low blood pressure (hypotension) lifestyle mayo clinic

Diseases and Conditions

Low blood pressure (hypotension)

Low blood pressure (hypotension) would seem to be something to strive for. However, for many people, lowblood pressure can cause symptoms of dizziness and fainting. In severe cases, low blood pressure can belife-threatening.

Although blood pressure varies from person to person, a blood pressure reading of 90 millimeters of mercury(mm Hg) or less systolic blood pressure (the top number in a blood pressure reading) or 60 mm Hg or lessdiastolic blood pressure (the bottom number) is generally considered low blood pressure.The causes of low blood pressure can range from dehydration to serious medical or surgical disorders. Lowblood pressure is treatable, but it's important to find out what's causing your condition so that it can be properlytreated.

For some people, low blood pressure can signal an underlying problem, especially when it drops suddenly or isaccompanied by signs and symptoms such as:

Dizziness or lightheadednessFainting (syncope)Lack of concentrationBlurred visionNauseaCold, clammy, pale skinRapid, shallow breathingFatigueDepressionThirst

When to see a doctorIn many instances, low blood pressure isn't serious. If you have consistently low readings but feel fine, yourdoctor is likely to monitor you during routine exams.

Even occasional dizziness or lightheadedness may be a relatively minor problem the result of milddehydration from too much time in the sun or a hot tub, for example. In these situations, it's not a matter so muchof how far, but of how quickly, your blood pressure drops.

Still, it's important to see your doctor if you experience any signs or symptoms of hypotension because theysometimes can point to more-serious problems. It can be helpful to keep a record of your symptoms, when theyoccur and what you were doing at the time.

Blood pressure is a measurement of the pressure in your arteries during the active and resting phases of eachheartbeat. Here's what the numbers mean:

By Mayo Clinic Staff

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Systolic pressure. The first (top) number in a blood pressure reading, this is the amount of pressure yourheart generates when pumping blood through your arteries to the rest of your body.Diastolic pressure. The second (bottom) number in a blood pressure reading, this refers to the amount ofpressure in your arteries when your heart is at rest between beats.

Current guidelines identify normal blood pressure as lower than 120/80 mm Hg.

Although you can get an accurate blood pressure reading at any given time, blood pressure isn't always thesame. 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 youeat and drink, and even time of day. Blood pressure is usually lowest at night and rises sharply on waking.

Blood pressure: How low can you go?What's considered low blood pressure for you may be normal for someone else. Most doctors considerchronically low blood pressure too low only if it causes noticeable symptoms.

Some experts define low blood pressure as readings lower than 90 mm Hg systolic or 60 mm Hg diastolic youneed to have only one number in the low range for your blood pressure to be considered lower than normal. Inother words, if your systolic pressure is a perfect 115, but your diastolic pressure is 50, you're considered to havelower than normal pressure.

A sudden fall in blood pressure also can be dangerous. A change of just 20 mm Hg a drop from 110 systolic to90 mm Hg systolic, for example can cause dizziness and fainting when the brain fails to receive an adequatesupply of blood.

And big plunges, especially those caused by uncontrolled bleeding, severe infections or allergic reactions, canbe life-threatening.

Athletes and people who exercise regularly tend to have lower blood pressure and a slower heart rate than dopeople who aren't as fit. So, in general, do nonsmokers and people who eat a healthy diet and maintain a normalweight.

But in some rare instances, low blood pressure can be a sign of serious, even life-threatening disorders.

Conditions that can cause low blood pressureSome medical conditions can cause low blood pressure. These include:

Pregnancy. Because a woman's circulatory system expands rapidly during pregnancy, blood pressure islikely to drop. This is normal, and blood pressure usually returns to your pre-pregnancy level after you'vegiven birth.Heart problems. Some heart conditions that can lead to low blood pressure include extremely low heart rate(bradycardia), heart valve problems, heart attack and heart failure.These conditions may cause low blood pressure because they prevent your body from being able to circulateenough blood.

Endocrine problems. Thyroid conditions such as parathyroid disease adrenal insufficiency (Addison'sdisease), low blood sugar (hypoglycemia) and, in some cases, diabetes can trigger low blood pressure.Dehydration. When you become dehydrated, your body loses more water than it takes in. Even milddehydration can cause weakness, dizziness and fatigue. Fever, vomiting, severe diarrhea, overuse ofdiuretics and strenuous exercise can all lead to dehydration.

Far more serious is hypovolemic shock, a life-threatening complication of dehydration. It occurs when lowblood volume causes a sudden drop in blood pressure and a reduction in the amount of oxygen reachingyour tissues. If untreated, severe hypovolemic shock can cause death within a few minutes or hours.

