Hypotension – Causes, Symptoms and Treatment

Proven content

Hypotension is a condition in which the patient struggles with low blood pressure. This word also describes muscle hypotension, i.e. significantly reduced muscle tone. Reduced arterial pressure is much less described than hypertension, but the diagnosis and treatment of this condition is equally important. What are the causes of hypotension, how to recognize it and what tests should be performed? Are there any known home remedies to regulate blood pressure?

Pressure – what should you know about it?

The arterial pressure is the pressure that flowing blood exerts against the walls of the arteries. However, it should be remembered that when describing arterial pressure, the pressure in the largest arteries of the human circulatory system is indicated, i.e. in the aorta or an artery on the arm. The pressure exerted by the blood on the walls of the arteries is higher than the pressure in the veins.

Blood pressure it is not a constant value and changes over a long period of time. Pressure changes are influenced by the patient’s age, health, physical activity and lifestyle. Blood pressure also changes in the medium term, which means that the readings of the blood pressure monitor will vary depending on the time of day, the current mental state of the patient, smoked cigarette, drunk coffee or consumed alcohol. Blood pressure is also subject to short-term changes depending on the heart’s cycle.

When the heart contracts, a portion of blood is pushed into the aorta, which causes the pressure in the arteries to rise, which in a healthy person should be between about 90 and 135 mm Hg. On the other hand, at the time of diastolic blood pressure is the lowest, ranging from about 50 to 90 mm Hg. Therefore, a reading of 120/80 mm Hg is considered to be a book blood pressure. However, it should be remembered that slightly higher or lower indications are also within the norm.

Blood pressure measurements are performed using the Korotkov method with the use of a sphygmomanometer and a stethoscope. In home conditions, the pressure can be measured with a pressure gauge. For many years, the blood pressure monitor has been one of the basic home medical devices. You can buy good blood pressure monitors at a pharmacy for as low as PLN 120.

Mean blood pressure in patients in various groups of results, it should oscillate around:

1. Adults:

– 120 mm Hg – systolic pressure;

– 80 mm Hg – diastolic pressure.

1. Newborns (up to 28 days of age)

– 102 mm Hg – press. systolic;

– 55 mm Hg – press. diastolic.

1. Children (1-8 years):

– 110 mm Hg – press. systolic;

– 75 mm Hg – press. diastolic.

If you want to know more about blood pressure, read on: Pressure – norms, arrhythmia, pressure spikes [EXPLAIN]

What is hypotension?

Hypotension is, in short, arterial hypotension. It is a condition in which systolic blood pressure is lower than 90 mmHg, mean arterial pressure is below 60 mmHg, or it is indicated that the blood pressure drops by more than 40 mmHg relative to the patient’s typical values. For people who suffer from chronic hypertension, hypotension can mean a test result greater than 90 mmHg, so it is important to monitor your blood pressure regularly. Chronic hypotension is a condition that affects men more than women. It is a disease that much less often affects young people. It is estimated that over 30% of people over 65 experience hypotension.

If you want to know more about hypertension, read on: Hypertension – Causes, Symptoms and Treatment. How to take a measurement?

Types of hypotension

There are three types of hypotension in the medical literature. Arterial hypotension is divided into primary (essential), secondary and orthostatic. Moreover, the hypotension may be one-off or chronic. Hypotension may occur in a patient once in a lifetime for a short time, e.g. during shock, and on the other hand, may be chronic and occur in patients with significant heart failure. It also happens that hypotension alternates with normal or elevated blood pressure several times a day.

Very often patients are diagnosed constitutional hypotensionwhich is usually asymptomatic and causes weakness, dizziness or low exercise tolerance.

It is worth mentioning that hypotension is the cause of 10% of all consultations conducted in hospital emergency departments. This condition occurs in about half of the patients who receive anesthesia. Hypotension is also diagnosed in patients undergoing dialysis or with insufficiency of the adrenal glands and pituitary gland.

