Low Blood Pressure: Symptoms, Causes, and Treatment

Blood Pressure

Low Blood Pressure (Hypotension) is the medical term for a condition in which your blood pressure is too low. It can be caused by many things, including dehydration, stress, or certain medications. Low blood pressure may also occur when you have an infection or other illness that causes swelling in your body.

This condition is generally considered to be a blood pressure reading lower than 90 mm Hg systolic or 60 mm diastolic. This measure is called “office blood pressure.” Blood pressure readings taken while you're resting are usually higher than those taken during activity because your heart beats faster when you're active.

What is Hypotension (Low Blood Pressure)

Contrary to high blood pressure, low blood pressure is not life-threatening and does not cause any other potentially serious diseases. It also protects against many cardiovascular diseases, such as heart attack or stroke.

Nonetheless, persons with low blood pressure (arterial hypotension) may also have complaints under which they may suffer very much sometimes: dizzy spells, disturbances of concentration and tiredness may be potential symptoms. In addition, mental performance may also be affected. Healthy people suffering from low blood pressure may have trouble concentrating and react slower.

The so-called primary (essential) hypotension is the most frequent form of low blood pressure and has not been classified as a disease. It occurs primarily in younger women, in particular, if this feature is a trait in the family.

Low blood pressure is a measured value only – and no disease. The World Health Organisation WHO has defined a blood pressure below 100 / 60 mmHg in women and less than 110 / 70 mmHg in men as low blood pressure (arterial hypotension).

However, it depends on the person whether complaints occur with these values. Especially sensitive persons may also suffer from dizziness and light-headedness in the case of higher values.

Symptoms and Causes

In case of chronically low blood pressure, the following complaints may occur:

  • Tiredness and/or increased sleep requirement
  • Reduced fitness
  • Difficulties in concentrating
  • Listlessness or depressive emotional response
  • Restlessness and sleep disorders
  • Lack of drive and lassitude
  • Long “period of adjustment” in the morning
  • State of exhaustion and feeling of faintness
  • Quick fatigability and reduction of fitness
  • Increased sensitivity to cold (cold hands and/or feet primarily)
  • Pale skin

Circulatory complaints

In case of low blood pressure, circulatory complaints may occur when the supply of blood to the brain deteriorates, which, for example, may appear on hot, sultry days when the blood vessels dilate.

Heavy perspiration leads to a fluid volume deficit. The blood pressure decreases, and complaints, such as fatigue and lassitude, make themselves felt.

These symptoms may also occur after the meal because the blood gathers in the area of the digestive organs and is missing in the brain.

Dizziness

In the case of low blood pressure, dizziness occurs when sensitive persons change their body positions too quickly – thus, from lying down to sitting up or from sitting down to standing up (orthostatic hypotension).

These problems may also occur when bending down. The blood rushes into the legs and belly, and the vessels cannot contract fast enough. The blood pressure decreases suddenly, and the following complaints may occur:

  • Dizziness
  • Light-headedness
  • Visual disturbances (flickering of the eyes)
  • Headache
  • Propensity to fainting and/or short unconsciousness (orthostatic collapse)

The body takes countermeasures against the drop in blood pressure: The heart starts beating faster (tachycardia); the blood vessels contract (paleness, cold hands); sweating and nausea occur. The dizzy spell subsides as a rule after a recovery phase of a few minutes.

Fainting

Fainting (syncope) occurs when the brain is not sufficiently supplied with blood and oxygen for a short period of time, caused by a sudden drop in blood pressure.

The first signs are dizziness, a feeling of emptiness in the head, nigrescence or flickering of the eyes. Persons affected lose consciousness for a short period of time and have no control of their muscles. They fall and find themselves lying on the floor after a few seconds.

In the case of otherwise healthy persons, the most frequent reason for syncope is a deviation from the normal dilatation of the blood vessels (vasovagal syncope).

As a sequel to a mental stress situation (such as anxiety, pain or stress, for example), a chain reaction is triggered, at the end of which the blood pressure drops.

