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Definition
Low blood pressure, also called hypotension, would seem to be something to strive
for. After all, high blood pressure (hypertension) is a well-known risk factor for heart
disease and other problems. In fact, in recent years there has been an ongoing
downward revision of what is considered a normal blood pressure reading. A blood
pressure less than 120/80 millimeters of mercury (mm Hg) is now considered normal
and optimal for good health.
So, it's easy to understand why you might assume the lower the better when it comes
to blood pressure. And it's true that for some people — those who exercise and are in
top physical condition — low blood pressure is a sign of health and fitness. But that's
not always the case.
For many people, low blood pressure can cause dizziness and fainting or indicate
serious heart, endocrine or neurological disorders. Severely low blood pressure can
deprive the brain and other vital organs of oxygen and nutrients, leading to a life-
threatening condition called shock.
Symptoms
Some people with low blood pressure are in peak physical condition with strong
cardiovascular systems and a reduced risk of heart attack and stroke. But low blood
pressure can also signal an underlying problem, especially when it drops suddenly or
is accompanied by signs and symptoms such as:
Dizziness or lightheadedness
Fainting (syncope)
Lack of concentration
Blurred vision
Nausea
Cold, clammy, pale skin
Rapid, shallow breathing
Fatigue
Depression
Thirst
Causes
Blood pressure is a measurement of the pressure in your arteries during the active and
resting phases of each heartbeat. Here's what the numbers mean:
Systolic pressure. The first number in a blood pressure reading, this is the
amount of pressure your heart generates when pumping blood through your
arteries to the rest of your body.
Diastolic pressure. The second number in a blood pressure reading, this refers
to the amount of pressure in your arteries when your heart is at rest between
beats.
Although you can get an accurate blood pressure reading at any given time, blood
pressure isn't static. It can vary considerably in a short amount of time — sometimes
from one heartbeat to the next, depending on body position, breathing rhythm, stress
level, physical condition, medications you take, what you eat and drink, and even time
of day. Blood pressure is usually lowest at night and rises sharply on waking.
Some experts define low blood pressure as readings lower than 90 systolic or 60
diastolic — you need to have only one number in the low range for your blood
pressure to be considered lower than normal. In other words, if your systolic pressure
is a perfect 115, but your diastolic pressure is 50, you're considered to have lower than
normal pressure.
Yet this can be misleading because what's considered low blood pressure for you may
be normal for someone else. For that reason, doctors often consider chronically low
blood pressure too low only if it causes noticeable symptoms.
On the other hand, a sudden fall in blood pressure can be dangerous. A change of just
20 mm Hg — a drop from 130 systolic to 110 systolic, for example — can cause
dizziness and fainting when the brain fails to receive an adequate supply of blood.
And big plunges, especially those caused by uncontrolled bleeding, severe infections
or allergic reactions can, be life-threatening.
But in some instances, low blood pressure can be a sign of serious, even life-
threatening disorders. The American Heart Association considers the following as
possible causes of low blood pressure:
Blood tests. These can provide a certain amount of information about your
overall health as well as whether you have low blood sugar (hypoglycemia) or
a low number of red blood cells (anemia), both of which can cause lower than
normal blood pressure.
Electrocardiogram (ECG, EKG). This noninvasive test, which can be
performed in your doctor's office, detects irregularities in your heart rhythm,
structural abnormalities in your heart, and problems with the supply of blood
and oxygen to your heart muscle. It can also tell if you're having a heart attack
or if you've had a heart attack in the past. Sometimes you may be asked to
wear a 24-hour Holter monitor to record your heart's electrical activity as you
go about your daily routine.
Echocardiogram. Using the same technology that allows you to view a fetus
in the womb, an echocardiogram uses sound waves to produce images of your
heart that may show abnormalities in your heart muscle or valves.
Stress test. Some heart problems which can cause low blood pressure are
easier to diagnose when your heart is working harder than when it's at rest.
