From the Guidelines
Hypotension with a blood pressure of 80/50 mmHg is a medical emergency that requires immediate attention to prevent organ damage and improve outcomes in terms of morbidity, mortality, and quality of life. The symptoms to look out for in a patient with this condition include dizziness, lightheadedness, fainting, blurred vision, fatigue, nausea, confusion, and cold, clammy skin 1.
Treatment Approach
Treatment depends on the underlying cause but generally involves:
- Lying down and elevating the legs to improve blood flow to the brain
- Oral rehydration with water or electrolyte solutions if dehydration is suspected
- Intravenous fluids like normal saline in medical settings
- Medications such as vasopressors (e.g., norepinephrine, phenylephrine) in severe cases to constrict blood vessels and raise blood pressure
- For chronic hypotension, medications like fludrocortisone or midodrine may be prescribed It's crucial to address the underlying cause, whether it's adjusting current medications, treating infections, or managing heart conditions 1.
Key Considerations
Patients should avoid sudden position changes and stay hydrated. Adding salt to the diet may be considered for those with chronic hypotension, provided there are no contraindications like heart failure or kidney disease. Given the potential for reduced perfusion to vital organs and the risk of organ damage if hypotension is prolonged, prompt treatment is essential to mitigate these risks and improve patient outcomes in terms of morbidity, mortality, and quality of life 1.
From the FDA Drug Label
Restoration of Blood Pressure in Acute Hypotensive States Blood volume depletion should always be corrected as fully as possible before any vasopressor is administered. When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, LEVOPHED can be administered before and concurrently with blood volume replacement After observing the response to an initial dose of 2 mL to 3 mL (from 8 mcg to 12 mcg of base) per minute, adjust the rate of flow to establish and maintain a low normal blood pressure (usually 80 mm Hg to 100 mm Hg systolic) sufficient to maintain the circulation to vital organs
The symptoms to look for with a blood pressure of 80/50 mmHg are not directly stated in the label, but it can be inferred that hypotension may lead to inadequate circulation to vital organs, potentially causing:
- Cerebral ischemia
- Coronary artery ischemia Treatment involves blood volume replacement and administration of a vasopressor like norepinephrine (IV) 2. The goal is to maintain a low normal blood pressure, usually between 80 mm Hg to 100 mm Hg systolic 2.
From the Research
Symptoms of Hypotension
- Dizziness or lightheadedness
- Fainting or syncope
- Fatigue or weakness
- Nausea or vomiting
- Cold, clammy, or pale skin
- Rapid or shallow breathing
- Decreased urine output
Treatment for Hypotension with BP 80/50 mmHg
- Fluid resuscitation to increase blood volume and blood pressure
- Vasopressor therapy, such as norepinephrine, to constrict blood vessels and increase blood pressure 3, 4, 5
- Inotrope therapy, such as dobutamine, to increase cardiac contractility and improve blood flow 3
- Treatment of underlying causes of hypotension, such as sepsis or bleeding
Vasopressor Therapy
- Norepinephrine is considered the first-line vasopressor for patients with sepsis-associated hypotension 3, 6, 4, 5
- Dopamine may be considered as an alternative vasopressor, but it has been shown to have a higher risk of adverse events and mortality compared to norepinephrine 6, 5
- Vasopressin and its analogues may be considered as second-line vasopressors, but their use is not recommended as first-line therapy 4, 5
Important Considerations
- The treatment of hypotension should be individualized based on the patient's underlying condition and response to therapy
- The goal of treatment is to improve blood pressure and perfusion of vital organs, rather than to achieve a specific blood pressure target
- Close monitoring of the patient's hemodynamic status and response to therapy is essential to ensure effective treatment and minimize adverse events 3, 4