Hypotension Symptoms and Treatment

Hypotension is excessively low blood pressure (the intricacies of blood pressure and its measurement are discussed fully under the hub on hypertension). Low blood pressure only causes concern when it causes symptoms or is detected in the course of investigation of other diseases (e.g. someone with a suspected heart attack). A person (particularly a young woman) may have a blood pressure of 90/50 and be perfectly well, but the same pressure in an elderly person may have serious consequences and require treatment. Hypotension (low blood pressure) is thus a relative term, the blood pressure is low compared to what is should be, and not an absolute one.

Low blood pressure may occur with a serious injury resulting in blood loss (shock), heart attack, heart failure, dehydration, alcoholism, serious infections, heat stroke, pregnancy, a large number of less common diseases, and with some drugs. In each case, the cause of the low blood pressure needs to be treated, rather than the blood pressure itself.

Anyone who has low blood pressure that is causing symptoms, such as dizziness and headaches, must be thoroughly investigated to find and treat any possible cause. In a very small number of people no specific cause can be found, and in these cases a medication may be given to raise the blood pressure slightly.

Postural Hypotension

Many people experience light-headedness and dizziness, and sometimes even blackouts or faints, when rising quickly from lying or sitting to a standing position. This is postural hypotension, and it is caused by a brief drop in blood pressure caused by the altered relative positions of the brain and the heart. The heart must pump harder, and the arteries must contract more to maintain blood flow by means of the blood pressure to a brain that is 30 cm above the heart, rather than one that is at the same level as the heart. It takes a few seconds for this adjustment to be made, particularly in those who have some degree of hardening of the arteries.

The best treatment for patients with hypotension, who are usually elderly, is to advise them to be slow in their position changes. This is far better treatment than adding further medications. On the other hand, those medications that are being taken by the patient may be aggravating the hypotension, and should be reviewed. Doctors can readily detect the problem by measuring the blood pressure when the patient is lying, and again immediately after they stand up.

Therapeutic Hypotension

In some forms of surgery it is necessary to reduce the blood pressure in order to reduce the amount of bleeding or swelling of certain tissues. Therapeutic hypotension is a procedure carried out under strictly controlled conditions in an operating theater by an anesthetist. Brain and heart surgery are some examples where therapeutic hypotension is required.

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