This type of syncope announces itself some seconds beforehand as a rule through alarm signals, such as staggering vertigo, blurred vision, tunnel vision, nausea, palpitations or sweating.

Dysregulation causes orthostatic syncope in the brain, leading to a fast drop in blood pressure.

Most fainting fits are harmless and end by themselves after a few seconds. However, injuries are possibly caused by a fall. Moreover, there is a high risk of injury when the affected person faints during athletic activities or in road traffic.

Persons who are affected by low blood pressure and faint frequently should pursue less dangerous types of sport or should ensure special safety precautions (in mountaineering, for example).

If necessary, ask your doctor whether you are subjected to a higher risk in your job or as a car driver caused by frequent fainting fits.

In rare cases, the fainting fit is caused by a serious disease. When a syncope occurs for the first time, it is essential that you see a doctor who will carry out an extensive diagnosis.

Rarer causes of syncope are:

  • Heart diseases (such as rhythm disturbances, heart attack or myocardial diseases, for example)
  • High loss of blood, bloodlessness (anaemia)
  • Severe fluid volume deficit
  • Nerve or brain diseases (such as damage to nerves caused by diabetes, for example)
  • Pregnancy during the last third (pressure of the child on the lower caval vein)

What Causes Low Blood Pressure?

There are several different reasons why someone's blood pressure might drop. The most common cause of low blood pressure is dehydration.

Dehydration occurs when you don't drink enough water to replace what you lose through sweating, breathing, and urinating. This happens because your kidneys aren't able to remove excess fluid from your bloodstream as well as they should.

Permanently low blood pressure may be inherited. The so-called essential hypotension (also: primary hypotension) is the most frequent form and usually affects young and slim women.

There is no clear understanding as to why the pressure remains so low. The tendency may be hereditary, so the mother and the daughter are affected frequently.

If no complaints occur, essential hypotension is harmless. In fact, it may provide protection against diseases which are encouraged by high blood pressure. The risk of developing sclerosis of the blood vessels (arteriosclerosis) and their consequences, such as coronary heart disease, heart attack, stroke or peripheral occlusive diseases, is lower in this case.

Secondary hypotension refers to low blood pressure, which is the consequence of a disease or an action of a drug.

Diseases which may cause hypotension are:

  • Thyroid hypofunction (hypothyreosis)
  • Hypofunction of the adrenal cortex (Addison's disease)
  • Hypofunction of the pituitary gland (insufficiency of the anterior lobe of the hypophysis)
  • Heart diseases (such as cardiac insufficiency, rhythm disturbances, pericarditis, for example)
  • Long confinement to bed
  • Fluid volume deficit (hypovolaemia)
  • Lack of salt (hyponatraemia)

Drugs which may cause hypotension are:

  • Psychopharmaceutical drugs (against depression, anxiety, insomnia)
  • Antiarrhythmic drugs (against cardiac arrhythmias)
  • Antihypertonic drugs (against high blood pressure)
  • Diuretics (diuretic drugs)
  • Coronary drugs (in case of cardiac angina, such as nitro sprays)
  • Vasodilating drugs (vasodilatory agents)
  • Psychopharmaceutical drugs (against depression, anxiety, insomnia)

In the case of orthostatic hypotension (orthostasis = standing upright), the blood rushes into the lower parts of the body when sitting down or standing up fast. For a short period, the brain is supplied with less blood.

Dizzy spells may occur, in the worst case causing the person to faint. This type of low blood pressure frequently occurs together with secondary hypotension. In most cases, however, the cause of the circulation problems can be disclosed using a Schellong test.

Potential causes for orthostatic hypotension are:

  • Secondary hypotension
  • Disorder of the autonomic nervous system (caused by diabetes, for example)
  • Nerve cell damage in the brain (caused by certain forms of Parkinson's disease and hydrocephalus, alcohol abuse, for example)
  • Post-thrombotic syndrome (after deep leg vein thrombosis)
  • Varicose veins (varicosis)

Types of Hypotension

There are several different types of low blood pressure. The most common type is called orthostatic hypotension. This occurs when your blood pressure drops as soon as you stand up from sitting down. Orthostatic hypotension usually happens gradually over time. Other types of low blood pressure include postural hypotension, vasovagal syncope, and neurogenic shock.

