Understanding Low Blood Pressure -- the Basics

 What Is Low Blood Pressure?

 What Causes Low Blood Pressure?

What Is Low Blood Pressure?

Hypotension is the medical term for low blood pressure (less than 90/60).
A blood pressure reading appears as two numbers. The first and higher of the two is a measure of
systolic pressure, or the pressure in the arteries when the heart beats and fills them with blood. The
second number measures diastolic pressure, or the pressure in the arteries when the heart rests between
beats.
Optimal blood pressure is less than 120/80 (systolic/diastolic). In healthy people, low blood pressure
without any symptoms is not usually a concern and does not need to be treated. But low blood pressure
can be a sign of an underlying problem -- especially in the elderly -- where it may cause inadequate blood
flow to the heart, brain, and other vital organs.

Chronic low blood pressure with no symptoms is almost never serious. But health problems can occur
when blood pressure drops suddenly and the brain is deprived of an adequate blood supply. This can
lead to dizziness or lightheadedness. Sudden drops in blood pressure most commonly occur in someone
who's rising from a lying down or sitting position to standing. This kind of low blood pressure is known as
postural hypotension or orthostatic hypotension. Another type of low blood pressure can occur when
someone stands for a long period of time. This is called neurally mediated hypotension.
Postural hypotension is considered a failure of the cardiovascular system or nervous system to react
appropriately to sudden changes. Normally, when you stand up, some blood pools in your lower
extremities. Uncorrected, this would cause your blood pressure to fall. But your body normally
compensates by sending messages to your heart to beat faster and to your blood vessels to constrict.
This offsets the drop in blood pressure. If this does not happen, or happens too slowly, postural
hypotension results.
The risk of both low and high blood pressure normally increases with age due in part to normal changes
during aging. In addition, blood flow to the heart muscle and the brain declines with age, often as a result
 of plaque buildup in blood vessels. An estimated 10% to 20% of people over age 65 have postural
hypotension.

Understanding Low Blood Pressure -- the Basics

What Causes Low Blood Pressure?

The cause of low blood pressure isn't always clear. It may be associated with the following:

 Pregnancy
 Hormonal problems such as an underactive thyroid (hypothyroidism), diabetes, or low blood
sugar (hypoglycemia)
 Some over-the-counter medications
 Some prescription medicines such as for high blood pressure, depression or Parkinson’s disease
 Heart failure
 Heart arrhythmias (abnormal heart rhythms)
 Widening, or dilation, of the blood vessels
 Heat exhaustion or heat stroke
 Liver disease

What Causes a Sudden Drop in Blood Pressure?

Sudden drops in blood pressure can be life-threatening. Causes of this type of hypotension include:

 Loss of blood from bleeding

 Low body temperature
 High body temperature
 Heart muscle disease causing heart failure
 Sepsis, a severe blood infection
 Severe dehydration from vomiting, diarrhea, or fever
 A reaction to medication or alcohol
 A severe allergic reaction, called anaphylaxis

Who Gets Postural Hypotension?

Postural hypotension, which is low blood pressure when standing up suddenly, can happen to anyone for
a variety of reasons, such as dehydration, lack of food, or being overly fatigued. It can also be influenced
by genetic make-up, aging, medication, dietary and psychological factors, and acute triggers, such as
infection and allergy.
Postural hypotension occurs most frequently in people who are taking drugs to control high blood
pressure (hypertension). It can also be related to pregnancy, strong emotions, hardening of the arteries
(atherosclerosis), or diabetes. The elderly are particularly affected, especially those who have high blood
pressure or autonomic nervous system dysfunction.
Hypotension after meals is a common cause of dizziness and falls after eating. This is most common after
large meals containing a lot of carbohydrates. It’s believed to be caused by blood pooling into the vessels
of the stomach and intestines.
Several drugs are commonly associated with postural hypotension. These medications can be divided
into two major categories:

 Drugs used to treat high blood pressure, such as diuretics, beta-blockers, calcium-channel
blockers, and angiotensin-converting enzyme (ACE) inhibitors
 Drugs that have hypotension as a side effect, including nitrates, erectile dysfunction medications,
drugs for Parkinson's disease, antipsychotics, neuroleptics, anti-anxiety agents, sedative-hypnotics, and
tricyclic antidepressants

Understanding Low Blood Pressure -- the Basics

What Causes Low Blood Pressure? continued...

Common causes of naturally occurring postural hypotension include:

 Dehydration and electrolyte loss, which may result from diarrhea, vomiting, excessive blood loss
during menstruation, or other conditions
 Age-associated decline in blood pressure regulation, which may be worsened by certain health
conditions or medications

Certain diseases can also cause postural hypotension. These include:

 Central nervous system disorders, such as Shy-Drager syndrome or multiple system atrophy
 Nerve problems, such as peripheral neuropathy or autonomic neuropathy
 Cardiovascular disorders
 Alcoholism
 Nutritional diseases

To know if you have high or low blood pressure, you need to know what a healthy blood pressure level is. Optimal
blood pressure is less than 120/80 mm Hg (systolic pressure is 120 AND diastolic pressure is less than 80). Within
certain limits, the lower your blood pressure reading is, the better. There is no specific number at which day-to-day
blood pressure is considered too low, as long as no symptoms of trouble are present.