During a stress test, you'll exercise, such as walking on a treadmill. (Or, you
may be given medication to make your heart work harder if you're unable to
exercise.) When your heart is working harder, your heart will be monitored
with electrocardiography or echocardiography. Your blood pressure also may
be monitored.
Valsalva maneuver. This noninvasive test checks the functioning of your
autonomic nervous system by analyzing your heart rate and blood pressure
after several cycles of a type of deep breathing: You take a deep breath and
then force the air out through your lips, as if you were trying to blow up a stiff
balloon.
Tilt-table test. If you have low blood pressure on standing, or from faulty
brain signals (neurally mediated hypotension), your doctor may suggest a tilt-
table test, which evaluates how your body reacts to changes in position.
During the test, you lie on a table that's tilted to raise the upper part of your
body, which simulates the movement from a prone to a standing position.
Complications
Even moderate forms of low blood pressure can seriously affect quality of life,
leading not only to dizziness and weakness but also to fainting and a risk of injury
from falls. And severely low blood pressure from any cause can deprive your body of
enough oxygen to carry out its normal functions, leading to damage to your heart and
brain.
If it's not clear what's causing low blood pressure or no effective treatment exists, the
goal is to raise your blood pressure and reduce signs and symptoms. Depending on
your age, health status and the type of low blood pressure you have, this may be
accomplished in several ways:
Use more salt. Experts usually recommend limiting the amount of salt in your
diet because sodium can raise blood pressure, sometimes dramatically. But for
people with low blood pressure, that can be a good thing. But because excess
sodium can lead to heart failure, especially in older adults, it's important to
check with your doctor before upping your salt intake.
Drink more water. Although nearly everyone can benefit from drinking
enough water, this is especially true if you have low blood pressure. Fluids
increase blood volume and help prevent dehydration, both of which are
important in treating hypotension.
Use compression stockings. The same elastic stockings and leotards
commonly used to relieve the pain and swelling of varicose veins may help
reduce the pooling of blood in your legs.
Medications. Several medications, either used alone or together, can be used
to treat low blood pressure that occurs when you stand up (orthostatic
hypotension). For example, the drug fludrocortisone is often used to treat this
form of low blood pressure. This drug helps boost your blood volume, which
raises blood pressure. Doctors often use the drug midodrine to raise standing
blood pressure levels in people with chronic orthostatic hypotension. It works
by restricting the ability of your blood vessels to expand, which raises blood
pressure. Other drugs, such as pyridostigmine, nonsteroidal anti-inflammatory
drugs (NSAIDs), caffeine and erythropoietin are sometimes used, too, either
alone or with other drugs.
Drink more water, less alcohol. Alcohol is dehydrating and can lower blood
pressure, even if you drink in moderation. Water, on the other hand, combats
dehydration and increases blood volume.
Follow a healthy diet. Get all the nutrients you need for good health by
focusing on a variety of foods, including whole grains, fruits, vegetables, and
lean chicken and fish. If your doctor suggests increasing your sodium intake
but you don't like a lot of salt on your food, try using natural soy sauce — a
whopping 1,200 milligrams of sodium per tablespoon — or adding dry soup
mixes, also loaded with sodium, to dips and dressings.
Go slow. You may be able to reduce the dizziness and lightheadedness that
occurs with low blood pressure on standing by taking it easy when you move
from a prone to a standing position. Before getting out of bed in the morning,
breathe deeply for a few minutes and then slowly sit up before standing.
Sleeping with the head of your bed slightly elevated also can help fight the
effects of gravity. If you begin to get symptoms while standing, cross your
thighs in a scissors fashion and squeeze or put one foot on a ledge or chair and
lean as far forward as possible. These maneuvers encourage blood to flow
from your legs to your heart.
Eat small, low-carb meals. To help prevent blood pressure from dropping
sharply after meals, eat small portions several times a day and limit high-
carbohydrate foods such as potatoes, rice, pasta and bread. Drinking
caffeinated coffee or tea with meals may temporarily raise blood pressure, in
some cases by as much as 3 to 14 millimeters of mercury (mm Hg). But
because caffeine can cause other problems, check with your doctor before
increasing your caffeine intake.