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 — those who exercise and are in top physical condition — 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 lifethreatening condition called shock.

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:
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Dizziness or lightheadedness Fainting (syncope) Lack of concentration Blurred vision Nausea Cold, clammy, pale skin Rapid, shallow breathing Fatigue Depression Thirst

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:

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.

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 — 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 — 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 — 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 — a drop from 130 systolic to 110 systolic, for example — 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 lifethreatening disorders. The American Heart Association considers the following as possible causes of low blood pressure:

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. 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. 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. 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. 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. 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. 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. Allergic reaction (anaphylaxis). Anaphylaxis is a severe and potentially lifethreatening 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. 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:

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

medications can also cause postural hypotension, particularly drugs used to treat high blood pressure — 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. Postural hypotension is especially common in older adults, with as many as 20 percent of those over age 65 experiencing postural hypotension. But postural hypotension can also affect young, otherwise healthy people who stand up suddenly after sitting with their legs crossed for long periods or after working for a time in a squatting position.

Low blood pressure due to nervous system damage (multiple system atrophy with orthostatic hypotension). Also called Shy-Drager syndrome, this rare disorder causes progressive damage to the autonomic nervous system, which controls involuntary functions such as blood pressure, heart rate, breathing and digestion. Although multiple system atrophy can be associated with muscle tremors, slowed movement, problems with coordination and speech, and incontinence, its main characteristic is severe orthostatic hypotension in combination with very high blood pressure when lying down. Multiple system atrophy can't be cured and usually proves fatal within seven to 10 years of diagnosis. Low blood pressure after eating (postprandial hypotension). A problem that almost exclusively affects older adults, postprandial hypotension is a sudden drop in blood pressure after eating. Just as gravity pulls blood to your feet when you stand, a large amount of blood flows to your digestive tract after you eat. Ordinarily, your body counteracts this by increasing your heart rate and constricting certain blood vessels to help maintain normal blood pressure. But in some people these mechanisms fail, leading to dizziness, faintness and falls. Postprandial hypotension is more likely to affect people with high blood pressure or autonomic nervous system disorders such as Parkinson's disease. Lowering the dose of blood pressure drugs and eating small, low-carbohydrate meals may help reduce symptoms. Low blood pressure from faulty brain signals (neurally mediated hypotension). Unlike orthostatic hypotension — which occurs when you stand up from a sitting or lying position — this disorder causes blood pressure to drop after standing for long periods, leading to symptoms such as dizziness, nausea and fainting. Although the end result is similar, neurally mediated hypotension differs from orthostatic hypotension in other important respects: It primarily affects young people, for instance, and rather than resulting from failed blood pressure regulation, it seems to occur because of a miscommunication between the heart and the brain. When you stand for extended periods, your blood pressure falls as blood pools in your legs. Normally, your body 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 brain that blood pressure is too high, rather than too low, and so the brain lessens the heart rate, decreasing blood pressure even further. This causes more blood to pool in the legs and less blood to reach the brain, leading to lightheadedness and fainting.

Risk factors
Low blood pressure (hypotension) can happen to anyone, though certain types of low blood pressure are more common depending on your age or other factors:

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Age. Drops in blood pressure on standing or after eating occur primarily in older adults. Orthostatic hypotension happens after standing up, while postprandial hypotension happens after eating a meal. Neurally mediated hypotension happens as a result of a miscommunication between the brain and heart. It primarily affects children and younger adults. Medications. People who take certain medications, such as high blood pressure medication, have a greater risk of low blood pressure. Certain diseases. Parkinson's disease and some heart conditions put you at a greater risk of developing low blood pressure.

When to seek medical advice
In many instances, low blood pressure isn't serious. If you have consistently low readings but feel fine, your doctor is likely to monitor you during routine exams. Even occasional dizziness or lightheadedness may be relatively minor — the result of mild dehydration, low blood sugar or too much time in the sun or a hot tub, for example. In these situations, it's not a matter so much of 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 they sometimes can point to more serious problems. It can be helpful to keep a record of your symptoms, when they occur and what you were doing at the time. If these occur at times that may endanger you or others, you should talk to your doctor.

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

Blood tests. These can provide a certain amount of information about your overall health as well as whether you have low blood sugar (hypoglycemia) or a low number of red blood cells (anemia), both of which can cause lower than normal blood pressure. Electrocardiogram (ECG, EKG). This noninvasive test, which can be performed in your doctor's office, detects irregularities in your heart rhythm, structural abnormalities in your heart, and problems with the supply of blood and oxygen to your heart muscle. It can also tell if you're having a heart attack or if you've had a heart attack in the past. Sometimes you may be asked to wear a 24-hour Holter monitor to record your heart's electrical activity as you go about your daily routine.

Echocardiogram. Using the same technology that allows you to view a fetus in the womb, an echocardiogram uses sound waves to produce images of your heart that may show abnormalities in your heart muscle or valves. Stress test. Some heart problems which can cause low blood pressure are easier to diagnose when your heart is working harder than when it's at rest. During a stress test, you'll exercise, such as walking on a treadmill. (Or, 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 or echocardiography. Your blood pressure also may be monitored. Valsalva maneuver. This noninvasive test checks the functioning of your autonomic nervous system by analyzing your heart rate and blood pressure after several cycles of a type of deep breathing: You take a deep 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 mediated hypotension), your doctor may suggest a tilttable test, which evaluates how your body reacts to changes in position. During the test, you lie on a table that's tilted to raise the upper part of your body, which simulates the movement from a prone to a standing position.

Even moderate forms of low blood pressure can seriously affect quality of life, leading not only to dizziness and weakness but also to fainting and a risk of injury from falls. And severely low blood pressure from any cause can deprive your body of enough oxygen to carry out its normal functions, leading to damage to your heart and brain.

Treatments and drugs
Low blood pressure that doesn't cause signs or symptoms rarely requires treatment. In symptomatic cases, the appropriate therapy depends on the underlying cause, and doctors usually try to address the primary health problem — dehydration, heart failure, diabetes or hypothyroidism, for example — rather than low blood pressure itself. When low blood pressure is caused by medications, treatment usually involves changing the dose of the medication 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 blood pressure and reduce signs and symptoms. Depending on your age, health status and the type of low blood pressure you have, this may be accomplished in several ways:

Use more salt. Experts usually recommend limiting the amount of salt in your diet because sodium can raise blood pressure, sometimes dramatically. But 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 with your doctor before upping your salt intake.

Drink more water. Although nearly everyone can benefit from drinking enough water, this is especially true if you have low blood pressure. Fluids increase blood volume and help prevent dehydration, both of which are important in treating hypotension. Use compression stockings. The same elastic stockings and leotards commonly used to relieve the pain and swelling of 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 pressure that 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 helps boost your blood volume, which raises blood pressure. Doctors often use the drug midodrine to raise standing blood pressure levels in people with chronic orthostatic hypotension. It works by restricting the ability of your blood vessels to expand, which raises blood pressure. Other drugs, such as pyridostigmine, nonsteroidal anti-inflammatory drugs (NSAIDs), caffeine and erythropoietin are sometimes used, too, either alone or with other drugs.

Lifestyle and home remedies
Depending on the reason for your low blood pressure, you may be able to take certain steps to help reduce or even prevent symptoms. Some suggestions include:

Drink more water, less alcohol. Alcohol is dehydrating and can lower blood pressure, even if you drink in moderation. 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 increasing your sodium intake but you don't like a lot of salt on your food, try using natural soy sauce — a whopping 1,200 milligrams of sodium per tablespoon — or adding dry soup mixes, also loaded with sodium, to dips and dressings. Go slow. You may be able to reduce the dizziness and lightheadedness that occurs with low blood pressure on standing by taking it easy when you move from a prone to a standing position. Before getting out of bed in the morning, breathe deeply for a few minutes and then slowly sit up before standing. 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 one foot on a ledge or chair and lean as far forward as possible. These maneuvers encourage blood to flow from your legs to your heart. Eat small, low-carb meals. To help prevent blood pressure from dropping sharply after meals, eat small portions several times a day and limit highcarbohydrate foods such as potatoes, rice, pasta and bread. Drinking caffeinated coffee or tea with meals may temporarily raise blood pressure, in some cases by as much as 3 to 14 millimeters of mercury (mm Hg). But because caffeine can cause other problems, check with your doctor before increasing your caffeine intake.

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