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Blood pressure (low)

Low blood pressure is also known as hypotension. People with a reading of around 90/60, or less, are commonly regarded as having low blood pressure.
Brought to you by NHS Choices

Overview

Introduction

Your heart pumps blood around your body through a circulatory system that is made up of tubes called arteries and capillaries. The blood flows back to your heart through a network of veins.

When your heart contracts (squeezes in) it pushes blood into your arteries, causing an increase in pressure. At this stage, the pressure in your arteries is at its highest, and is known as the systolic pressure. When your heart relaxes and refills with blood, the pressure in your arteries decreases. This is known as the diastolic pressure. Both your systolic and diastolic pressures are measured in terms of millimetres of mercury (mmHg).

Throughout the day, your blood pressure can vary by between 30-40 mmHg (both systolic and diastolic) depending on what you are doing. When you are asleep or relaxed your blood pressure will be at its lowest. When you exercise, or you are stressed or anxious, your blood pressure will increase. Therefore, each time you have your blood pressure measured, it is important that the test is carried out under similar conditions so that the results are consistent.

The highs and lows

For a young, healthy adult, normal blood pressure is about 110/70, but generally, the lower your blood pressure is, the better. If you have a reading of 140/90 or more, you have high blood pressure, also known as hypertension. If your blood pressure is high, your GP may give you advice about how to lower it by making some simple lifestyle changes, such as altering your diet, giving up smoking, and taking regular exercise. Alternatively, you may be prescribed drugs that will help to reduce your blood pressure.

Low blood pressure is also known as hypotension. People with a reading of around 90/60, or less, are commonly regarded as having low blood pressure. If you have low blood pressure, you have (to a certain degree) some protection against factors that increase blood pressure, such as eating too much salt, not eating enough fruit and vegetables, or being overweight. However, some people who have low blood pressure may experience symptoms, and there may be an underlying cause.

Symptoms

Symptoms of low blood pressure

On its own, low blood pressure does not always cause symptoms. If you have low blood pressure, and do not have any symptoms, you do not require treatment. However, sometimes if your blood pressure is too low, there may not be enough blood flowing to your brain and other vital organs. As a result, you may experience symptoms such as dizziness and fainting. If you do, your GP will try to find out whether there is an underlying cause for your symptoms.

As well as dizziness and fainting, other symptoms of hypotension may include:

  • light-headedness,
  • blurred vision,
  • palpitations,
  • confusion,
  • nausea,
  • general weakness, and
  • a temporary loss of consciousness.


Postural, or orthostatic hypotension

You may feel dizzy, or faint, after changing posture - for example, when you sit up from a lying position, or stand up from a sitting position. However, the fall in blood pressure usually only lasts for a few minutes as it adjusts to your new posture. This is known as postural, or orthostatic hypotension, and can affect you more as you get older. Similar symptoms may also occur after exercise.

Postprandial hypotension

Dizziness, light-headedness, faintness and falls are symptoms that can sometimes occur after eating, as a result of low blood pressure. This condition, known as postprandial hypotension, tends to occur more often in older people, particularly in those who have high blood pressure, or a condition such as Parkinsons disease or diabetes.

After a meal, the intestines need a large amount of blood for digestion, and so the heart rate increases, and the blood vessels in other parts of the body constrict (narrow) to help maintain blood pressure. However, the heart rate of some elderly people may not increase enough, and their blood vessels may not constrict enough to maintain blood pressure. As a result, their blood pressure falls. Lying down after eating, and eating frequent, small, low-carbohydrate meals may help to reduce the effects of postprandial hypotension.

Causes

Causes of low blood pressure

There are a number of things that can cause low blood pressure. They include:

  • the use of certain medications, such as anti-depressants, and medicines to treat high blood pressure,
  • diabetes mellitus, which can cause damage to the nerves that supply your blood vessels, resulting in a fall in blood pressure when you stand up (postural or orthostatic hypotension),
  • serious injuries, such as burns, or those that cause severe blood loss, and lead to shock and a reduction in blood volume,
  • serious illnesses, or conditions, such as a heart attack, or adrenal gland failure,
  • rare nerve conditions that affect the nerves in your legs can cause a severe drop in blood pressure when you stand up (postural or orthostatic hypotension),
  • increasing age, as you get older, your arteries become stiffer which can cause your blood pressure to drop, particularly when you stand up, and
  • pregnancy, during the early to mid stages of pregnancy low pressure is fairly common.

