What are the first aid measures for a patient experiencing extreme hypertension or hypotension at home?

First Aid for Extreme Hypertension and Hypotension at Home

Extreme Hypertension (Hypertensive Crisis) at Home

If someone experiences blood pressure ≥180/120 mmHg at home, immediately assess for symptoms of organ damage—if present (chest pain, severe headache, vision changes, difficulty breathing, confusion), call emergency services immediately; if absent, contact their physician urgently within hours rather than attempting home management. 1, 2

Recognizing Hypertensive Emergency vs. Urgency

Hypertensive Emergency (Call 911 immediately):

• Blood pressure ≥180/120 mmHg PLUS any of these symptoms: 2, 3, 4
  • Severe chest pain or pressure (possible heart attack or aortic dissection) 5, 3
  • Severe headache with confusion, vision changes, or altered consciousness (possible stroke or brain bleeding) 5, 4
  • Severe shortness of breath or inability to breathe lying flat (pulmonary edema) 5, 3
  • Seizures 4
  • Severe back pain radiating between shoulder blades (possible aortic dissection) 5
  • Sudden vision loss 5

Hypertensive Urgency (Contact physician within hours):

• Blood pressure ≥180/120 mmHg with only mild symptoms: 5, 6
  • Mild headache 5, 4
  • Dizziness 4
  • Palpitations 5
  • General malaise 5

Immediate Home Actions for Hypertensive Urgency

Do NOT attempt rapid blood pressure reduction at home—this can cause stroke or organ damage. 5

1. Have the person sit or lie down calmly in a quiet room 1

2. Recheck blood pressure after 3-5 minutes of rest using proper technique: 1

   • Use a validated automated upper-arm cuff 1
   • Empty bladder first 1
   • No talking during measurement 1
   • Feet flat on floor, back supported, arm at heart level 1
   • Take 2-3 readings 1 minute apart and average them 1

3. Check medication adherence—most hypertensive crises occur because patients stopped or reduced their medications 5, 3

4. Contact their physician immediately for guidance on restarting or adjusting medications 2, 5

5. Avoid these common mistakes: 3

   • Do NOT give sublingual nifedipine (immediate-release)—it causes dangerous rapid drops 3
   • Do NOT attempt to lower blood pressure to normal within minutes or hours 5
   • Do NOT give extra doses of their regular medications without physician guidance 5

What NOT to Do

• Never use immediate-release nifedipine—it can cause stroke or heart attack 3
• Never attempt to reduce blood pressure by more than 20-30% in the first 24-48 hours 5
• Never ignore symptoms of organ damage—these require emergency room treatment 2, 4

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Hypotension (Low Blood Pressure) at Home

Science and Symptoms of Hypotension

Hypotension becomes clinically significant when it causes symptoms, typically when systolic pressure drops below 90 mmHg or there's a sudden drop of 20 mmHg or more from baseline. 1

Common Symptoms: 1

• Dizziness or lightheadedness, especially when standing up 1
• Fainting or near-fainting 1
• Blurred vision 1
• Nausea 1
• Fatigue or weakness 1
• Confusion or difficulty concentrating 1
• Cold, clammy, pale skin 1
• Rapid, shallow breathing 1
• Rapid, weak pulse 1

Postural (Orthostatic) Hypotension: 1

• Blood pressure drops when standing from sitting/lying position 1
• Particularly common in elderly patients and those with diabetes 1
• Defined as drop of ≥20 mmHg systolic or ≥10 mmHg diastolic within 1-3 minutes of standing 1

Immediate Home Management for Symptomatic Hypotension

If someone experiences dizziness or fainting from low blood pressure:

1. Have them lie down immediately with legs elevated 12 inches above heart level 1

   • This increases blood flow to the brain and vital organs 1
   • Keep them lying down until symptoms resolve 1

2. If lying down isn't possible, have them sit with head between knees 1

3. Loosen tight clothing, especially around neck and waist 1

4. If conscious and able to swallow, give fluids: 1

   • Water or electrolyte-containing beverages 1
   • Avoid alcohol or caffeine initially 1

5. Check blood pressure after symptoms resolve: 1

   • Measure lying down, then after standing for 1 minute and 3 minutes 1
   • A drop of ≥20/10 mmHg confirms orthostatic hypotension 1

When to Seek Emergency Care for Hypotension

Call emergency services if the person has: 2, 4

• Loss of consciousness lasting more than a few seconds 4
• Chest pain 2, 4
• Shortness of breath 2
• Confusion or altered mental status 4
• Rapid or irregular heartbeat 3
• Signs of shock (cold, clammy skin; rapid breathing; weak pulse) 4
• Suspected bleeding or severe dehydration 4

Preventing Hypotensive Episodes at Home

For patients prone to low blood pressure: 1

• Rise slowly from lying or sitting positions—sit on edge of bed for 1-2 minutes before standing 1
• Increase fluid intake to 2-3 liters daily unless contraindicated 1
• Increase salt intake to approximately 5g daily (about 1 teaspoon) if not contraindicated by heart or kidney disease 1
• Avoid prolonged standing, especially in hot environments 1
• Eat smaller, more frequent meals rather than large meals 1
• Avoid alcohol 1
• Wear compression stockings if recommended by physician 1
• Review medications with physician—many blood pressure medications can cause hypotension 1

Critical Pitfall to Avoid

Never assume low blood pressure readings are accurate without proper measurement technique—ensure the person has been resting 3-5 minutes, bladder is empty, and arm is at heart level. 1