What happens when blood pressure bottoms out

What is hypotension?

Hypotension is abnormally low blood pressure (lower than 90/60 mm Hg). If your blood pressure gets too low, it can cause dizziness, fainting or death.

Low blood pressure is not a condition that is usually treated except if it occurs in the elderly or occurs suddenly. In patients over 65, it could indicate the brain and limbs are not receiving adequate blood supply. If your blood pressure drops suddenly, it could deprive the brain of blood, which can lead to lightheadedness or dizziness.

When blood pressure drops suddenly after moving from a lying down to a sitting position, it is called postural hypotension or orthostatic hypotension.

When blood pressure drops from standing for a long period of time and leads to passing out, it is called vasovagal syncope.

Common related conditions

Causes of hypotension

There are several causes of hypotension including:

• Prolonged bed rest
• Pregnancy
• Low or high body temperature
• Excessive blood loss
• Severe dehydration
• Blood infections such as sepsis
• Anaphylaxis allergic reaction
• Reactions to medication or alcohol

Risk factors for hypotension

• Age — your risk of low pressure increases as you age. Approximately 10-20% of people older than 65 have postural hypotension.
• Medications — medications, such as alpha blockers, can lower blood pressure.
• Other serious conditions — if you have diabetes or Parkinson’s disease, you have a higher risk for developing hypotension.

Symptoms of hypotension

Most doctors don’t consider hypotension serious unless it produces noticeable symptoms such as:

• Nausea
• Fainting
• Dehydration
• Blurred vision
• Cold, clammy, pale skin
• Fatigue
• Depression

If you have cold, clammy or pale skin, rapid or shallow breathing, weak or rapid pulse or confusion, you could be suffering from extreme hypotension, which could lead to death. Call 911 immediately if you suspect you are suffering from extreme hypotension.

Diagnosis of hypotension

One abnormally low blood pressure reading without any other symptoms will usually not cause concern. In most cases, your doctor will monitor you over a series of visits to evaluate if the low blood pressure is a consistent pattern. The physician may also order other diagnostic tests to determine the underlying cause of the condition.

Tests that your doctor may order include:

• Blood tests — can help you determine if you have hypoglycemia (low blood sugar), hyperglycemia/diabetes (high blood sugar) or anemia (low red blood count).
• Electrocardiogram (ECG) — can detect the heart’s electrical signals to detect heart rhythm or structural abnormalities, as well as problems with the supply of oxygen-rich blood to the heart.
• Echocardiogram — can show detailed images of the heart to determine structure and function.
• Stress test — during a stress test, you will do some form of exercise to get your heart pumping faster and then you will be monitored with an echocardiogram or electrocardiogram.
• Tilt table test — will determine how your body reacts to changes in position; you will lie on a table that is then tilted to simulate moving from a lying to standing position.

Treatments of hypotension

Low blood pressure that doesn’t show any symptoms does not typically require treatment. For those who do have symptoms, you will be treated based on what the underlying cause of the low blood pressure is.

Home treatments include:

• Increasing water consumption and limiting alcohol consumption — water helps increase blood volume and prevent dehydration.
• Wearing compression socks — wearing compression socks promotes blood flow in the legs.
• Consuming more salt — sodium makes it harder for your body to rid itself of excess fluid and adds strain to the blood vessels resulting in raised blood pressure.
• Exercising regularly — regular exercise promotes blood flow.

If conservative treatments are not successful in increasing your blood pressure, your doctor may need to prescribe medication.

Drugs that treat hypotension include:

• Fludrocortisone — a drug which helps the body retain sodium in the kidney, which helps raise blood pressure.
• Midodrine — a drug that can increase blood pressure by activating receptors on the small arteries and veins.

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Low blood pressure, also called hypotension, happens when blood pressure falls below what is considered normal — a reading of 90/60 or lower. When blood pressure is much lower than normal, it means not enough blood is flowing to the heart, brain and other parts of the body.

Some people may naturally have low blood pressure all the time with no symptoms. Their low readings are normal for them. But for others, their blood pressure may drop for a variety of reasons ranging from a medical condition to dehydration.

Low blood pressure is only a problem if a person develops symptoms, which can include dizziness, fainting or shock. In severe cases, it can be life-threatening. But low blood pressure without these serious symptoms is usually not unhealthy.

Low blood pressure that reduces the blood supply to your body’s organs can cause stroke, kidney failure or heart attack.

Understanding how to treat and prevent low blood pressure is important for your cardiovascular health.

Understanding Blood Pressure

Blood pressure is the force of blood pressing against arteries as the heart pumps it through the body. The pressure is highest when your heart beats, pumping the blood. It’s lowest between beats, when the heart rests.

Blood pressure is measured by comparing these two numbers, placing one over the other. The high measurement is called the systolic pressure, and it is placed on the top of the reading. The lower pressure is called the diastolic pressure, and it’s written as the bottom number.

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Ideally, your blood pressure should be 120 over 80 — written as 120/80 — or lower. Low blood pressure is anything lower than 90/60.

What Causes Low Blood Pressure?

Causes of low blood pressure are wide-ranging and can include changes in your body’s functions, environmental causes, and trauma or a serious medical condition.

Causes of low blood pressure include:

• Anaphylactic shock
• Endocrine conditions such as Addison’s disease, hypothyroidism, parathyroid disease, low blood sugar and diabetes
• Heart conditions such as heart attack, heart failure, low heart rate and heart valve issues
• Long-term bed rest
• Medications
• Nutritional deficiencies such as low folic acid or vitamin B12 levels, which can lead to anemia
• Pregnancy, especially in the first 24 weeks
• Septic shock
• Sudden loss of blood volume such as from an accident, dehydration or internal bleeding

Source: American Heart Association

Age, medications and medical conditions are all risk factors for low blood pressure.