Blood pressure lowering medicines

Nowadays, most blood pressure lowering medicines do not cause a drop in blood pressure when you stand up. Alpha-blockers, such as doxazosin, are the only type of medicine that may cause a decrease in your standing blood pressure. You should have your standing blood pressure checked if you are taking doxazosin and you feel dizzy or faint when you stand up.

In the past, it was thought that low blood pressure could cause tiredness, depression and anxiety. However, recent studies have found no strong evidence to suggest that low blood pressure causes these symptoms.

Adrenal gland failure

The adrenal glands are two small glands that are located just above your kidneys. They produce a number of hormones, including aldosterone, which controls the amount of salt in your body. If your adrenal glands become damaged, the production of aldosterone may be reduced, resulting in a loss of salt from your body. This can lead to low blood pressure, and may make you feel dizzy or faint if you stand up too quickly. Adrenal gland failure is rare but, if it is diagnosed, it can be treated by increasing the amount of aldosterone.

Diagnosis

Diagnosing low blood pressure

Blood pressure is measured using two numbers the first is known as systolic (the pressure in your arteries when your heart contracts and pushes the blood around your body), and the second is known as diastolic (the pressure in your arteries when the heart refills with blood between heart beats). Both your systolic and diastolic pressures are measured in millimetres of mercury (mmHg).

Your GP or practice nurse will use an inflatable cuff to measure your blood pressure. The cuff is placed around your upper arm and inflated. Your GP or practice nurse will watch a pressure gauge and listen to the blood flow in the main artery of your arm, using a stethoscope. Upon hearing the heart beat, the systolic pressure will be recorded, and when the sound disappears, the diastolic pressure will be recorded. Alternatively, a digital blood pressure machine may be used to take readings automatically.

After you have had your blood pressure taken, your GP or nurse will give you your systolic reading first, followed by your diastolic reading. If your systolic blood pressure is 120 mmHg, and your diastolic blood pressure is 80 mmHg, you will be told that your blood pressure is 120 over 80, which is commonly written as 120/80.

Your blood pressure may be measured both while you are lying down and while you are standing. If you have high or low blood pressure and you are taking medication, you should have your blood pressure checked on a regular basis.

Treatment

Treating low blood pressure

If you have low blood pressure, but do not have any symptoms, you do not require treatment. Only a small number of people who have low blood pressure are prescribed medication to treat the condition. For example, some elderly people may experience symptoms when changing posture, and are sometimes given medication to constrict (narrow) their arteries.

Medications that cause low blood pressure

If you are taking medication and your GP suspects that it may be causing low blood pressure, s/he will probably advise a change of medication or alter the dose. If you are taking a blood pressure lowering medicine, such as the alpha blocker, doxazosin, and you feel dizzy or faint when you stand up, you should have your blood pressure measured to see if it drops. If it does, you might need to have your medicine changed. You should discuss this with your GP or practice nurse.

Underlying illnesses or conditions

If your GP suspects that a disorder, such as a heart condition, adrenal gland failure, or a nerve condition, is causing your low blood pressure, you may be referred to hospital for further tests and treatment. If adrenal gland failure is the cause of your low blood pressure, replacing the missing hormone, aldosterone, will rectify the problem. If a nerve condition is causing low blood pressure, it can be more difficult to treat. You might be given medicines in order to stimulate your nervous system.

Salt and fluids

While people who have high blood pressure are usually advised to restrict their salt intake, if you have low blood pressure, you may be advised to include more salt in your diet. If you have postural (orthostatic) hypotension, you may be advised to increase your salt intake, either by adding more salt to your food, or by using salt tablets. Your GP will be able to advise you about how much additional salt you require. Also, if you are dehydrated, ensuring that you drink enough fluid (at least eight glasses a day) will help.

Other treatments

If you have low blood pressure, your GP may recommend wearing support stockings to help stimulate your circulation, or using several pillows to raise your head while sleeping.

Prevention

Preventing low blood pressure

If you have low blood pressure, and it is part of your genetic make up, you are lucky because it means that, to a certain degree you have some natural protection against the factors that cause high blood pressure (hypertension).

Older people, particularly those with diabetes, may have a tendency for their blood pressure to fall when standing, and blood pressure lowering drugs may make this worse. However, getting up slowly will help you to avoid sudden falls in your blood pressure. When getting out of bed, you should sit up slowly first, before standing up slowly.

Useful links

NHS Choices links

External links

This article was originally published by NHS Choices

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