Is a blood pressure of 113/41 millimeters of mercury (mmHg) considered hypertensive (high blood pressure) or indicative of hypotension (low blood pressure)?

From the Guidelines

A blood pressure reading of 113/41 mmHg is considered indicative of hypotension, specifically isolated diastolic hypotension, due to the dangerously low diastolic pressure, and requires immediate medical attention. While the systolic pressure of 113 is within a normal range, a diastolic pressure of 41 mmHg is significantly lower than the optimal diastolic blood pressure of less than 80 mmHg, as outlined in the 2007 guidelines for the management of arterial hypertension 1. According to these guidelines, a diastolic blood pressure of less than 70 mmHg should be regarded as an additional risk, and a value of 41 mmHg is substantially lower than this threshold.

Key Considerations

• The diastolic pressure represents the pressure in the arteries when the heart rests between beats, and when it drops too low, it can compromise circulation to vital organs such as the brain, heart, and kidneys.
• Isolated diastolic hypotension can reduce blood flow to these organs and may indicate serious underlying health issues, including severe dehydration, blood loss, severe infection, heart problems, or medication side effects.
• The 2024 ESC guidelines for the management of elevated blood pressure and hypertension do not specifically address hypotension, but they do emphasize the importance of prompt intervention in cases of hypertensive emergencies, which suggests that similarly urgent attention may be warranted for severe hypotension 1.

Recommendations

• If you experience a blood pressure reading of 113/41 mmHg, especially with symptoms like dizziness, lightheadedness, fainting, confusion, blurry vision, or weakness, you should seek emergency medical care immediately.
• Do not attempt to treat this condition at home, as it may require prompt medical intervention, such as IV fluids, medication adjustments, or other interventions, depending on the underlying cause.
• It is essential to consult with a healthcare professional to determine the cause of the low diastolic blood pressure and to develop an appropriate treatment plan to prevent potential complications and improve quality of life.

From the Research

Blood Pressure Classification

• A blood pressure of 113/41 mmHg is not considered hypertensive, as the systolic value is below the threshold for hypertension, which is typically defined as a systolic blood pressure of 180 mmHg or higher, or a diastolic blood pressure of 120 mmHg or higher 2, 3, 4.
• The diastolic value of 41 mmHg is lower than the normal range, suggesting that this blood pressure reading may be indicative of hypotension, particularly orthostatic hypotension, which is characterized by a drop in blood pressure upon standing 5.

Hypotension Diagnosis

• Orthostatic hypotension is defined as a drop in blood pressure of at least 20mmHg for systolic blood pressure and at least 10mmHg for diastolic blood pressure within 3 minutes of standing up 5.
• A blood pressure of 113/41 mmHg may be considered low, especially if the individual is experiencing symptoms such as dizziness or lightheadedness upon standing.

Comparison to Hypertensive Crisis

• A hypertensive crisis is defined as a systolic blood pressure >180 mm Hg or a diastolic blood pressure >120 mm Hg, which is significantly higher than the given blood pressure reading 2, 3, 4.
• The given blood pressure reading does not meet the criteria for a hypertensive crisis, and instead may be indicative of hypotension.