From the Guidelines
Hypotension is most commonly caused by vasodilation, hypovolaemia, bradycardia, and low cardiac output, which are all modifiable causes that can be treated with specific interventions. The common etiologies of hypotension can be broken down into several key categories, including:
- Vasodilation, which can be reversed by vasopressors such as phenylephrine or norepinephrine 1
- Hypovolaemia, which can be treated with intravascular fluid administration using crystalloid and colloid solutions or blood 1
- Bradycardia, which is typically pharmacologically managed with anticholinergic agents such as atropine or glycopyrronium, and in some cases, epinephrine or isoprenaline may be necessary 1
- Low cardiac output, which can be treated with positive inotropic agents such as dobutamine or epinephrine 1 It's essential to identify the underlying cause of hypotension to provide effective treatment, as prolonged hypotension can lead to inadequate tissue perfusion, organ dysfunction, and potentially death if left unaddressed. In clinical practice, the treatment of hypotension should be based on the presumed underlying causes, with a focus on fluid resuscitation, vasopressors, and specific interventions for cardiac dysfunction, as recommended by the perioperative quality initiative (poqi) international consensus statement on perioperative arterial pressure management 1.
From the Research
Common Etiology of Hypotension
- Hypotension can be a sign of significant underlying pathology, and if it is not rapidly identified and addressed, it can contribute to organ injury 2
- The common etiology of hypotension is not explicitly stated in the provided studies, but it can be related to various factors such as:
- Underlying medical conditions like sepsis, diabetes, and heart failure
- Medications like antihypertensive drugs, which can sometimes cause hypotension as a side effect
- Dehydration and blood loss
- Orthostatic hypotension (OH) is a type of hypotension that occurs when mechanisms for the regulation of orthostatic blood pressure control fail, and it is common in the elderly 3
- OH can be caused by various factors, including:
- Aging
- Diseases like diabetes and Parkinson's disease
- Baroreflex failure
- Excessive venous pooling
- Sepsis is another condition that can cause hypotension, and the use of certain antihypertensive drugs like ACE inhibitors and ARBs may be associated with improved sepsis outcomes 4