What are the complications and health effects of hypertension? Read: The dangerous effects of hypertension. Four reasons why you should fight high blood pressure

Idiopathic hypotension

Idiopathic hypotension is primary hypotension, also known as constitutional hypotension. Spontaneous hypotension is the most commonly diagnosed form of arterial hypotension. This type of hypotension occurs in approximately 16% of men and 14% of women. This means that in Poland alone, hypotension occurs in over 3 million people. The studies conducted so far have shown that the majority of diagnosed cases were older men, and women with hypotension had slightly lower body weight.

Most patients with spontaneous hypotension do not complain of any symptoms, and if they do, the most common are difficulties with concentration, a feeling of cooling down the limbs, low exercise tolerance or a general reduction in the quality and comfort of life.

Prognosis in idiopathic hypotension they are very good, therefore it is very rare to find extensive descriptions of this type of hypotension. Spontaneous hypotension does not require treatment, unless the patient has symptoms differently. However, patients who complain about ailments that are not characteristic of low blood pressure very often come to the primary care physician. In the treatment of these symptoms, pharmacotherapy is avoided and changes in lifestyle and daily nutrition are recommended.

Is blood pressure measurement important during the coronavirus pandemic? Check: Doctors: In a pandemic, pressure control is more important than ever! Why?

Orthostatic hypotension

Orthostatic hypotension is much more often described in the medical literature. This type of hypotension is diagnosed when the systolic blood pressure drops by at least 20 mm Hg or the diastolic blood pressure by at least 10 mm Hg within 3 minutes after standing. Orthostatic hypotension can also be diagnosed when a patient’s systolic blood pressure drops below 90 mmHg. There are two types of orthostatic hypotension. The first is early orthostatic hypotension, which was described above. Delayed orthostatic hypotension is the second type in which clinical symptoms are observed between the 5th and 40th minutes after upright standing.

Orthostatic hypotension typically occurs in people over the age of 60-65. year of life. According to medical statistics, about 30% of people over 60 years of age develop symptoms of orthostatic arterial hypotension. Moreover, there is a correlation between the patient’s age and the severity of the symptoms of hypotension. The rate of hypotension incidence increases with the age of seniors. For example, in nursing homes, this type of hypotension occurs in almost 60% of patients.

The etiopathogenetic factors that influence the occurrence of orthostatic hypotension are divided into those that lead to primary failure of the neurological system and secondary autonomic failure. In the case of primary failure of the neurological system, patients may develop, for example, Parkinson’s disease, while in the case of secondary failure, adrenal gland disease, diabetes or porphyria occur.

Recent studies have shown that orthostatic hypotension not only causes unpleasant symptoms, but also increases the risk of cardiovascular disease and causes premature death.

How to choose the right blood pressure monitor for you? Read: Shoulder or wrist blood pressure monitor – which will work better?

What are the causes of hypotension

The causes of hypotension vary depending on the type of arterial hypotension with which the diagnosed patient is struggling.

1. Causes of secondary hypotension – secondary hypotension occurs as a symptom of another chronic disease. The most frequently indicated cause of secondary hypotension is cardiovascular failure, cardiac arrhythmias, stenosis of the aortic opening, hormonal disorders, pulmonary hypertension, taking antihypertensive drugs, shock and pericarditis. Secondary hypotension is also associated with Alzheimer’s disease, dementia, depression and Down’s syndrome. In rare cases, it is caused by the body’s production of substances such as medullipin or bradykinin. These compounds are responsible for vasodilation, which lowers blood pressure. There are also cases of postprandial hypotension in which blood pressure drops after a meal by a minimum of 20 mm Hg. Secondary hypotension can also be caused by dialysis in which too much filtration takes place over a short period of time. 
2. The causes of primary hypotension – hypotension is chronic and the causes are usually unclear. Primary hypotension occurs in adolescence, in middle age and much more often in young women with a slim body. Primary hypotension is often genetically determined, and its occurrence is favored by stress and low physical activity.
3. Causes of orthostatic hypotension – in this case, the insufficient regulation of the circulation due to a change in body position is responsible for the low pressure. Blood collects in the lower parts of the body and at the same time it is less drained towards the heart. In this case, there is a sudden drop in blood pressure due to the reduction in stroke volume. Orthostatic hypotension is the result of incorrect adjustment to the sudden upright position of the body. This type of hypotension is most common in the elderly, pregnant women or patients who are immobilized for a long time. Orthostatic hypotension occurs as a result of diseases such as diabetes, porphyria, brain tumor, peripheral neuropathy, electrolyte disturbances, anemia, and atherosclerosis. 

