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Hypertension, or high blood pressure, affects about 75 million adults in the U.S. and was the primary or contributing cause of death for 410,000 Americans in 2014, according to the Centers for Disease Control and Prevention. But what are the causes and effects of hypotension, or low blood pressure?
Although not as common as hypertension, hypotension is also a potentially serious condition that affects both young and old, and—depending on the type you have—may cause serious complications or even death if not treated. According to a study published in American Family Physician, 20 percent of patients over the age of 65 were diagnosed with hypotension in 2011, and for those with lengthy hospital stays or living in nursing homes, the risk of hypotension often increases.
While hypotensive episodes often go unnoticed or resolve themselves quickly, the condition can negatively affect your daily activities, so it’s important to know why it’s happening and how its symptoms can be reduced or even eliminated.
What Is Blood Pressure?
Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out the blood. It is recorded as two numbers—the systolic pressure (the force generated as the heart beats or contracts) over the diastolic pressure (the force when the heart is relaxing between beats). The measurement is written with the systolic number on top and the diastolic number on the bottom. For example, blood pressure numbers expressed verbally as “120 over 80” would be written on a blood pressure chart as 120/80 mmHg (millimeters of mercury).
Normal blood pressure numbers would be less than 120 mmHg systolic and less than 80 mmHg diastolic. But if your systolic number is less than 90 or your diastolic number is less than 60, it would be considered low and you would be diagnosed as having hypotension.
Causes and Symptoms of Hypotension
Unlike hypertension, hypotension isn’t always directly linked to weight, diet, or lack of exercise, but rather one or more of the following:
- Heart problems, such as low heart rate (bradycardia), heart valve issues, heart attack, or heart failure
- Endocrine issues, such as Addison’s disease, hypoglycemia or diabetes
- Swallowing, straining or coughing
- Severe infection, such as septicemia
- Severe allergic reactions
- Blood loss
- Medications for Parkinson’s disease, depression and erectile dysfunction, as well as beta blockers, alpha blockers and water pills.
- Lack of nutrients, such as vitamin B12 and folate
While some people with hypotension have no signs or symptoms at all, others can experience symptoms anywhere between mild and severe. They can include:
Types of Hypotension
Hypotension is often categorized into four types, depending on its cause. Those with no signs or symptoms are diagnosed with chronic asymptomatic hypotension, which often doesn’t require treatment. It is likely that they were born with low blood pressure, so their numbers are considered “normal” for them.
The other three types of hypotension are caused by a sudden drop in blood pressure and include:
- Orthostatic: This type occurs when your body’s blood pressure and flow can’t adjust quickly enough to changes in your position. As a result, you may feel dizzy or faint after standing up. This type of hypotension can also occur after eating a meal, which is known as postprandial hypotension. Orthostatic hypotension can affect all ages, but older adults are more prone to this type.
- Neurally mediated: This type occurs when your blood pressure drops after standing for a long period of time or when you’re experiencing stress. This type of hypotension is more common in children and young adults and often improves as they get older.
- Severe: This type is related to shock, which occurs when your blood pressure drops low enough to prevent your vital organs from receiving enough blood. Major blood loss, infection, anaphylaxis, poisoning or severe burns can cause shock and immediate treatment is needed to avoid death.
Diagnosing hypotension often begins with blood pressure monitoring. If your doctor suspects that you’re hypotensive, one or more of the following tests will be administered to come up with an official diagnosis:
- Blood tests to check for anemia or low blood sugar
- Electrocardiogram and/or Holter and event monitors to record your heart’s electrical activity
- Echocardiography to check the size and shape of your heart as well as blood flow to the heart
- Stress test to check the strength of your heart
- Valsalva Maneuver to test the part of your nervous system that controls your heartbeat and the narrowing and widening of your blood vessels.
- Tilt Table Test to check your reaction to changes in position. This is often given to people experiencing unexplained fainting spells.
If you’re experiencing mild symptoms or no symptoms at all, your doctor might tell you that treatment isn’t necessary. However, if your symptoms are more severe, any underlying causes should be addressed.
If you’re diagnosed with orthostatic hypotension, your doctor may advise the following to reduce or eliminate your symptoms:
- Drink plenty of fluids.
- Move slowly when standing up.
- Abstain from alcohol.
- Eat small, low-carb meals to avoid the symptoms of postprandial hypotension.
- Don’t cross your legs while sitting.
- If you’re on bed rest, try sitting up for short periods of time.
- Wear compression stockings to increase blood circulation.
If you’re diagnosed with neutrally mediated hypotension, you may be instructed to:
- Avoid stressful situations.
- Drink plenty of fluids.
- Increase your salt intake.
- Put your head between your knees while sitting down to alleviate symptoms.
Your doctor may also prescribe medications, such as fludrocortisone, to raise your blood pressure or adjust your current prescriptions to relieve your symptoms.
Exercising with Hypotension
If you have orthostatic hypotension, your symptoms may temporarily worsen after you exercise, but you don’t have to quit your workout completely if you follow these precautions, as suggested by LiveStrong.com:
- Eat a small meal before you exercise.
- Avoid any exercises that require your head to go below heart level.
- Change positions slowly and avoid exercise routines that require quick postural changes, such as yoga.
- Stay hydrated with water or sports drinks containing electrolytes.
- Take time to warm up and cool down so that your heart rate increases and decreases gradually.
- Monitor your blood pressure before and after your workout and report any concerns to your doctor.