Blood loss. Losing a lot of blood from a major injury or internal bleeding reduces the amount of blood in yourbody, leading to a severe drop in blood pressure.


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Severe infection (septicemia). Septicemia can happen when an infection in the body enters thebloodstream. This condition can lead to a life-threatening drop in blood pressure called septic shock.Severe allergic reaction (anaphylaxis). Anaphylaxis is a severe and potentially life-threatening allergicreaction. Common triggers of anaphylaxis include foods, certain medications, insect venoms and latex.Anaphylaxis can cause breathing problems, hives, itching, a swollen throat and a drop in blood pressure.Lack of nutrients in your diet. A lack of the vitamins B-12 and folate can cause a condition in which yourbody doesn't produce enough red blood cells (anemia), causing low blood pressure.

Medications that can cause low blood pressureSome medications you may take can also cause low blood pressure, including:

Diuretics (water pills), such as furosemide (Lasix) and hydrochlorothiazide (Microzide, Oretic)Alpha blockers, such as prazosin (Minipress) and labetalolBeta blockers, such as atenolol (Tenormin), propranolol (Inderal, Innopran XL, others) and timololDrugs for Parkinson's disease, such as pramipexole (Mirapex) or those containing levodopaCertain types of antidepressants (tricyclic antidepressants), including doxepin (Silenor), imipramine (Tofranil),protriptyline (Vivactil) and trimipramine (Surmontil)Sildenafil (Viagra) or tadalafil (Cialis), particularly in combination with the heart medication nitroglycerin

Types of low blood pressureDoctors often break down low blood pressure (hypotension) into different categories, depending on the causesand other factors. Some types of low blood pressure include:

Low blood pressure on standing up (orthostatic, or postural, hypotension). This is a sudden drop inblood pressure when you stand up from a sitting position or if you stand up after lying down.

Ordinarily, gravity causes blood to pool in your legs whenever you stand. Your body compensates for this byincreasing your heart rate and constricting blood vessels, thereby ensuring that enough blood returns to yourbrain.

But in people with orthostatic hypotension, this compensating mechanism fails and blood pressure falls,leading to symptoms of dizziness, lightheadedness, blurred vision and even fainting.

Orthostatic hypotension can occur for a variety of reasons, including dehydration, prolonged bed rest,pregnancy, diabetes, heart problems, burns, excessive heat, large varicose veins and certain neurologicaldisorders.

A number of medications also can cause orthostatic hypotension, particularly drugs used to treat high bloodpressure diuretics, beta blockers, calcium channel blockers and angiotensin-converting enzyme (ACE)inhibitors as well as antidepressants and drugs used to treat Parkinson's disease and erectile dysfunction.

Orthostatic hypotension is especially common in older adults, with as many as 20 percent of those older thanage 65 experiencing orthostatic hypotension.

But orthostatic hypotension can also affect young, otherwise healthy people who stand up suddenly aftersitting with their legs crossed for long periods or after working for a time in a squatting position.

Low blood pressure after eating (postprandial hypotension). Postprandial hypotension is a sudden dropin blood pressure after eating. It affects mostly older adults.

Just as gravity pulls blood to your feet when you stand, a large amount of blood flows to your digestive tractafter you eat.

Ordinarily, your body counteracts this by increasing your heart rate and constricting certain blood vessels tohelp maintain normal blood pressure. But in some people these mechanisms fail, leading to dizziness,faintness and falls.


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Postprandial hypotension is more likely to affect people with high blood pressure or autonomic nervoussystem disorders such as Parkinson's disease.

Lowering the dose of blood pressure drugs and eating small, low-carbohydrate meals may help reducesymptoms.

Low blood pressure from faulty brain signals (neurally mediated hypotension). This disorder causesblood pressure to drop after standing for long periods, leading to signs and symptoms such as dizziness,nausea and fainting.

Neurally mediated hypotension mostly affects young people, and it seems to occur because of amiscommunication between the heart and the brain.

When you stand for extended periods, your blood pressure falls as blood pools in your legs. Normally, yourbody then makes adjustments to normalize your blood pressure.But in people with neurally mediated hypotension, nerves in the heart's left ventricle actually signal the brainthat blood pressure is too high, rather than too low.

As a result, the brain lessens the heart rate, decreasing blood pressure even further. This causes more bloodto pool in the legs and less blood to reach the brain, leading to lightheadedness and fainting.

Low blood pressure due to nervous system damage (multiple system atrophy with orthostatichypotension). Also called Shy-Drager syndrome, this rare disorder causes progressive damage to theautonomic nervous system, which controls involuntary functions such as blood pressure, heart rate, breathingand digestion.