What are spots in front of the eyes and when do they occur most often? Check: Dark spots in front of my eyes. What do they show and how to fight them?

How is hypotension manifested?

The primary symptom of hypotension is the low blood pressure shown during the measurement. Additional symptoms of hypotension reported by patients are:

1. fainting;
2. dizziness and spots in front of the eyes;
3. problems with concentration;
4. weakness;
5. night sweats;
6. pale skin;
7. cold hands and feet;
8. Heart arythmia;
9. fast heart rate;
10. malaise when the weather changes;
11. fast fatigue;
12. increased drowsiness;
13. inner restlessness;
14. tinnitus;
15. pain, palpitations or pressure in the retrosternal area.

However, it is worth remembering that hypotension may be asymptomatic. That is why it is so important to check your blood pressure regularly and see your doctor. In the case of diseases associated with hypotension, there are also symptoms characteristic of these ailments.

Could the pain in the back of the head be related to a blood pressure problem? Read: Pain in the back of the head, or what should be associated with disturbances in the back of the head?

Hypotension – essential diagnostics

Regular measurement of blood pressure may lead the patient to suspect hypotension. If the low blood pressure recurs in subsequent measurements, consult a doctor. Your primary care physician or cardiologist may order additional tests to help make an accurate diagnosis. Among the tests that should be performed when hypotension is suspected, there are urine tests, blood counts, ECG, and sometimes ultrasound of the heart. It is not uncommon to perform an analysis of the concentration of bioelements or assume the so-called pressure recorder that measures pressure around the clock. This test allows the physician to determine whether the patient has primary or orthostatic hypotension.

In the case of orthostatic hypotension, the doctor may perform orthostatic test. During the visit to the office, the doctor asks the patient if he or she has fainted recently, if there are breathing or visual disturbances while standing, or if the patient experiences neck pain, weakness or bending legs when standing. If the patient answers yes to these questions, the diagnosis should be extended towards orthostatic hypotension.

To begin with, the doctor performs an orthostatic test. It consists in measuring the blood pressure of the patient after 5 minutes of lying on the back or in a sitting position. The next measurement is taken one minute and three minutes after standing. If this test shows a decrease in systolic blood pressure of at least 3 mm Hg or in diastolic blood pressure by 20 mm Hg, the doctor may diagnose orthostatic hypotension.

In the diagnosis of people with orthostatic hypotension, an analysis of the medications taken by the patient should also be performed, which may cause or worsen symptoms of arterial hypotension. These drugs include preparations such as levodopa, drugs used in the treatment of depression, anticholinergic drugs or drugs for arterial hypertension.

Are you sure you measure your blood pressure well? Check how to do it correctly: How do I measure my blood pressure? Check that you are not making any mistakes

How is hypotension treated?

The most difficult thing for doctors who care for patients with hypotension is that it is very difficult to raise blood pressure permanently. Obviously, if the hypotension is caused by another disease entity, then treatment is about eliminating the cause and not increasing blood pressure pharmacologically or functionally.

Low blood pressure is an indication for a specific form of treatment. Before the doctor decides to prescribe any pharmacological preparations, at the beginning he will recommend the patient to change his lifestyle, i.e. proper nutrition and hydration of the body.

It is worth mentioning that asymptomatic hypotension is not amenable to treatment. However, if a patient is diagnosed with very low blood pressure, appropriate steps must be taken as this condition affects the overall health of the patient. Too much drop in blood pressure can lead to severe hypoxia in the internal organs. In this case, the hypotension is treated with drugs that are used in the treatment of heart failure. Important information for patients is that the prognosis for this condition is very good and certainly better than in the case of hypertension.

The situation is different in the case of orthostatic hypotension, where the prognosis is much worse.