1. Orthostatic Hypotension

This is the most common cause of low blood pressure. In this case, your blood pressure falls after standing up. You may feel dizzy or lightheaded. Your heart rate will increase to compensate for the drop in blood pressure. If you experience these symptoms, sit or lie down immediately.

2. Postural Hypotension

This type of low blood pressure occurs when your blood pressure decreases while you're lying down. It's often associated with conditions such as diabetes, high blood sugar levels, or kidney disease.

3. Vasovagal Syncope

This is a temporary decrease in blood pressure that results from sudden changes in blood volume. For example, if you suddenly bend forward, your blood pressure will fall. Vasovagal syncope is more likely to happen in people who have low blood pressure already.

4. Neurogenic Shock

This type of low pressure occurs when there is damage to nerves in your brain or spinal cord. Nerve damage can result from injury, stroke, multiple sclerosis, or head trauma. Neurogenic shock can lead to problems like confusion, weakness, or paralysis.

Natural Treatment: Preventing A Low Blood Pressure Level

If low blood pressure causes complaints, you should try first of all to get the circulation going again by leading a healthy way of life. The following non-medicinal measures increase the blood pressure, improve the complaints and prevent dizzy spells.

By using some simple tricks and changing habits in everyday life, you can raise low blood pressure a little in most cases. If this is not enough, drugs can be applied to stimulate the circulatory system. It is only in very rare cases that severe disease is behind low blood pressure.

1. Nutritional Recommendation

It is imperative that you choose the right nutrition to treat low blood pressure. Here are a number of nutritional recommendations that you should take into consideration.

Use More Salt

By increasing the intake of table salt, more liquid is bound in the body, which causes the blood pressure to rise. Salt is especially helpful in the morning (such as bread with salted butter, salt pretzel or English breakfast, for example).

You should keep to a low-salt diet only in case of pregnancy, if the heart muscle develops a persistent weakness (cardiac insufficiency), or if a severe functional impairment of the kidneys is established.

Drink More

The more liquid circulates in the veins, the higher the blood pressure is. For this reason, drink at least two to three litres of (unsweetened) liquid per day, such as water, diluted fruit juices or fruit or herbal tea, for example.

Avoid excessive volumes of black tea or coffee. Please keep in mind that you should drink more than three litres a day sometimes in case of hot weather.

Avoid Alcohol

Alcohol encourages circulatory troubles in various ways. Slowly but surely, it destroys the small nerves, which actually should constrict the blood vessels when standing up. Moreover, alcohol affects the regulation of the balance in the brain stem and the cerebellum and reduces the heart's performance (alcoholic cardiomyopathy).

In addition, alcohol increases the excretion of liquid. For this reason, keep your fingers off alcohol if you suffer from severe complaints caused by low blood pressure!

Have Small Meals More Often

Big meals concentrate the blood in the digestive tract. Low blood pressure complaints are evident, particularly during the first hour after the meal. Rather eat several small portions distributed throughout the day. An espresso (or coffee) or some sweets help some people not to drop into the “deep” after the meal.

Caffeine

A cup of coffee at the right time can get the circulation going – but not for a very long time, unfortunately. For a short period of time, only caffeine acts on the receptors which are involved in the control of blood pressure. But then it's over again.

Drinking coffee permanently is no solution either: In case of a surplus of caffeine, the receptors are regulated down, and the espresso has next to no effect anymore. Instead, the blood pressure drops even further to rock bottom when deprived of coffee.

A cup of tea keeps you awake for longer as the caffeine (theine) in the tea is bonded to the tanning agents. Thus, it unfolds its effect slower. The caffeine level varies less than in coffee; the blood pressure reacts slower. But, if you drink a cup of tea regularly, your body will also get accustomed to the caffeine.

Other stimulants

The same applies to other stimulants as well: Guarana, energy drinks or sparkling wine. They act very well on the blood pressure for a short period but cannot produce a lasting improvement.

In addition, the high share of carbohydrates in energy drinks causes sensitive persons to bind a lot of blood in the abdominal cavity, and the blood pressure will decrease further.

2. Lifestyle

If you have been diagnosed with low blood pressure, there are several lifestyle changes you can make to help treat low blood pressure naturally.

Cold Jets of Water

Kneippism, such as water treading and cold jets of water, increase blood pressure by stimulating the sympathetic nervous system. (Brief) cold showering helps to overcome tiredness in the morning. A massaging brush used under the shower improves blood circulation in addition. In contrast, hot baths are the worst thing you can do to your circulation: They decrease the blood pressure and increase dizziness and falls when standing up. For this reason, always have a cold shower after a bath. Apply dry brush massages also to get the circulation going.

More Cushions

Sleep with a raised upper part of the body (use two to five extra cushions to increase by 20 to 45 degrees). This action will prevent low blood pressure at night, during which excessive volumes of water are excreted. Dizzy spells in the morning will occur less frequently.

Tight stockings

Compression stockings (or compression tights) prevent dizzy spells by preventing the blood from rushing to the feet. In addition, the blood flow to the heart increases. Caution! Compression stockings have to be very tight to be effective – but they must not cause any constriction, which means the stockings have to be tailor-made and have to be changed in regular intervals because they wear out by and by.

Be Attentive

Fainting fits are frequently preceded by first signs, such as dizziness, heart hurry or sweating. Watch out for such signals in your body and sit, kneel down or squat before the pressure drops completely and everything goes black.

3. Body Movement

Low blood pressure can be treated by moving around more often. This helps the heart pump better and reduces stress on the arteries. It also improves circulation and increases oxygen levels in the blood. 

Do Some Exercise

By pursuing endurance sports (circulatory training) in regular intervals, the blood pressure does not increase extremely, but the body learns to deal with blood pressure fluctuations – the complaints improve distinctly.

Pursuing endurance sports regularly will strengthen the heart and trains the circulation. Persons suffering from low blood pressure should aim to train their vascular system. It will adapt faster and better to the demands (such as standing up, change in weather and temperature, for example), and the dizzy spells will occur less frequently.

All types of sports with medium exertion are suitable for vascular training, in which all muscle groups are put on stress at the same time, if possible. Examples here are hiking, swimming, gymnastics or Nordic walking. High constant strain (fast jogging without breaks) and peak loads (weight-lifting) are less beneficial. Muscle re-education is not necessarily the main objective in this case, but the physical activation causes a positive effect.

To get your circulation going through sports, you should talk to your doctor about your intentions. He will tell you which type of sport is suitable for your form of low blood pressure. Persons suffering from cardiovascular disease or following a long absence from the sport should pass an exercise tolerance test before starting training.

Which type of sports benefits what?

  1. Jogging: Jogging will stabilize the blood pressure primarily by heart performance. At the end of the exertion, the blood pressure may drop quickly. Gymnastic phases are beneficial whilst jogging. Jogging phases may also be alternated with fast walking periods in order to dose the exertion. If you want, you can check the exertion by means of a pulse monitor.
  2. Swimming: All muscle groups are exercised in this case. On account of the water pressure from the outside, the filling and elasticity of the vessels are improved at the same time. For this reason, swimming in regular intervals is considered to be very suitable for vascular training.
  3. Gymnastics: The peripheral vessels are trained very well by the permanent change between exertion and relief. In addition, the body gets used to the fast change of body position. Untrained persons will suffer from dizziness rather quickly, other than trained persons after regular gymnastics.
  4. Cycling: Cycling activates the so-called muscle pump. The muscles of the lower legs primarily press the blood from the veins up against gravity. Thus, the blood is available for circulation again instead of rushing into the legs. Moreover, cycling is a joint-sparing endurance sport in which the exertion can be dosed well. Depending on your fitness, you can relax on easy tours or rage yourself out during difficult mountain legs. For this reason, cycling is highly recommended as circulatory training.