Although this condition can be associated with muscle tremors, slowed movement, problems withcoordination and speech, and incontinence, its main characteristic is severe orthostatic hypotension incombination with very high blood pressure when lying down.

Low blood pressure (hypotension) can occur in anyone, though certain types of low blood pressure are morecommon depending on your age or other factors:

Age. Drops in blood pressure on standing or after eating occur primarily in adults older than 65. Orthostatic,or postural, hypotension happens after standing up, while postprandial hypotension happens after eating ameal.

Neurally mediated hypotension happens as a result of a miscommunication between the brain and heart. Itprimarily affects children and younger adults.

Medications. People who take certain medications, such as high blood pressure medications like alphablockers, have a greater risk of low blood pressure.Certain diseases. Parkinson's disease, diabetes and some heart conditions put you at a greater risk ofdeveloping low blood pressure.

Even moderate forms of low blood pressure can cause not only dizziness and weakness but also fainting and arisk of injury from falls.And severely low blood pressure from any cause can deprive your body of enough oxygen to carry out its normalfunctions, leading to damage to your heart and brain.

No special preparations are necessary to have your blood pressure checked. You might want to wear a short-sleeved shirt to your appointment so that the blood pressure cuff can fit around your arm properly.

Don't stop taking any prescription medications that you think may affect your blood pressure without yourdoctor's advice.

Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be preparedfor your appointment. Here's some information to help you get ready for your appointment, and what to expectfrom your doctor.


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What you can doBe aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask ifthere's anything you need to do in advance, such as restrict your diet for a blood test.Write down any symptoms you're experiencing, including any that may seem unrelated to low bloodpressure.Write down key personal information, including a family history of low blood pressure and any majorstresses or recent life changes.Make a list of all medications, vitamins or supplements that you're taking.Take a family member or friend along, if possible. Sometimes it can be difficult to remember all theinformation provided to you during an appointment. Someone who accompanies you may remembersomething that you missed or forgot.Be prepared to discuss your diet and exercise habits. If you don't already follow a diet or exercise routine,be ready to talk to your doctor about any challenges you might face in getting started.Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your timetogether. List your questions from most important to least important in case time runs out. For low bloodpressure, some basic questions to ask your doctor include:

What is likely causing my symptoms or condition?What are other possible causes for my symptoms or condition?What kinds of tests will I need?What's the most appropriate treatment?What foods should I eat or avoid?What's an appropriate level of physical activity for me?How often should I be screened for low blood pressure?I have other health conditions. How can I best manage them together?Are there any restrictions that I need to follow?Should I see a specialist?Is there a generic alternative to the medicine you're prescribing for me?Are there any brochures or other printed material that I can take home with me? What websites do yourecommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask any other questions youmay think of during your appointment.

What to expect from your doctorYour doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go overany points you want to spend more time on. Your doctor may ask:

When did you begin experiencing symptoms?Have your symptoms been continuous or occasional?How severe are your symptoms?What, if anything, seems to improve your symptoms?What, if anything, appears to worsen your symptoms?Have you been diagnosed with any other health conditions?What medications are you currently taking?What is your typical daily diet?


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How much exercise do you get in an average week?Do you have a family history of heart disease?

The goal in testing for low blood pressure is to find the underlying cause. This helps determine the correcttreatment and identify any heart, brain or nervous system problems that may cause lower than normal readings.To reach a diagnosis, your doctor may recommend one or more of the following tests:

Blood pressure test. Blood pressure is measured with an inflatable arm cuff and a pressure-measuringgauge.

A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper,number measures the pressure in your arteries when your heart beats (systolic pressure). The second, orlower, number measures the pressure in your arteries between beats (diastolic pressure).Blood tests. These can provide information about your overall health as well as whether you have low bloodsugar (hypoglycemia), high blood sugar (hyperglycemia or diabetes) or a low number of red blood cells(anemia), all of which can cause lower than normal blood pressure.Electrocardiogram (ECG). During this painless, noninvasive test, soft, sticky patches (electrodes) areattached to the skin of your chest, arms and legs. The patches detect your heart's electrical signals while amachine records them on graph paper or displays them on a screen.

An ECG, which can be performed in your doctor's office, detects irregularities in your heart rhythm, structuralabnormalities in your heart, and problems with the supply of blood and oxygen to your heart muscle. It canalso tell if you're having a heart attack or if you've had a heart attack in the past.

Sometimes, heart rhythm abnormalities come and go, and an ECG won't find any problems. If this happens,you may be asked to wear a 24-hour Holter monitor to record your heart's electrical activity as you go aboutyour daily routine.

