What is the treatment for hypotension?

From the Guidelines

Symptoms of low blood pressure, also known as hypotension, can include dizziness, lightheadedness, fainting, fatigue, nausea, and vomiting.

Causes and Treatment

The treatment for hypotension focuses on addressing the underlying cause while raising blood pressure to adequate levels.

• For mild cases, increasing fluid intake, consuming more salt (if appropriate), and wearing compression stockings may help.
• In acute situations, intravenous fluids like normal saline are typically administered at 500-1000mL boluses to restore blood volume, as recommended by 1.

Medication Options

Medication options include vasopressors such as norepinephrine (starting at 0.1-0.5 mcg/kg/min), phenylephrine (starting at 100-180 mcg/min), or vasopressin (0.01-0.04 units/min), as well as midodrine (2.5-10mg three times daily) or fludrocortisone (0.1-0.2mg daily) for chronic orthostatic hypotension, as stated in 1 and 1.

Lifestyle Changes

Patients should rise slowly from lying or sitting positions, stay hydrated with 2-3 liters of fluid daily, avoid alcohol, and be cautious with hot environments that can worsen hypotension.

Monitoring

Regular blood pressure monitoring is essential during treatment to ensure the therapy is effective without causing hypertension, as emphasized in 1 and 1. The most recent and highest quality study, 1, prioritizes nonpharmacologic measures, such as ensuring adequate salt intake and avoiding medications that aggravate hypotension, in addition to pharmacologic measures, to minimize postural symptoms and restore normotension.

From the FDA Drug Label

The patient should be cautioned to report symptoms of supine hypertension immediately. Symptoms may include cardiac awareness, pounding in the ears, headache, blurred vision, etc. Patients who experience any signs or symptoms suggesting bradycardia (pulse slowing, increased dizziness, syncope, cardiac awareness) should be advised to discontinue midodrine and should be re-evaluated.

The symptoms of low blood pressure (hypotension) are not directly stated in the provided drug labels. However, symptoms of supine hypertension and bradycardia are mentioned, which can be related to the treatment of hypotension.

• Symptoms of supine hypertension may include:
  • Cardiac awareness
  • Pounding in the ears
  • Headache
  • Blurred vision
• Symptoms of bradycardia may include:
  • Pulse slowing
  • Increased dizziness
  • Syncope
  • Cardiac awareness 2 2

From the Research

Symptoms of Low Blood Pressure

• Dizziness or lightheadedness 3
• Blurred vision 3
• Weakness or fatigue 3, 4
• Nausea 3
• Palpitations 3
• Headache 3
• Syncope (fainting) 3
• Dyspnea (shortness of breath) 3
• Chest pain 3
• Neck and shoulder pain 3

Treatment for Hypotension

• Nonpharmacologic treatment, such as increasing fluid and salt intake and venous compression methods 5, 3
• Fludrocortisone, a mineralocorticoid that increases blood volume and blood pressure 6, 5, 3
• Midodrine, an α-1 adrenergic agonist that is a direct vasoconstrictor 6, 7, 3, 4
• Pyridostigmine, a pharmacologic therapy proven to be beneficial in treating orthostatic hypotension 5, 3

Medication Comparison

• Fludrocortisone and midodrine have been compared in several studies, with midodrine showing similar efficacy to fludrocortisone in some cases 6, 7
• Midodrine has been shown to be more effective than dimetofrine and ephedrine in patients with orthostatic hypotension 7, 4
• Fludrocortisone may have a higher risk of all-cause hospitalizations compared to midodrine 6