Always Jiggle Your Feet

By stimulating the muscle pump in the calves, blood is pumped from the leg to the heart. For this reason, do not stand on the same spot for too long, but move up and down on the balls of your feet or walk about. A similarly positive effect is achieved if you do some foot gymnastics when sitting down or actively rotate the feet a bit. If you cross your legs, you risk blood stasis in the legs.

Take Stool Along

If moving up and down on the balls of your feet is not sufficient and guided tours in a museum belong to your hobbies, there are small, very light and easy-to-handle stools or folding chairs. They permit a change between sitting and standing and thus stimulate your circulation.

Get Up Slowly

In the morning, sit on the side of the bed for about a minute before you get up properly. If you gently get your circulation accustomed to the new demand, dizzy spells will become less frequent.

Drugs Used to Treat Hypotension

Several groups of active substances can raise the blood pressure slightly, can relieve the complaints of low blood pressure and can prevent dizzy spells. However, all drug-induced therapies may cause undesired actions (such as high blood pressure, for example). For this reason, you should first try to reduce the complaints of low blood pressure by non-medicinal measures.

Sympathomimetic Agents

Drugs in this group are used most frequently to treat low blood pressure. Similar to the body's own messengers, adrenaline and noradrenaline, they increase the return flow of the blood to the heart and stimulate the heartbeat.

The potential side effects include, among other things, heart hurry, heart rhythm disorders and bladder emptying disorders. Sympathomimetic agents must not be used in case of coronary heart disease, glaucoma, prostate gland enlargement, or thyroid hyperfunction during the first third of pregnancy and professional sports (positive doping test).

This group includes etilefrine, ameziniummetilsulfate, midodrine, norfenefrine, pholedrine and oxilofrine.

Fludrocortisone

Fludrocortisone is a synthetically produced hormone of the adrenal cortex (mineralocorticoid). In the kidney, it prevents the excretion of salt and water, thus causing the blood volume and hence the blood pressure to increase.

Fludrocortisone is applied to patients primarily who have circulation problems when standing up and do not develop an increase in pulse for compensation (asympathicoton orthostatic hypotension).

Dihydroergotamine

Dihydroergotamine is a so-called vasoconstrictor which contracts the large veins. This action improves the return flow of the blood to the heart and prevents circulation problems when standing up.

For this reason, dihydroergotamine is applied primarily in the case of sympathicoton orthostatic hypotension, the most frequently circulatory trouble which leads to circulation-induced falls (syncopes).

Erythropoietin

Erythropoietin (epoetin alpha or epoetin beta) is a hormone which stimulates the maturation of the red blood cells (erythrocytes) in the bone marrow. Erythrocytes ensure the transport of oxygen in the blood.

In patients suffering from severe orthostatic hypotension, who do not respond to other drugs, erythropoietin may reduce the complaints.

Conclusion

In conclusion, hypotension is a condition where blood pressure drops too low. This can happen because of several factors, including dehydration, stress, certain medications, and pregnancy.

However, the main cause of low blood pressure is dehydration. When you're dehydrated, your kidneys aren't able to produce enough urine, which means less water is leaving your system. This causes your blood volume to decrease, which lowers your blood pressure.

The symptoms of hypotension include dizziness, fainting, headache, nausea, vomiting, weakness, confusion, fatigue, cold hands and feet, and shortness of breath. In severe cases, patients can develop seizures, coma, and death. Fortunately, you can usually reverse these conditions through proper hydration.

As far as prevention goes, the easiest way to avoid hypotension is to drink plenty of fluids throughout the day. Try drinking eight glasses of water each day, and keep your fluid intake high during exercise.

Also, be careful about taking diuretics since they can lower your blood pressure. Finally, immediately seek medical attention if you notice any signs of dehydration, such as dry mouth or dark yellowing of the tongue.

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