From the Guidelines
Diastolic hypotension is primarily caused by decreased peripheral vascular resistance, which can occur due to various factors including medications, dehydration, endocrine disorders, autonomic nervous system dysfunction, and heart conditions. The causes of diastolic hypotension can be multifaceted, involving a range of physiological and pathological processes. According to the 2007 guidelines for the management of arterial hypertension by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) 1, the management of blood pressure, including diastolic blood pressure, is crucial for preventing cardiovascular and renal damage. However, the optimum diastolic blood pressure to be achieved by treatment is not clear, with some studies suggesting that an achieved diastolic pressure of less than 70 mmHg, and especially below 60 mmHg, may identify a high-risk group with a poorer outcome, possibly due to overtreatment 1.
Some key factors that can lead to diastolic hypotension include:
- Medications such as vasodilators, alpha-blockers, and some antidepressants, which can cause excessive dilation of blood vessels
- Dehydration, which reduces blood volume and can lead to decreased peripheral vascular resistance
- Endocrine disorders like adrenal insufficiency and hypothyroidism, which can affect vascular tone regulation
- Autonomic nervous system dysfunction, as seen in diabetic neuropathy or Parkinson's disease, which impairs the body's ability to maintain vascular tone
- Sepsis, which causes widespread vasodilation through inflammatory mediators
- Heart conditions such as severe aortic regurgitation, which can contribute to diastolic hypotension by causing rapid diastolic runoff of blood
- Aging, which naturally reduces arterial elasticity and predisposes older adults to diastolic hypotension
Management of diastolic hypotension typically involves addressing the underlying cause, ensuring adequate hydration, adjusting medications, and in some cases, using medications like fludrocortisone to increase blood volume and midodrine to constrict blood vessels. It is essential to consider the individual patient's characteristics, including other risk factors, target organ damage, and associated cardiovascular or non-cardiovascular clinical conditions, when managing diastolic hypotension 1.
From the Research
Causes of Diastolic Hypotension
The causes of diastolic hypotension are not directly addressed in the provided studies. However, some studies discuss orthostatic hypotension and its relationship to diastolic blood pressure.
- Orthostatic hypotension is a condition characterized by a significant drop in blood pressure when standing up from sitting or lying down, which can lead to dizziness, lightheadedness, and fainting 2.
- Diastolic dysfunction is associated with increased cardiovascular morbidity and mortality, as well as the development of heart failure 3.
- The studies provided focus on the treatment of orthostatic hypotension and diastolic dysfunction, rather than the causes of diastolic hypotension specifically.
Related Conditions
Some conditions that may be related to diastolic hypotension include:
- Orthostatic hypotension, which can cause a drop in diastolic blood pressure when standing up 4, 5, 2, 6
- Diastolic dysfunction, which is associated with increased cardiovascular morbidity and mortality 3
- Autonomic failure, which can cause orthostatic hypotension and may be related to diastolic hypotension 2, 6
Treatment and Management
While the causes of diastolic hypotension are not directly addressed, the studies provide information on the treatment and management of related conditions, such as: