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Hypotension

Hypotension

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Published by Nader Smadi

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Published by: Nader Smadi on Feb 07, 2009
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02/01/2013

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Hypotension
Definition

Low blood pressure, also called hypotension, would seem to be something to strive
for. After all, high blood pressure (hypertension) is a well-known risk factor for heart
disease and other problems. In fact, in recent years there has been an ongoing
downward revision of what is considered a normal blood pressure reading. A blood
pressure less than 120/80 millimeters of mercury (mm Hg) is now considered normal
and optimal for good health.

So, it's easy to understand why you might assume the lower the better when it comes to blood pressure. And it's true that for some people \u2014 those who exercise and are in top physical condition \u2014 low blood pressure is a sign of health and fitness. But that's not always the case.

For many people, low blood pressure can cause dizziness and fainting or indicate
serious heart, endocrine or neurological disorders. Severely low blood pressure can
deprive the brain and other vital organs of oxygen and nutrients, leading to a life-
threatening condition called shock.

Symptoms

Some people with low blood pressure are in peak physical condition with strong
cardiovascular systems and a reduced risk of heart attack and stroke. But low blood
pressure can also signal an underlying problem, especially when it drops suddenly or
is accompanied by signs and symptoms such as:

\ue000
Dizziness or lightheadedness
\ue000
Fainting (syncope)
\ue000
Lack of concentration
\ue000
Blurred vision
\ue000
Nausea
\ue000
Cold, clammy, pale skin
\ue000
Rapid, shallow breathing
\ue000
Fatigue
\ue000
Depression
\ue000
Thirst
Causes
Blood pressure is a measurement of the pressure in your arteries during the active and
resting phases of each heartbeat. Here's what the numbers mean:
\ue000
Systolic pressure. The first number in a blood pressure reading, this is the
amount of pressure your heart generates when pumping blood through your
arteries to the rest of your body.
\ue000
Diastolic pressure. The second number in a blood pressure reading, this refers
to the amount of pressure in your arteries when your heart is at rest between
beats.

Although you can get an accurate blood pressure reading at any given time, blood
pressure isn't static. It can vary considerably in a short amount of time \u2014 sometimes
from one heartbeat to the next, depending on body position, breathing rhythm, stress
level, physical condition, medications you take, what you eat 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?

Current guidelines identify normal blood pressure as lower than 120/80 \u2014 many
experts think 115/75 is optimal. Higher readings indicate increasingly serious risks of
cardiovascular disease. Low blood pressure, on the other hand, is much harder to
quantify.

Some experts define low blood pressure as readings lower than 90 systolic or 60
diastolic \u2014 you need to have only one number in the low range for your blood
pressure to be considered lower than normal. In other words, if your systolic pressure
is a perfect 115, but your diastolic pressure is 50, you're considered to have lower than

normal pressure.

Yet this can be misleading because what's considered low blood pressure for you may
be normal for someone else. For that reason, doctors often consider chronically low
blood pressure too low only if it causes noticeable symptoms.

On the other hand, a sudden fall in blood pressure can be dangerous. A change of just
20 mm Hg \u2014 a drop from 130 systolic to 110 systolic, for example \u2014 can cause
dizziness and fainting when the brain fails to receive an adequate supply of blood.
And big plunges, especially those caused by uncontrolled bleeding, severe infections
or allergic reactions can, be life-threatening.

Causes of low blood pressure vary

Athletes and people who exercise regularly tend to have lower blood pressure than do
people who aren't as fit. So, in general, do nonsmokers and people who eat well and
maintain a normal weight.

But in some instances, low blood pressure can be a sign of serious, even life-
threatening disorders. The American Heart Association considers the following as
possible causes of low blood pressure:

\ue000
Pregnancy. Because a woman's circulatory system expands rapidly during

pregnancy, blood pressure is likely to drop. In fact, during the first 24 weeks
of pregnancy, systolic pressure commonly drops by five to 10 points and
diastolic pressure by as much as 10 to 15 points.

\ue000
Medications. Many drugs can cause low blood pressure, including diuretics

and other drugs that treat high blood pressure; heart medications such as beta
blockers; drugs for Parkinson's disease; tricyclic antidepressants; sildenafil
(Viagra), particularly in combination with nitroglycerine; narcotics; and

alcohol. Some over-the-counter medications can cause low blood pressure
when taken in combination with medications used to treat high blood pressure.
\ue000
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 circulate enough blood.

\ue000
Endocrine problems. An underactive thyroid (hypothyroidism) or overactive

thyroid (hyperthyroidism) can cause low blood pressure. In addition, other
conditions, such as adrenal insufficiency (Addison's disease), low blood sugar
(hypoglycemia), and in some cases, diabetes, can trigger low blood pressure.

\ue000
Dehydration. When you become dehydrated, your body loses more water

than it takes in. Even mild dehydration can cause weakness, dizziness and
fatigue. Fever, vomiting, severe diarrhea, overuse of diuretics and strenuous
exercise can all lead to dehydration. Far more serious is hypovolemic shock, a
life-threatening complication of dehydration. It occurs when low blood
volume causes a sudden drop in blood pressure and a corresponding reduction
in the amount of oxygen reaching your tissues. If untreated, severe
hypovolemic shock can cause death within a few minutes or hours.

\ue000
Blood loss. Losing a lot of blood from major injury or severe internal bleeding
reduces the amount of blood in your body, leading to a severe drop in blood
pressure.
\ue000
Severe infection (septicemia). Septicemia can happen when an infection in

the body enters the bloodstream. Lung, abdomen or urinary tract infections are usually the cause of septicemia. These conditions can lead to a life-threatening drop in blood pressure called septic shock.

\ue000
Allergic reaction (anaphylaxis). Anaphylaxis is a severe and potentially life-

threatening allergic reaction. 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.

\ue000
Nutritional deficiencies. A lack of the vitamins B-12 and folate can cause

anemia, a condition in which your body doesn't produce enough red blood
cells. In addition to making you feel tired because you're not getting enough
oxygen, anemia can lead to low blood pressure.

Types of low blood pressure
Doctors often break down low blood pressure (hypotension) into different categories,
depending on the causes and other factors. Some types of low blood pressure include:
\ue000
Low blood pressure on standing up (postural or orthostatic hypotension).

This is a sudden drop in blood pressure when you stand up from a sitting
position or if you stand up after lying down. Ordinarily, blood pools in your
legs whenever you stand, but your body compensates for this by increasing
your heart rate and constricting blood vessels, thereby ensuring that enough
blood returns to your brain. But in people with postural hypotension, this
compensating mechanism fails and blood pressure falls, leading to dizziness,
lightheadedness, blurred vision and even fainting.

Postural 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 neurological disorders. A number of

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