 
If my blood pressure stays around 85/55, do I have a health problem?

As long as you are not experiencing symptoms of low blood pressure, there is no need for concern. Most doctors
consider chronically low blood pressure dangerous only if it causes noticeable signs and symptoms, such as:

 Dizziness or lightheadedness
 Fainting (called syncope)
 Dehydration and unusual thirst
Dehydration can sometimes cause blood pressure to drop. However, dehydration does not automatically
signal low blood pressure. Fever, vomiting, severe diarrhea, overuse of diuretics and strenuous exercise
can all lead to dehydration, a potentially serious condition in which your body loses more water than you
take in. Even mild dehydration (a loss of as little as 1 percent to 2 percent of body weight), can cause
weakness, dizziness and fatigue.
 Lack of concentration
 Blurred vision
 Nausea
 Cold, clammy, pale skin
 Rapid, shallow breathing
 Fatigue
 Depression

As long as no symptoms are present, low blood pressure is not a problem. However, if your blood pressure is
normally higher or if you are experiencing any of the symptoms listed above, your low pressure may have an
underlying cause.

Low blood pressure can occur with:

 Prolonged bed rest

 Pregnancy
During the first 24 weeks of pregnancy, it's common for blood pressure to drop.
 Decreases in blood volume
A decrease in blood volume can also cause blood pressure to drop. A significant loss of blood from major
trauma, dehydration or severe internal bleeding reduces blood volume, leading to a severe drop in blood
pressure.
 Certain medications
A number of drugs can cause low blood pressure, including diuretics and other drugs that treat
hypertension; heart medications such as beta blockers; drugs for Parkinson's disease; tricyclic
antidepressants; erectile dysfunction drugs, particularly in combination with nitroglycerine; narcotics and
alcohol. Other prescription and over-the-counter drugs may cause low blood pressure when taken in
combination with HBP medications.
  Heart problems
Among the heart conditions that can lead to low blood pressure are an abnormally low heart rate
(bradycardia), problems with heart valves, heart attack and heart failure. Your heart may not be able to
circulate enough blood to meet your body's needs.
 Endocrine problems
Such problems include complications with hormone-producing glands in the body's endocrine systems;
specifically, an under-active thyroid (hypothyroidism), parathyroid disease, adrenal insufficiency (Addison's
disease), low blood sugar and, in some cases, diabetes.
 Severe infection (septic shock)
Septic shock can occur when bacteria leave the original site of an infection (most often in the lungs,
abdomen or urinary tract) and enter the bloodstream. The bacteria then produce toxins that affect blood
vessels, leading to a profound and life-threatening decline in blood pressure.
 Allergic reaction (anaphylaxis)
Anaphylactic shock is a sometimes-fatal allergic reaction that can occur in people who are highly sensitive
to drugs such as penicillin, to certain foods such as peanuts, or to bee or wasp stings. This type of shock
is characterized by breathing problems, hives, itching, a swollen throat and a sudden, dramatic fall in blood
pressure.
 Neurally mediated hypotension
Unlike orthostatic hypotension, this disorder causes blood pressure to drop after standing for long periods,
leading to symptoms such as dizziness, nausea and fainting. This condition primarily affects young people
and occurs because of a miscommunication between the heart and the brain.
 Nutritional deficiencies
A lack of the essential vitamins B-12 and folic acid can cause anemia, which in turn can lead to low blood
pressure.

Severely low blood pressure can have underlying causes

that may:

 Be an indication of serious heart, endocrine or

neurological disorders
   

 Deprive the brain and other vital organs of oxygen

and nutrients, ultimately leading to shock, which can
   
be life threatening

What if I notice a sudden decline in my blood pressure?

A single lower-than-normal reading is not cause for alarm if you are not experiencing any other symptoms or
problems. However, a sudden drop in blood pressure --- even a change of just 20 mm Hg --- can cause dizziness or
fainting. Sometimes a rapid decrease in blood pressure can indicate an underlying problem such as:

 Uncontrolled bleeding
 Severe infections
 Allergic reaction
 Postural (orthostatic) hypotension
This occurs for some people when standing from a sitting or prone position. Their blood pressure drops
rapidly, causing dizziness, lightheadedness, blurred vision and/or even fainting. Causes can include
dehydration, prolonged bed rest, diabetes, heart problems and excessive heat. Medications like diuretics,
beta-blockers, calcium channel blockers, ACE inhibitors, antipsychotics, antidepressants and drugs for
Parkinson's disease can also cause this condition. In some cases, sitting for long periods of time with legs
crossed or squatting can be the cause.

When to see your healthcare professional

If you experience any dizziness or lightheadedness, it's a good idea to consult with your healthcare provider. If you
have gotten dehydrated, have low blood sugar or have spent too much time in the sun or a hot tub, it is more
important to recognize how quickly your blood pressure drops than how low it drops. Keep a record of your symptoms
and your activities at the time your symptoms occurred.