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Is low blood pressure guilty or innocent?

 

For healthy people, low blood pressure without symptoms is usually not a cause for concern and does not require treatment. Blood pressure is measured in millimeters of mercury (mmHg) and has two numbers:

 

• Systolic pressure The first (top) number is the pressure in the arteries when the heart beats. 
•  Diastolic pressure The second (bottom) number is the pressure in the arteries when the heart rests between beats.

A drop in blood pressure for one person may be acceptable for another person. Low blood pressure may not cause any noticeable symptoms, or it may cause dizziness and fainting. Sometimes, low blood pressure can be life-threatening as it can reduce blood flow to the heart, brain, and other vital organs and is a sign of an underlying problem, especially in older adults.

It is considered low if your blood pressure reading falls below 90 millimeters of mercury (mmHg) for the top number (systolic) or 60 mmHg for the bottom number (diastolic).

Its types

1. Postural hypotension A sudden drop in blood pressure often occurs when rising from a lying or sitting position to standing. This is called postural hypotension or orthostatic hypotension. It occurs when the cardiovascular or nervous system does not react appropriately to sudden changes in postural status, prolonged bed rest, certain other medical conditions, during pregnancy, and when taking certain medications. Between 10% and 20% of people over the age of 65 years suffer from postural hypotension.
2. Low blood pressure after eating Sometimes blood pressure drops an hour or two after eating a meal, and it is believed that it is caused by the blood flowing to the blood vessels in the stomach and intestines more than other organs, and it tends to occur after large meals that contain a lot of carbohydrates. It is more common in older people with high blood pressure or nervous system diseases such as Parkinson's disease.
3. Neurologically moderate hypotension Hypotension that occurs after standing for prolonged periods. This type of low blood pressure mostly affects young adults and children. It may be the result of miscommunication between the heart and the brain.
4. Multiple system atrophy with orthostatic hypotension This disorder affects the nervous system, which controls involuntary functions such as blood pressure, heart rate, breathing, and digestion.

  

 

Its symptoms

Hypotension does not always cause symptoms. But sometimes, if blood pressure drops and the patient feels tired, these are two indicators that the vital organs are not receiving the amount of blood flow they need.

Symptoms of hypotension may include:

• Blurred vision

• Severe dizziness or vertigo. Slight dizziness or vertigo can sometimes be caused by many things, such as spending too much time in the sun.

• Fainting

• Exhaustion

• Difficulty concentrating

• Nausea

• Cold and clammy skin

• Pale skin

Severe low blood pressure can lead to a condition known as shock. Symptoms of shock include:

• Confusion, especially in the elderly

• Cold and clammy skin

• Pale skin color

• Rapid and shallow breathing

• Rapid pulse

If blood pressure readings are persistently low and symptoms are present it will be helpful to keep a record of symptoms, when they occur, and what is being done at the time. The doctor will review the patient's medical history, age, and symptoms he has recorded, and will conduct a physical examination. Check your blood pressure and pulse rate frequently after lying down for a few minutes, immediately after standing, and within a few minutes after standing quietly.

The doctor may order other procedures, such as an electrocardiogram (ECG), echocardiogram (ultrasound test to image the heart), and blood tests to look for anemia or problems with blood sugar levels. An exercise stress test or electrophysiology (EP) test may be requested. For some types of postural hypotension, you may need a  tilt table  test.

 

Its reasons

The American Heart Association classifies blood pressure as normal when it is less than 120/80 mm Hg. It is noted that blood pressure is at its lowest levels during the night and rises clearly upon waking. Blood pressure varies throughout the day depending on:

