From the Guidelines
To manage low blood pressure, it is essential to prioritize increasing fluid intake to 2-3 liters daily, especially water, and consuming more salt in the diet, unless contraindicated, as dehydration is a common cause of hypotension. Low blood pressure, or hypotension, occurs when blood pressure readings fall below 90/60 mmHg. The symptoms of hypotension can be asymptomatic but may produce dizziness, lightheadedness, or blurred vision, as seen with beta-blockers that also block alpha-1-receptors, such as carvedilol 1.
Some key points to consider in managing low blood pressure include:
- Increasing fluid intake to prevent dehydration
- Consuming more salt in the diet, unless contraindicated
- Standing up slowly from sitting or lying positions to prevent dizziness
- Eating small, frequent meals to prevent post-meal blood pressure drops
- Considering medications like fludrocortisone or midodrine for persistent symptoms, as prescribed by a doctor
- Using compression stockings to improve circulation
It is crucial to note that orthostatic or postural hypotension is defined as a reduction of systolic blood pressure of at least 20 mm Hg or 10 mm Hg in diastolic blood pressure within 3 minutes of quiet standing 1. Factors affecting this response to posture include food ingestion, time of day, medications, ambient temperature, hydration, deconditioning, standing after vigorous exercise, and age. If chronic, the fall of blood pressure may be part of pure autonomic failure, multiple system atrophy, associated with Parkinsonism or a complication of diabetes, multiple myeloma, and other dysautonomias.
In patients with autonomic failure, there is a disabling failure of control of many autonomic functions, including the inability to control the level of blood pressure, especially in those patients with orthostatic hypotension who concomitantly have supine hypertension 1. This can lead to life-threatening target organ damage, such as left ventricular hypertrophy, coronary heart disease, flash pulmonary edema, heart failure, renal failure, stroke, and sudden death. Therefore, it is vital to seek medical attention if experiencing severe dizziness, fainting, confusion, or cold, clammy skin.
From the Research
Definition and Prevalence of Low BP
- Low blood pressure, also known as hypotension, can be defined as a reduction of systolic blood pressure (SBP) of at least 20 mm Hg or diastolic blood pressure (DBP) of at least 10 mm Hg within 3 minutes of standing 2, 3.
- Orthostatic hypotension (OH) occurs in 0.5% of individuals and as many as 7-17% of patients in acute care settings 2.
- OH may be more prevalent in the elderly due to the increased use of vasoactive medications and the concomitant decrease in physiologic function, such as baroreceptor sensitivity 2, 3.
Causes and Risk Factors of Low BP
- The fall in blood pressure seen in OH results from the inability of the autonomic nervous system (ANS) to achieve adequate venous return and appropriate vasoconstriction sufficient to maintain BP 2, 3.
- An evaluation of patients with OH should consider hypovolemia, removal of offending medications, primary autonomic disorders, secondary autonomic disorders, and vasovagal syncope, the most common cause of syncope 2, 3.
- Intensive blood pressure lowering may be responsible for systemic hypotension, and antihypertensive treatment may predispose to orthostatic and postprandial hypotension 4.
- Older age, chronic kidney disease, and frailty are associated with a higher risk of syncope, hypotension, and falls 5.
Diagnosis and Treatment of Low BP
- A thorough review of patient symptomatology combined with appropriate clinical tests should be employed to narrow the differential diagnosis and pinpoint the etiology of OH 2, 3.
- Treatment for OH can effectively be managed with a combination of nonpharmacologic treatment, pharmacologic treatment, and patient education 2, 3.
- Agents such as fludrocortisone, midodrine, and selective serotonin reuptake inhibitors have shown promising results in the treatment of OH 2.
- Syncope units have been shown to improve the rate of diagnosis while reducing cost and thus are highly recommended for the evaluation and management of syncope 6.