pacemaker placement - Used to increase heart rate in certain forms of hypotension.

Non-drug approaches like more frequent movement, avoiding sudden postural changes, and drinking 2-3 cups of caffeinated coffee or tea per day can also minimize symptoms.

Emergency Treatment for Severe Hypotension

Rapid drops in blood pressure that lead to transient loss of consciousness, low blood flow to vital organs, or shock require prompt emergency treatment including:

• Leg elevation above heart level
• Rapid IV infusion of normal saline to increase fluid volume
• Medications like dopamine, epinephrine, vasopressin, or norepinephrine to quickly elevate blood pressure
• Oxygen therapy
• Hospital admission for monitored care and additional testing

Identifying and addressing the cause of the hypotensive crisis, like adrenal crisis, sepsis or internal bleeding, is critical.

Preventing Low Blood Pressure

While the cause is not always controllable, some ways to help prevent low blood pressure include:

• Drinking plenty of water and electrolyte-containing fluids
• Consuming enough salt
• Wearing compression stockings
• Not skipping meals
• Getting regular physical activity
• Taking medication as prescribed
• Standing up slowly and steadily
• Raising top half of bed for sleep
• Avoiding excess alcohol intake
• Preventing and promptly treating infections

Preemptively increasing fluid and salt intake before activities that lower blood pressure, like exercising in heat or sitting in a hot tub, can also help stabilize levels.

Living with Chronic Low Blood Pressure

Those diagnosed with hypotension due to persistent underlying causes can still enjoy a high quality of life by following their treatment plan and making sensible lifestyle adjustments like:

• Using compression garments to prevent blood pooling in legs
• Increasing salt and fluid intake
• Planning rest periods during activity to avoid precipitous blood pressure drops
• Rising slowly from seated or lying positions
• Being cautious with hot baths or showers which can dilate blood vessels
• Staying well-hydrated, especially before exertion or heat exposure
• Engaging in leg strengthening exercises to facilitate venous blood return
• Taking hypotension medications at recommended times

While hypotension can cause some activity limitations, taking proactive steps to avoid significant blood pressure drops and manage symptoms can allow those with chronically low pressure to thrive.

When to See a Doctor

Consulting a physician is recommended if you experience:

• Systolic pressure below 90 mmHg
• Symptoms like frequent dizziness, fainting, blurred vision or fatigue
• Confusion, chest pain or shortness of breath
• Injuries from hypotension-related falls
• Blood pressure that drops excessively upon standing
• New onset of hypotension without explanation

Those diagnosed with hypotension should follow up regularly to monitor blood pressure trends and adjust treatment as needed under medical supervision.

Take-Home Message

While not always a cause for concern, abnormally low blood pressure can lead to symptoms affecting quality of life, and may indicate an underlying medical disorder. However, with appropriate diagnosis and treatment guided by a physician, along with sensible lifestyle precautions, the symptoms and risks associated with chronic hypotension can often be well managed.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.