People with Parkinson’s disease, diabetes and certain heart conditions are at greater risk. Those 65 and older are more likely to experience a sudden blood pressure drop when standing or right after eating.

Medications that Can Cause Low Blood Pressure

Several medicines may cause low blood pressure, including some medications used to control high blood pressure.

Working with your doctor or other health care provider to change your medication or adjust your dosage can help control low blood pressure. You should never modify a dose or stop taking a medication without first consulting your health care provider.

Alpha and beta blockers, diuretics, erectile dysfunction drugs, Parkinson’s disease drugs and some types of antidepressants can cause low blood pressure.

Medications that can cause low blood pressure include:

• Benicar (olmesartan medoxomil) — a prescription blood pressure medication
• Cialis (tadalafil) — an erectile dysfunction drug; risk is especially high when taken with nitroglycerin heart medication
• Cymbalta (duloxetine) — a serotonin and norepinephrine inhibitor (SNRI) antidepressant
• Hydrochlorothiazide — a widely used generic diuretic
• Inderal, Innopran XL and other versions of propranolol — beta blockers
• Lasix (furosemide) — a diuretic
• Levodopa — a generic name for Parkinson’s disease drugs
• Minipress (prazosin) and other alpha blockers
• Mirapex (pramipexole) — a Parkinson’s disease drug
• Tenormin (atenolol) — an alpha blocker
• Tricyclic antidepressants — includes Silenor (doxepin) and Trofranil (imipramine)
• Valsartan and other blood pressure drugs in the sartan family
• Viagra (sildenafil) — an erectile dysfunction drug; risk is especially high when taken with nitroglycerin heart medication

Side Effect Information

Valsartan side effects range from headaches to low blood pressure. Learn more about the common and serious side effects assciated with this blood pressure medication.

View Side Effects

Symptoms

In most cases, you shouldn’t worry about a low blood pressure reading unless you have symptoms of a serious or underlying problem.

Common symptoms of low blood pressure include:

• Blurred vision
• Dehydration
• Depression
• Fainting
• Fatigue
• Lack of concentration
• Lightheadedness or dizziness
• Nausea

Severe or extreme low blood pressure can be life-threatening. This can happen if your body goes into shock from blood loss, an anaphylactic reaction or septic shock from a serious infection.

Serious symptoms of low blood pressure include:

• Rapid but weak pulse
• Rapid shallow breathing
• Pale, cold, clammy skin
• Confusion (especially in older people)

What to Do if You Experience a Sudden Drop in Blood Pressure

A single low blood pressure reading is no cause to be concerned unless you experience other symptoms.

A sudden drop in blood pressure — as little as a drop from 120 to 100 in your systolic (top) number — can be dangerous if it triggers dizziness and fainting. Such symptoms can be a sign of an underlying problem that may need medical attention.

You should keep a record of your activities and when symptoms happen to discuss them with your doctor. If you experience any low blood pressure symptoms related to shock, you should seek immediate medical attention.

Types of Low Blood Pressure

There are three major types of low blood pressure: orthostatic hypotension, postprandial hypotension and neurally mediated hypotension. Each is triggered by something different such as a change in body position, a meal or an abnormal reflex.

Orthostatic Hypotension

Orthostatic hypertension is low blood pressure caused by a change in your body’s position that most often happens when you stand up after lying down. It lasts only a few seconds or minutes.

Orthostatic low blood pressure is caused by gravity as your blood pools in your legs. Your heart would normally compensate, pumping more blood to your brain. But with this type of low blood pressure, that mechanism fails, your brain gets less oxygen from the bloodstream and you may feel lightheaded or dizzy. In some cases, you may faint.

It most often affects older people, people with high blood pressure and those with Parkinson’s disease. But you may also experience it if you are pregnant, dehydrated, overheated, or have heart problems, diabetes or certain nerve disorders.

Postprandial Hypotension

Postprandial hypotension is a sudden drop in blood pressure after eating.

Usually after a meal, your heart rate ramps up to send blood flowing to your digestive system. But with this type of low blood pressure, the mechanism fails causing dizziness and fainting. It can also cause people to fall and possibly injure themselves.

Eating small meals that are low in carbohydrates can sometimes reduce symptoms.

Neurally Mediated Hypotension

Neurally mediated hypotension happens when there is an abnormal reflex between a person’s otherwise normally functioning heart and brain, according to Johns Hopkins Hospital. It’s sometimes called the fainting reflex.

People with this type of low blood pressure may feel lightheaded or dizzy or may faint. Other symptoms may include chronic fatigue, muscle aches, headaches and confusion.

Symptoms may happen after being in warm surroundings such as a hot shower or bath or hot summer weather. Other triggers include standing quietly for a long period of time, such as a service member at attention. It can happen after exercise, after eating or following emotionally stressful situations.

With this type of low blood pressure, gravity allows blood to pool in the legs. The heart needs to beat faster to supply the brain with enough blood, but a malfunction causes the brain to tell the heart to beat less, decreasing the blood supply to the brain.

Treatments

Low blood pressure seldom requires treatment, unless it’s the result of sudden trauma, infection, anaphylactic shock or other serious underlying cause.

If it’s caused by medications, your doctor may prescribe a different medication or simply alter your dosage.

Ways to correct low blood pressure:

• Wear compression stockings to prevent the pooling of blood in the legs
• Drink fluids to prevent or relieve dehydration, a major cause of common low blood pressure
• Eat more salt to raise blood pressure

Your doctor may prescribe Orvaten (midodrine) to raise your blood pressure if you are diagnosed with chronic orthostatic hypotension. For milder forms, a doctor may prescribe fludrocortisone to boost your blood volume. There are several other drugs that may be available depending on your particular type and severity of low blood pressure.

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