Echocardiogram. This noninvasive exam, which includes an ultrasound of your chest, shows detailedimages of your heart's structure and function.

Ultrasound waves are transmitted, and their echoes are recorded with a device called a transducer, which isheld outside your body. A computer uses the information from the transducer to create moving images on avideo monitor.

Stress test. Some heart problems that can cause low blood pressure are easier to diagnose when your heartis working harder than when it's at rest. During a stress test, you'll exercise, such as walking on a treadmill.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 orechocardiography. Your blood pressure also may be monitored.

Valsalva maneuver. This noninvasive test checks the functioning of your autonomic nervous system byanalyzing your heart rate and blood pressure after several cycles of a type of deep breathing: You take adeep 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 mediatedhypotension), your doctor may suggest a tilt table test, which evaluates how your body reacts to changes inposition.

During the test, you lie on a table that's tilted to raise the upper part of your body, which simulates themovement from horizontal to a standing position.

Low blood pressure that either doesn't cause signs or symptoms or causes only mild symptoms, such as briefepisodes of dizziness when standing, rarely requires treatment.

If you have symptoms, the most appropriate treatment depends on the underlying cause, and doctors usually tryto address the primary health problem dehydration, heart failure, diabetes or hypothyroidism, for example rather than the low blood pressure itself.


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When low blood pressure is caused by medications, treatment usually involves changing the dose of themedication or stopping it entirely.

If it's not clear what's causing low blood pressure or no effective treatment exists, the goal is to raise your bloodpressure and reduce signs and symptoms. Depending on your age, health status and the type of low bloodpressure you have, you can do this in several ways:

Use more salt. Experts usually recommend limiting the amount of salt in your diet because sodium can raiseblood pressure, sometimes dramatically. 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 withyour doctor before increasing the salt in your diet.

Drink more water. Although nearly everyone can benefit from drinking enough water, this is especially true ifyou have low blood pressure.

Fluids increase blood volume and help prevent dehydration, both of which are important in treatinghypotension.

Wear compression stockings. The same elastic stockings commonly used to relieve the pain and swellingof 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 pressurethat 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 helpsboost your blood volume, which raises blood pressure.

Doctors often use the drug midodrine (Orvaten) to raise standing blood pressure levels in people with chronicorthostatic hypotension. It works by restricting the ability of your blood vessels to expand, which raises bloodpressure.

Depending on the reason for your low blood pressure, you may be able to take certain steps to help reduce oreven prevent symptoms. Some suggestions include:

Drink more water, less alcohol. Alcohol is dehydrating and can lower blood pressure, even if you drink inmoderation. 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 using more salt but you don't like a lot of salt on your food, try using natural soy sauceor adding dry soup mixes to dips and dressings.

Go slowly when changing body positions. You may be able to reduce the dizziness and lightheadednessthat occur with low blood pressure on standing by taking it easy when you move from a prone to a standingposition.

Before getting out of bed in the morning, breathe deeply for a few minutes and then slowly sit up beforestanding. 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 onefoot on a ledge or chair and lean as far forward as possible. These maneuvers encourage blood to flow fromyour legs to your heart.

Eat small, low-carb meals. To help prevent blood pressure from dropping sharply after meals, eat smallportions several times a day and limit high-carbohydrate foods such as potatoes, rice, pasta and bread.

Your doctor also may recommend drinking caffeinated coffee or tea with meals to temporarily raise bloodpressure. But because caffeine can cause other problems, check with your doctor before drinking morecaffeinated beverages.

References


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May 02, 2014

Original article: http://www.mayoclinic.org/diseases-conditions/low-blood-pressure/basics/lifestyle-home-remedies/con-20032298

Hypotension. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/hyp/. Accessed Jan. 6, 2014.1.

Low blood pressure. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Low-Blood-Pressure_UCM_301785_Article.jsp. Accessed Jan. 6, 2014.

2.

Kaufman H, et al. Mechanisms, causes and evaluation of orthostatic hypotension. http://www.uptodate.com/home. Accessed Jan. 6,2014.

3.

Kaufman H, et al. Treatment of orthostatic and postprandial hypotension. http://www.uptodate.com/home. Accessed Jan. 6, 2014.4.

Bonow RO, et al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa.: Saunders Elsevier;2012. http://www.clinicalkey.com. Accessed Jan. 6, 2014.

5.

NINDS Multiple system atrophy with orthostatic hypotension information page. National Institute for Neurological Disorders and Stroke.http://www.ninds.nih.gov/disorders/msa_orthostatic_hypotension/msa_orthostatic_hypotension.htm. Accessed Jan. 7, 2014.

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Shep SG (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 11, 2014.7.

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