From the Guidelines
Hypotension is most commonly caused by vasodilation, hypovolaemia, bradycardia, and low cardiac output, which are all modifiable causes that can be treated with targeted interventions. These causes can be addressed through various treatments, including:
- Vasodilation, which can be reversed by vasopressors such as phenylephrine or norepinephrine 1
- Hypovolaemia, which can be treated with intravascular fluid administration using crystalloid and colloid solutions or blood 1
- Bradycardia, which is typically pharmacologically managed with anticholinergic agents such as atropine or glycopyrronium, and in some cases, epinephrine or isoprenaline may be necessary 1
- Low cardiac output due to acute or chronic myocardial dysfunction, which can be treated with positive inotropic agents such as dobutamine or epinephrine 1 It is essential to identify and address the underlying cause of hypotension to provide effective treatment and improve patient outcomes. Key considerations in managing hypotension include:
- Identifying the underlying cause of hypotension
- Selecting the most appropriate treatment based on the cause
- Monitoring patient response to treatment and adjusting as needed
- Preventing complications and improving quality of life by promptly addressing hypotension.
From the FDA Drug Label
- CLINICAL STUDIES 14.1 Hypotension associated with Septic Shock Fourteen clinical studies from the literature documented that epinephrine increases the mean arterial pressure (MAP) in patients with hypotension associated with septic shock.
The most common cause of hypotension mentioned is septic shock.
- Septic shock is directly associated with hypotension. The FDA drug label does not provide a comprehensive list of the most common causes of hypotension, only mentioning it in the context of septic shock 2.
From the Research
Causes of Hypotension
The most common causes of hypotension, or low blood pressure, can be categorized into several types of shock, including:
- Hypovolemic shock: caused by a low intravascular volume, often due to blood loss or dehydration 3
- Cardiogenic shock: caused by a reduction in myocardial contractility, often due to acute myocardial infarction or advanced heart failure 4, 5, 3
- Distributive shock: caused by an abnormal distribution of cardiac output, often due to sepsis or other conditions 6, 7
- Obstructive shock: caused by an obstruction in the circulatory system, often due to pulmonary embolism or cardiac tamponade 6
Key Characteristics of Shock
Shock states are characterized by:
- Hypotension, defined as a systolic blood pressure less than 90 mmHg or a mean arterial pressure less than 60 mmHg 3
- Poor peripheral perfusion, often manifested as cool and clammy skin 3
- Oliguria, or low urine output 3
- Hyperlactatemia, or elevated lactate levels 7
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of shock are critical to improving patient outcomes and reducing morbidity and mortality 4, 5, 6, 3, 7 Prompt recognition of the underlying cause of shock and initiation of appropriate therapy can help to restore blood pressure and improve clinical perfusion markers 7