Understanding the Risks and Impact of Hypotension

Understanding Low Blood Pressure

Blood pressure is an important health metric that can provide insight into the status of your overall health. It measures the force exerted by blood on the walls of the arteries as it circulates through the body. Blood pressure that is too high (known as hypertension) is a major risk factor for several dangerous health conditions like heart disease, stroke, and kidney failure.

However, the risks of blood pressure that is too low, or hypotension, often do not receive as much attention. While not always problematic, continually low blood pressure or a sudden drop in blood pressure can lead to worrisome symptoms and even serious health problems.

What Is Considered Low Blood Pressure?

Blood pressure is measured in two numbers, with the top number representing systolic pressure (when the heart contracts) and the bottom number representing diastolic pressure (when the heart relaxes between beats). Normal blood pressure levels are less than 120 mm Hg systolic and less than 80 mm Hg diastolic.

Low blood pressure, or hypotension, is generally defined as:

• Systolic pressure of 90 mm Hg or lower
• Diastolic pressure of 60 mm Hg or lower

Some variation in blood pressure based on factors like age, medications, and underlying health conditions is normal. But consistently low blood pressure may require further evaluation, especially if it is causing symptoms.

Causes of Low Blood Pressure

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

• Dehydration - Losing fluids through vomiting, diarrhea, sweating, or not drinking enough water can lower blood volume and pressure.
• Pregnancy - Hormonal changes during pregnancy often cause blood pressure drops.
• Nutrient deficiencies - Being deficient in nutrients like vitamin B-12, folate or iron impacts red blood cell levels and oxygen circulation.
• Heart conditions - Issues with heart rate, heart valves, or damage from heart attacks/disease can depress blood pressure.
• Medications - Certain prescription medications like diuretics, beta-blockers, ACE inhibitors and antidepressants list low blood pressure as a side effect.
• Neurologic disorders - Parkinson's disease, dementia, and diabetic neuropathy are examples of conditions affecting blood pressure regulation by the nervous system.
• Severe infections - Blood poisoning, sepsis and life-threatening infections can result in severely low blood pressure.
• Anaphylaxis - A severe allergic reaction can trigger a sudden drop in blood pressure.

Risk Factors

While anyone can experience low blood pressure, certain factors that may increase your risk include:

• Being over the age of 65
• Having an endocrine disorder like diabetes or thyroid dysfunction
• Taking certain prescription medications
• Having a vitamin/mineral deficiency
• Being pregnant
• Having an eating disorder or being underweight
• Having a neurologic condition like Parkinson's disease

Symptoms of Low Blood Pressure

Some people with mild hypotension may have no symptoms at all and the low readings may be discovered incidentally during a routine well visit. However, low blood pressure becomes concerning when it begins causing the following troubling symptoms:

• Dizziness/lightheadedness - This sensation of feeling faint is one of the hallmarks of low blood pressure.
• Fainting (syncope) - Significantly low pressure deprives the brain of enough oxygenated blood to stay conscious.
• Blurred vision - Eyes depend on healthy blood flow to function properly.
• Nausea - The autonomic nervous system, which regulates digestion and blood pressure, is disrupted.
• Pale, clammy skin - Constricted blood vessels cause paleness; perspiration is the body's attempt to stabilize falling blood pressure.
• Rapid, shallow breathing - The respiratory system responds to low oxygen circulation with this pattern.
• Tiredness/weakness - Insufficient blood circulation deprives muscles of oxygen needed for normal activity.
• Confusion - The brain struggles without its normal blood supply.

Low Blood Pressure Emergencies

While symptoms like dizziness and nausea can be scary, the most serious manifestation of significantly low blood pressure is shock. Two examples include:

• Septic shock - Life-threatening low blood pressure secondary to a massive systemic infection that releases chemicals further widening blood vessels.
• Anaphylactic shock - Extreme drop in pressure caused by a severe allergic reaction constricting respiratory airways and blood vessels.

Without swift emergency medical treatment, both kinds of shock can lead to organ damage/failure, seizures, loss of consciousness and death. Seek immediate help if experiencing any signs of allergic reaction or possible infection combined with sudden hypotension symptoms like fainting or extreme paleness/weakness.

Risks and Complications

While not an outright health condition itself, low blood pressure serves as warning sign that something else may be medically wrong. Potential risks and complications associated with significant, lasting hypotension include:

Falls/Accidents

Lightheadedness, blurry vision, weakness and confusion from low blood pressure make falls and accidents more likely. Head trauma, fractures and serious injuries can result.

Stroke

Prolonged low blood flow may allow blood clots to form, later breaking loose and causing strokes. Some hypotension medications also increase stroke risk.

Heart Disease

Over time, continually low pressure taxes the heart, forcing it to work harder to pump enough oxygenated blood through the body.

Kidney Failure

The kidneys rely on healthy blood flow and pressure to filter waste. Prolonged hypotension denies them adequate circulation to function properly.

Cognitive Impairment

Research shows associations between chronic low blood pressure and problems with memory, focus and dementia, especially in already at-risk populations like the elderly.

Diagnosing Low Blood Pressure

Doctors use several methods to definitively diagnose hypotension, including:

Blood Pressure Readings

Repeated blood pressure checks in the medical office or through at-home monitoring that find numbers consistently under healthy limits indicate hypotension.

Medical History & Physical Exam

Looking for risk factors in the patient's medical history and checking for symptoms like pale skin and rapid heart rate help confirm low blood pressure.

Blood Tests

Testing blood counts and levels of oxygen/carbon dioxide determine if an underlying condition like severe anemia, malnutrition or respiratory disease is causing low pressure.

Tilt Table Test

This assessment looks for dramatic drops in blood pressure/oxygen saturation when the patient moves from lying down to standing up. Orthostatic hypotension indicates dysfunctional autonomic nerves.

Cardiac Stress Test

Electrodes and blood pressure cuffs check pressure/heart tracings during different intensities of exercise. Heart or lung abnormalities may show.

Treating Low Blood Pressure

Doctors determine necessary hypotension treatments based on the suspected underlying cause:

Medication Changes

If prescribed medicines like diuretics or antidepressants are suspected, dosages may be adjusted or alternatives tried.

Dietary Changes

Increasing fluid/sodium intake helps increase blood volume. Smaller, more frequent meals avoid blood sugar crashes.

Compression Garments

Stockings or abdominal binders provide gentle pressure to keep blood circulating and prevent pooling in extremities.

Medications

In severe cases, drugs like vasopressors and corticosteroids narrow blood vessels/raise pressure. Drops during standing can be treated with midodrine.

Surgery

Procedures like pacemaker implantation help strengthen the heart muscle in associated conduction disorders. Angioplasty opens blockages restricting blood flow.

In many non-emergency cases, simply avoiding triggers like hot places, sudden position changes, excess alcohol intake, and checking for drug interactions improves hypotension. However, consistently low pressure warrants thorough medical investigation for any underlying illness.

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.