• Body position

• Breathing

• Food and drinks

• Medications

• Physical condition

• Time of day

Conditions that can cause hypotension

 A - Medical conditions 

1. In the case of pregnancy, blood vessels expand rapidly. These changes may lead to a drop in blood pressure. Low blood pressure is common in the first 24 weeks of pregnancy and blood pressure usually returns to pre-pregnancy levels after birth.
2. Heart attack, heart failure, heart valve disease, and arrhythmia can cause hypotension.
3. Conditions that affect the thyroid or adrenal glands, such as Addison's disease. Low blood sugar, as diabetes may also lead to hypotension.
4. When the body does not get enough water, the amount of blood in the body (blood volume) decreases due to dehydration. This can cause low blood pressure. Fever, vomiting, severe diarrhea, excessive use of diuretics, and strenuous exercise can lead to dehydration.
5. Losing too much blood, due to injury or internal bleeding, reduces blood volume and leads to a sharp drop in blood pressure.
6. When an infection enters the body and into the bloodstream, it can lead to a drop in blood pressure called septic shock.
7. Severe allergic reactions cause a sudden drop in blood pressure.
8. Low levels of vitamin B12, folate, and iron may prevent the body from producing enough red blood cells (anemia), which may lead to low blood pressure.
9. Other conditions such as heat stroke, prolonged bed rest, and blood donation may lead to low blood pressure.
10. Some liver diseases lead to low blood pressure.

B- Taking some medications 

1. Water pills (diuretics), such as furosemide (Lasix) and hydrochlorothiazide (Microzide).
2. Alpha blockers, such as prazosin (Minipress).
3. Beta blockers, such as atenolol (Tenormin) and propranolol (Inderal, Inopran XL, Hemangol).
4. Parkinson's disease medications, such as pramipexole (Mirapex) or those containing levodopa.
5. Certain types of antidepressants (tricyclic antidepressants), including doxepin (Silenor) and imipramine (Tofranil).
6. Erectile dysfunction medications, including sildenafil (Revatio, Viagra) or tadalafil (Adcirca, Allique, Cialis), especially when taken with the heart medication nitroglycerin (Nitrostat, Nitro-Dur, Nitromist).

 

Its complications

There are complications that can develop due to hypotension with symptoms without treatment, which are: 

1- Severe low blood pressure can limit blood flow to the body's organs to the point of shock.

2- Dizziness from low blood pressure can cause falling or fainting. Falls can lead to serious injuries.

3- The heart may try to compensate for low blood pressure by pumping blood too forcefully or too quickly. This can lead to problems such as heart failure, stroke, or deep vein thrombosis.

4- Low blood pressure during pregnancy can lead to an increased risk of miscarriage .

The appropriate treatment

Treatment depends on the cause and type of hypotension and the situations causing the low blood pressure The doctor recommends lifestyle changes, medical treatment, or both. For many patients, treatment occurs when the patient changes his diet and lifestyle, as the patient does the following:

1. Follow a diet high in salt.
2. Drink plenty of water to avoid hypotension due to dehydration, especially if the patient is suffering from vomiting or diarrhea. Keeping the body hydrated during exercise, when in a hot place, and during a viral illness, such as a cold or flu.
3. Exercise regularly to boost blood flow.
4. Be careful when getting up from lying down or sitting for a long time. To improve circulation, move your feet and ankles several times before standing. Then go slowly. When getting out of bed, sit upright on the edge of the bed for a few minutes before standing up.
5. Raise your head slightly when sleeping by raising the pillow.
6. Avoid lifting heavy objects.
7. Avoid standing still for long periods.
8. Avoid prolonged exposure to hot water while showering. If you feel dizzy, sit down. It may be helpful to keep a chair or bench in the bathroom in case you need to sit.
9. To reduce dizziness attacks After meals and blood pressure drops, try eating smaller meals by dividing the main meal into small meals and eating them at intervals. Reduce your intake of carbohydrates and rest after eating, avoiding standing suddenly after eating .
10. Change positions slowly and gradually instead of standing quickly, move to a sitting or standing position using small movements. Slow, deep breathing may help.

There are cases where the doctor needs to give the patient the appropriate medication with changing the diet and lifestyle.

 

 

References

 

-https://www.nhs.uk/conditions/low-blood-pressure-hypotension/

-https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/low-blood-pressure-when-blood-pressure-is-too-low

-https://my.clevelandclinic.org/health/diseases/21156-low-blood-pressure-hypotension

-https://www.healthline.com/health/hypotension#types