Chronic hypotension

Blood pressure (BP) considered low at 100/60 mm Hg. or lower.

But this level of blood pressure can sometimes be found in healthy people who do not feel discomfort in everyday life. This may be an individual norm, which is found, for example, among athletes or among residents of high mountains.

Hypotension is considered a pathology when it is accompanied by certain symptoms. People prone to hypotension are generally not at risk of cardiovascular complications like hypertensive people. Hypotension receives much less attention, but patients with hypotension suffer from decreased vital activity, so this problem certainly deserves attention.

Risk groups for hypotension

Hypotension is common among people of all ages, with a particularly high incidence in young adults, but in recent decades the emphasis has shifted towards older age groups, in whom low blood pressure can cause ischemic stroke.

Causes of hypotension

The reason for the development of hypotension lies in the disruption of blood pressure regulation. These disorders may have a different nature, but their manifestations have common features. A very painful manifestation of hypotension can be orthostatic hypotension – an additional decrease in blood pressure after moving from a horizontal to a vertical position (usually persists for 1-3 minutes).

These episodes are observed more often and are more severe in older people with low muscle tone, which is associated with a violation of the vasoconstriction mechanism and a decrease in cardiac output. They often occur in the morning and are accompanied by a deterioration in blood supply to the brain – dizziness, darkening of the eyes, tinnitus, sometimes fainting (with the risk of ischemic stroke), falling (with the possibility of injuries and fractures). In some patients, a significant decrease in pulse pressure can be noticed during these minutes. Changes in the ECG are also possible, indicating a violation of the blood supply to the heart. Orthostatic hypotension is caused by prolonged bed rest, severe illness, surgery, and many medications. In some individuals, such episodes of hypotension occur after eating, which is explained by the redistribution of blood flow in favor of the digestive tract.

orthostatic hypotension sometimes observed in individuals who have normal blood pressure readings outside of an attack. They are common in elderly hypertensive patients receiving antihypertensive treatment.

Manifestations of hypotension

General manifestations of hypotension, in addition to low blood pressure and a tendency to orthostatic hypotension, are: weakness, fatigue, fatigue in the morning, low performance, headaches, and a tendency to faint. Pain in the heart area is also possible. Poor tolerance to cold, heat, stuffiness, and chilliness are also characteristic. Patients tolerate physical activity less well, and this can be demonstrated by bicycle ergometry. Exercise is often stopped due to fatigue before the proper heart rate is achieved. Heart rate recovery is slow.

The most common cause of chronic hypotension is neurocirculatory dystonia (NCD), especially in young adults. In this case, additional symptoms may be present in the form of sweating, increased gastric secretion, dyskinesia of the digestive tract, and a tendency to hypoglycemia. There may be a feeling of anxiety, a psychogenic aggravation of hypotension after traumatic situations, which brings it closer to neurotic conditions. It has been noted that the hypotonic form of NCD is more common in tall, thin asthenics.

With drug-induced hypotension, additional symptoms associated with the disease for which the medicine was prescribed are possible. Many drugs may be responsible for lowering blood pressure, including the common ones – antihypertensives, diuretics, antiarrhythmics, nitrates, tranquilizers, phenothiazines, narcotics, levodopa.

Autonomic regulation of blood pressure may be disrupted in the presence of changes in various parts of the nervous system.

The development of persistent hypotension is possible with:

• alcoholic and diabetic polyneuropathy,
• with organic vegetative failure,
• after surgical sympathectomy,
• for any diseases of the spinal cord,
• in poliomyelitis,
• syringomyelia,
• after brain injuries.

These diseases manifest themselves with neurological symptoms and usually do not cause diagnostic difficulties. In addition to it and the symptoms associated with hypotension itself, dysfunction of the bladder and intestines, impotence, and sweating disorders are possible. Such patients are examined and treated together with a neurologist.

The most common somatic diseases as a cause of hypotension are diseases accompanied by reduced cardiac output, excessive expansion of peripheral vessels, and a decrease in circulating blood volume.

• chronic heart failure,
• heart defects,
• some forms of arrhythmias,
• nephrotic syndrome,
• severe anemia,
• severe varicose veins with venous insufficiency,
• starvation,
• hypothyroidism and hyperthyroidism (in case of drug overdose),
• adrenal and pituitary insufficiency,

Peptic ulcer disease and pulmonary tuberculosis can also be accompanied by arterial hypotension, which in these cases is complex. Usually the symptoms of a somatic illness predominate, although in some cases hypotension is an early manifestation of the disease and can help in establishing the correct diagnosis.

Hypotension treatment

Treatment of hypotension associated with NCD, as well as the treatment of NCD in general, is a problem of normalizing lifestyle. General measures – regular physical activity in the air within well-tolerated limits and with a positive emotional connotation, adequate sleep and rest, avoidance of alcohol – can improve autonomic regulation over time. Sometimes spa treatment is useful.

The patient must understand that consolidating a rational lifestyle is the main treatment, but it takes time, improvement will occur slowly.

If possible, it is necessary to eliminate factors that contribute to the maintenance of hypotension. If there is orthostatic hypotension, you need to teach him to get out of bed not immediately, sit for 1-2 minutes before getting up. The reaction is softened if you sleep with the head of the bed raised. Hypotension that develops after eating can be gradually eliminated by eating more often and in small portions. Medicines that contribute to hypotension should be partially or completely discontinued.

Some types of activities – work in transport, at heights, near moving mechanisms, work in conditions of high temperature, stuffiness, in contact with vibration, electromagnetic radiation, mercury – for various reasons are not suitable for people prone to dizziness and fainting.

In cases where, despite the measures taken, clinical symptoms associated with hypotension persist, there is a need to prescribe medications. Tonic herbal preparations (ginseng tincture, Eleutherococcus extract) and drug treatment are used, aimed at increasing vascular tone and improving arterial circulation. As a result, blood pressure increases and the stagnation of blood in the venous circle is prevented, hypotonic complaints are eliminated: morning weakness and fatigue, frequent yawning, dizziness, etc.

Hypotension associated with organic damage to the nervous system or somatic pathology can be reduced or eliminated only with active treatment of the underlying disease. Understanding that a persistent decrease in blood pressure can serve as an early symptom of a serious illness, you should not postpone a visit to a general practitioner and an examination. Before prescribing treatment aimed at normalizing blood pressure, it is necessary to establish the cause of its decrease. In endocrine diseases, blood pressure normalizes relatively quickly with adequate replacement therapy with appropriate hormones. Diseases of the cardiovascular and nervous system may require lengthy and complex treatment.