From the Guidelines
Arterial hypotension is a medical condition characterized by abnormally low blood pressure in the arteries, typically defined as a systolic blood pressure below 90 mmHg or a diastolic pressure below 60 mmHg, and its management should prioritize maintaining a mean arterial pressure of at least 65 mmHg, especially in patients with sepsis or at risk of organ injury 1.
Definition and Causes
Arterial hypotension can occur acutely or chronically and may be symptomatic or asymptomatic depending on its severity and the individual's ability to compensate. Common symptoms include dizziness, lightheadedness, fatigue, blurred vision, confusion, and in severe cases, fainting or shock. It occurs when there is inadequate vascular resistance, decreased cardiac output, or reduced blood volume, disrupting the body's ability to maintain adequate perfusion to vital organs.
Diagnosis and Treatment
Treatment depends on the underlying cause and may include:
- Intravenous fluids for dehydration-related hypotension
- Medications such as vasopressors (norepinephrine, phenylephrine, or vasopressin) for shock
- Midodrine (starting at 2.5-5 mg three times daily) for chronic orthostatic hypotension Lifestyle modifications are also important, including:
- Adequate hydration
- Gradual position changes
- Increased salt intake (unless contraindicated)
- Compression stockings
- Avoiding triggers like alcohol or hot environments
Management Goals
The goal of management is to restore adequate perfusion to vital organs, and maintaining a mean arterial pressure of at least 65 mmHg is a good initial goal, especially in patients with sepsis or at risk of organ injury 1. Continuous intraoperative arterial pressure monitoring can help reduce the severity and duration of hypotension compared to intermittent arterial pressure monitoring 1.
Key Considerations
- Postoperative hypotension is often unrecognized and may be more important than intraoperative hypotension because it is often prolonged 1.
- The optimal strategy to achieve blood pressure targets is yet to be definitively shown to improve outcomes, but prompt recognition and treatment are essential to prevent complications, especially in acute, symptomatic cases 1.
From the FDA Drug Label
Arterial hypotension is not explicitly defined in the provided drug label.
The FDA drug label does not answer the question.
From the Research
Definition of Arterial Hypotension
Arterial hypotension, also known as orthostatic hypotension, is a condition characterized by an excessive fall in blood pressure while standing, resulting from a decrease in cardiac output or defective or inadequate vasoconstrictor mechanisms 2.
Causes and Symptoms
The condition can be caused by various factors, including chronic peripheral neuropathy, central autonomic neuropathy, or autonomic failure from other causes 2. Symptoms of orthostatic hypotension include weakness, syncope, blurred vision, and fatigue 3.
Treatment Options
Treatment options for orthostatic hypotension include non-pharmacological strategies, such as discontinuing offending medications, switching medication administration to bedtime, avoiding large carbohydrate-rich meals, limiting alcohol, maintaining adequate hydration, and adding salt to the diet 4. Pharmacological therapies, such as fludrocortisone and midodrine, can also be used to increase blood pressure and alleviate symptoms 4, 5, 6, 3, 2.
Key Points
- Orthostatic hypotension is a condition characterized by an excessive fall in blood pressure while standing 2.
- The condition can be caused by various factors, including chronic peripheral neuropathy, central autonomic neuropathy, or autonomic failure from other causes 2.
- Treatment options include non-pharmacological strategies and pharmacological therapies, such as fludrocortisone and midodrine 4, 5, 6, 3, 2.
- Fludrocortisone and midodrine have been shown to be effective in increasing blood pressure and alleviating symptoms, but the evidence is very uncertain about their long-term effects and potential adverse events 5, 6, 2.
Comparison of Treatment Options
- Fludrocortisone and midodrine have been compared in several studies, with fludrocortisone seeming to be more effective than midodrine in increasing 24-h SBP and reducing SBP drops 6.
- However, midodrine has been shown to have a lower risk of all-cause hospitalizations compared to fludrocortisone 5.
- The choice of treatment should be guided by patient-specific factors, such as tolerability, adverse effects, and drug-drug and drug-disease interactions 4.