The Health Counsellor

Low blood pressure (hypotension) is regarded as a sign of good health. It is most likely a reflection of genetic factors and suggests that your risk of heart disease is lower than average. Ideal blood pressure is considered anything lower than 120/80 – the top (systolic) number represents the amount of pressure the heart generates when it fully contracts, while the lower (diastolic) number refers to the amount of pressure in the arteries when the heart fully relaxes between beats. Low blood pressure is often defined as consistent readings below 90/60 – but it can also include cases where only one of the numbers is in that range or lower.

The most common ones are dizziness and lightheadedness, or fainting. When low blood pressure stems from an underlying medical problems, symptoms may include lack of concentration; blurred vision; nausea; cold, clammy, pale skin; rapid, shallow breathing; fatigue, depression and thirst.

Blood pressure is a measurement of the pressure in your arteries during the active and resting phases of each heartbeat.

• Systolic pressure: The top number in a blood pressure reading is the amount of pressure your heart generates when pumping blood through your arteries to the rest of your body.
• Diastolic pressure: The bottom number in a blood pressure reading refers to the amount of pressure in your arteries when your heart is at rest between beats.

Current guidelines identify normal blood pressure as lower than 120/80 mm Hg.

Throughout the day, blood pressure varies, depending on body position, breathing rhythm, stress level, physical condition, medications you take, what you eat and drink, and time of day. Blood pressure is usually lowest at night and rises sharply on waking.

Medical conditions that can cause low blood pressure include:

• Pregnancy: Because the circulatory system expands rapidly during pregnancy, blood pressure is likely to drop. This is normal, and blood pressure usually returns to your pre-pregnancy level after you’ve given birth.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.

• Endocrine problems: Thyroid conditions such as parathyroid disease, adrenal insufficiency (Addison’s disease), low blood sugar (hypoglycemia) and, in some cases, diabetes can trigger low blood pressure.

• Dehydration: When your body loses more water than it takes in, it can cause weakness, dizziness and fatigue. Fever, vomiting, severe diarrhea, overuse of diuretics and strenuous exercise can lead to dehydration.

• Blood loss: Losing a lot of blood, such as from a major injury or internal bleeding, reduces the amount of blood in your body, leading to a severe drop in blood pressure.

• Severe infection (septicemia): When an infection in the body enters the bloodstream, it can lead to a life- threatening drop in blood pressure called septic shock.

• Severe allergic reaction (anaphylaxis): Common triggers of this severe and potentially life-threatening reaction include foods, certain medications, insectvenoms and latex. Anaphylaxis can cause breathing problems, hives, itching, a swollen throat and a dangerous drop in blood pressure.

• Lack of nutrients in your diet: A lack of the vitamins B-12 and folate can keep your body from producing enough red blood cells (anemia), causing low blood pressure.

Some medications can cause low blood pressure, including:

• Water pills (diuretics), such as furosemide (Lasix) and hydrochlorothiazide (Maxzide, Microzide, others)

• Alpha blockers, such as prazosin (Minipress)

• Beta blockers, such as atenolol (Tenormin) and propranolol (Inderal, Innopran XL, others)

• Drugs for Parkinson’s disease, such as pramipexole (Mirapex) or those containing levodopa

• Certain types of antidepressants (tricyclic antidepressants), including doxepin (Silenor) and imipramine (Tofranil)

• Drugs for erectile dysfunction, including sildenafil (Revatio, Viagra) or tadalafil (Adcirca, Cialis), particularly when taken with the heart medication nitroglycerin.

Doctors often break down low blood pressure (hypotension) into categories, depending on the causes and other factors. Some types of low blood pressure include:

• Low blood pressure on standing up (orthostatic, orpostural, hypotension): This is a sudden drop in blood pressure when you stand up from a sitting position or after lying down.

Gravity causes blood to pool in your legs when you stand. Ordinarily, your body compensates by increasing your heart rate and constricting blood vessels, thereby ensuring that enough blood returns to your brain. But in people with orthostatic hypotension, this compensating mechanism fails and blood pressure falls, leading to dizziness, lightheadedness, blurred vision and even fainting.

Orthostatic hypotension can occur for various reasons, including dehydration, prolonged bed rest, pregnancy, diabetes, heart problems, burns, excessive heat, large varicose veins and certain neurological disorders.

   
  A number of medications also can cause orthostatic 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.

Orthostatic hypotension is especially common in older adults, but it also affects young, otherwise healthy people who stand up suddenly after sitting with their legs crossed for long periods or after squatting for a time. It’s also possible to have delayed orthostatic hypotension, with signs and symptoms developing 5 to 10 minutes after a change in posture. This might be a milder form of the condition, or it could be an early stage of it.

• Low blood pressure after eating (postprandial hypotension): This sudden drop in blood pressure after eating affects mostly older adults.

Blood flows to your digestive tract after you eat. Ordinarily, your body increases your heart rate and constricts 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 might help reduce symptoms.

• Low blood pressure from faulty brain signals (neurally mediated hypotension): This disorder, which causes a blood pressure drop after standing for long periods, mostly affects young adults and children. It seems to occur because of a miscommunication between the heart and the brain.

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

• Age: Drops in blood pressure on standing or after eating occur primarily in adults older than 65. Neurally mediated hypotension primarily affects children and younger adults.
• Medications: People who take certain medications, for example, high blood pressure medications such as alpha blockers, have a greater risk of low blood pressure.
• Certain diseases: Parkinson’s disease, diabetes and some heart conditions put you at a greater risk of developing low blood pressure.