From the Guidelines
Management of hypotension should prioritize identifying and treating the underlying cause while supporting blood pressure, with initial treatment involving intravenous fluid resuscitation with crystalloids like normal saline or lactated Ringer's solution, as recommended by the most recent guidelines 1. The goal of treatment is to minimize postural symptoms rather than to restore normotension, and most patients require both nonpharmacologic measures, such as ensuring adequate salt intake and avoiding medications that aggravate hypotension, and pharmacologic measures 1. Key considerations in managing hypotension include:
- Initial fluid resuscitation with crystalloids, typically starting with a 500-1000 mL bolus and reassessing 1
- Use of vasopressors, such as norepinephrine or phenylephrine, if fluids are insufficient 1
- Addition of vasopressin or inotropes, such as dobutamine, as needed for specific causes of hypotension 1
- Monitoring in an intensive care setting with continuous vital sign monitoring, frequent blood work, and possibly arterial lines for direct pressure measurement 1
- Addressing the underlying cause of hypotension, as vasopressors and fluids are temporary measures that support blood pressure while definitive treatment takes effect 1. It is also recommended to test for orthostatic hypotension before starting or intensifying BP-lowering medication, and to pursue non-pharmacological approaches as the first-line treatment of orthostatic hypotension among persons with supine hypertension 1.
From the Research
Symptoms of Low Blood Pressure
- The symptoms of low blood pressure, also known as hypotension, can include dizziness, lightheadedness, and fainting 2.
- Other symptoms may include fatigue, nausea, and difficulty concentrating.
Management and Treatment Options
- Treatment for hypotension typically involves increasing blood volume and blood pressure, and may include medications such as fludrocortisone, a mineralocorticoid that increases blood volume and blood pressure 2.
- Other treatment options may include midodrine, an α-1 adrenergic agonist that is a direct vasoconstrictor 3, 4.
- Mechanical and positional measures, such as increasing fluid and salt intake and venous compression methods, may also be used to manage hypotension 2.
Comparison of Treatment Options
- A study comparing fludrocortisone and midodrine found that fludrocortisone was associated with a higher risk of all-cause hospitalizations, especially among patients with congestive heart failure 3.
- Another study found that both fludrocortisone and midodrine effectively increased 24-hour systolic blood pressure and reduced systolic blood pressure drops, but fludrocortisone seemed to be more effective than midodrine 4.