Treatment of orthostatic hypotension consists in:

1. stopping or reducing doses of the drug that may have triggered low blood pressure;
2. adequate hydration of the body – the patient should drink at least 2,5 liters of fluid a day;
3. consuming the right amount of salt – salt is an ingredient that should usually be eliminated from the diet. However, in orthostatic hypotension, salt is an essential component of the diet because it is rich in sodium, which increases blood pressure;
4. avoiding high body temperature – high temperature affects the relaxation of blood vessels, which in turn causes a drop in blood pressure;
5. avoiding situations that lead to orthostatic syncope.

If the above-mentioned elements of the therapy do not help to raise the excessively low blood pressure, pharmacological treatment should be introduced. Most often, orthostatic hypotension is treated midodrinewhich increases vascular resistance, which automatically increases blood pressure.

Another drug used to treat orthostatic hypotension is droxidopawhich also works by increasing vascular resistance. The use of drugs for hypotension, as in other pharmacotherapy, may cause side effects and complications. For this reason, before starting treatment with pharmacological preparations, it is worth trying to change your lifestyle, eat healthier and properly hydrate. And, importantly, follow your doctor’s instructions.

What medications are helpful in treating high blood pressure? Check: Drugs for hypertension – selection and effectiveness

Hypotonia on diet

The way to regulate your blood pressure is through a proper diet. In the event of hypotension, proper nutrition is of utmost importance, even because asymptomatic hypotension is not amenable to treatment.

When planning a diet for a person struggling with hypotension, there are several important aspects to keep in mind:

1. ensuring the right amount of fluids – from 2 to 3 liters per day. Patients can drink coffee that contains caffeine. Drinking the right amount of coffee can positively affect blood pressure;
2. increasing the amount of sodium in meals, e.g. by appropriate adding salt to them;
3. eating smaller meals more often. Too large meals can cause postprandial hypotension;
4. avoiding prolonged starvation as it increases the feeling of weakness associated with low blood glucose levels;
5. the inclusion of marine fish in the diet, which are a rich source of omega-3 fatty acids that have a beneficial effect on the functioning of the cardiovascular system;
6. the right amount of fruit and vegetables in your daily meals. Some plant preparations that contain ginseng or licorice root turn out to be helpful;
7. avoiding alcohol as it impairs the sensitivity of the baroreceptor reflex and the cardipulmoreceptor reflex. These are the receptors that respond to changes in blood pressure and transmit information about the pressure to the vasomotor center;
8. paying attention to drug interactions with food. For example, fat-rich foods increase the absorption of drugs such as theophylline or antidepressants.

What is a healthy diet and conscious eating? Check: Conscious eating, or what you don’t know about your diet

Hypotension in infants

As mentioned in the introduction, hypotension does not always mean problems with blood pressure. In infants, hypotension refers to decreased muscle tone.

A child diagnosed with muscle hypotension is characterized by very low physical activity. Usually, the baby sleeps a lot. When he is awake, the child’s motor skills are very poor and the child practically does not move.

Assessment of muscle tone is one of the elements of the first child examination, the results of which are presented on the Apgar scale. Every newborn baby undergoes such an examination right after birth. If the neonatologist notices any abnormalities during the examination, he immediately sends the toddler for a neurological consultation. Usually, the hypotensive child is referred to appropriate physical therapy.

Reduced muscle tone in a child may also be caused by a disease. Muscular hypotonia is very easy to recognize, because affected babies have trouble lifting their heads, grasping toys, and sometimes they don’t cry at all. They also have difficulty sucking on the breasts and are unable to focus their eyesight. If left untreated, the muscle tone may delay the child’s physical development.

If you want to know more about muscle hypotension in babies, read on: Problems with infant muscle tone

The content of the medTvoiLokony website is intended to improve, not replace, the contact between the Website User and their doctor. The website is intended for informational and educational purposes only. Before following the specialist knowledge, in particular medical advice, contained on our Website, you must consult a doctor. The Administrator does not bear any consequences resulting from the use of information contained on the Website. Do you need a medical consultation or an e-prescription? Go to halodoctor.pl, where you will get online help – quickly, safely and without leaving your home.Now you can use e-consultation also free of charge under the National Health Fund.