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Most physicians in the English-speaking world consider hypotension - low blood pressure - to be a symptom of some other disorder. In other parts of the world, however, hypotension is itself considered to be a disorder that can cause various symptoms, including depression, lethargy and fatigue. This different attitude is probably the result of different methods of medical training.
There are different kinds of hypotension and the following is one way of classifying them: - Constant Hypotension. The blood pressure is always low, less than 90/60mm Hg. When the blood pressure is too low there is inadequate blood flow to the heart, brain and other vital organs. Borderline low blood pressure for one person may be normal for another. Many people have a chronic problem with low blood pressure that is not particularly serious.
- Temporary Hypotension. The most important factor is how the blood pressure changes from the baseline or normal condition. A fall of 30mm Hg or more from a person's baseline is considered low blood pressure. This can be caused by any of the following:
- Shock
- Stress/trauma
- Sudden change in posture (orthostatic hypotension)
- Allergy
- Dehydration
- Drug-induced, including alcohol toxicity, anesthesia, antianxiety agents, antihypertensives, calcium channel blockers, diuretics, general anesthetics, antiarrhythmics, monoamine oxidase inhibitors, narcotic analgesics, tranquilizers, vasodilators
- Neurally Mediated Hypotension (NMH). The usual blood pressure may be low, normal or even high, but under certain circumstances blood pressure drops and symptoms develop.
- Age-related decline in blood pressure regulation.
- Secondary to diseases such as central nervous system disorders, for example Shy-Drager syndrome; peripheral neuropathy and autonomic neuropathy (nerve problems), such as may be caused by diabetes mellitus; cardiovascular disorders; nutritional diseases amyloidosis; vitamin deficiencies; spinal cord injuries; Adrenal failure (Addisonian crisis); and neuropathies associated with cancer, particularly lung cancer or pancreatic cancer.
Causes & Development
Postural hypotension can happen to anyone for a variety of physiologic reasons, such as dehydration, lack of food, prolonged standing in the heat or being generally run down. Postural hypotension occurs most frequently in people who are taking drugs to control high blood pressure (hypertension). It can also be related to pregnancy, strong emotion, atherosclerosis or diabetes. The elderly are particularly affected, especially those who have high blood pressure or autonomic nervous dysfunction. Postprandial (after meals) hypotension is estimated to affect up to one-third of elderly people and is a common cause of dizziness and falls after eating.
Diagnosis & Tests
Symptoms of dizziness and lightheadedness upon standing do not necessarily mean that you have postural hypotension. A wide range of underlying conditions may cause these symptoms. An accurate diagnosis must be based on repeated evaluation of blood pressure and pulse rate after you have been lying down for at least five minutes and then after you stand quietly for one minute and then for three minutes. A hypotensive response may be immediate or delayed. Prolonged standing or a tilt test may be needed to detect a delayed hypotensive response.
Treatment & Prevention
If you have an underlying medical problem that causes postural hypotension, seek treatment for the underlying condition. There is a spontaneous improvement in many individuals, although treatment of the cause helps the return to normal.
For many people, chronic physiologic postural hypotension can be effectively treated with diet and lifestyle changes.
Have your doctor evaluate your prescription and over-the-counter medications to identify any that may be causing your symptoms.
Be careful when rising from a prone or sitting position. To improve circulation, stretch your feet back and forth before standing up. Then proceed slowly. When getting out of bed, sit upright on the edge of the bed for a few moments before standing.
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Signs, symptoms & indicators of Hypotension:
Recommendations and treatments for Hypotension: | | | | | Botanical |  Coffee | If tolerated, you may try drinking coffee in the morning. The amount of caffeine normally found in two cups of coffee (200mg) can decrease postural hypotension in young adults and can be safely used by older adults as well. |
 Scots Broom| | Scots Broom has a well-known effect of raising blood pressure because of a mild peripheral vaso-constricting action combined with a gentle cardiotonic effect. Thus it is strongly contra-indicated for hypertension.
One possible herbal prescription using up to 2.5ml of tincture tid is: 2 parts each of hawthorn and scots broom; 1 part each of gentian, rosemary and ginger. |
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Diet |
Increased Water Consumption| | The first step in treating hypotension is generally to increase fluid intake. Patients who have discovered the importance of drinking fluids regularly throughout the day seem to do better than those who don't take this task seriously. Drink a minimum of eight glasses per day of non-alcoholic fluids. Sports drinks that are high in sodium and potassium are recommended, especially during exercise or in hot weather. |
Smaller, More Frequent Meals| | As more blood is drawn to the digestive tract, less may be available for maintaining blood pressure. To avoid problems with low blood pressure which occurs after meals, try eating smaller, more frequent meals and resting after eating to lessen episodes of dizziness. Avoid taking hypotensive drugs before meals. |
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Drug |
Conventional Drug Use| | If simple measures don't alleviate the problem, you may need conventional medication. Although a wide range of drugs (including phenylpropanolamine, ephedrine and the nonsteroidal antiinflammatory drugs indomethacin and ibuprofen) have been used to treat hypotension, many of them are not consistently effective.
The following medications have proven effective in treating postural hypotension:
Fludrocortisone. Fludrocortisone is a mineralocorticosteroid that appears to be effective for most types of postural hypotension. It works by promoting sodium retention by the kidney, thereby causing fluid retention and some swelling, which is necessary to improve blood pressure. Its sparing effect on sodium is done at the expense of a concurrent loss of potassium. Therefore, when taking fludrocortisone, it's important to also take adequate amounts of potassium each day. Fludrocortisone has none of the anti-inflammatory properties of cortisone or prednisone and it is not a muscle-building agent.
Midodrine. Midodrine activates receptors on the arterioles and veins to produce an increase in blood pressure. Studies show that it is effective in improving standing blood pressure in those with postural hypotension related to nervous system dysfunction, such as in patients with Shy-Drager syndrome. |
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Habits |
Aerobic Exercise| | Regular exercise to promote blood flow and regulation can improve low blood pressure. |
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Mineral |
Increased Salt Consumption| | Consuming a diet higher in salt will sometimes help restore a more normal blood pressure. One of the most common - and treatable - problems identified in those with NMH (Neurally Mediated Hypotension) is a low dietary salt (sodium) intake. Salt helps us retain fluid in the blood vessels, and helps maintain a healthy blood pressure. Salt has received bad press in the last couple of decades because a high salt diet in some individuals with high or high-normal blood pressure can contribute to further elevations, and thereby to heart disease and stroke. This has led to general health recommendations to cut down on salt. As we are finding, this general recommendation isn’t right for all people.
Consume extra salt and drink more fluids during hot weather and while sick with a viral illness, such as a cold or the flu. |
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Physical Medicine |
Hydrotherapy| | Heating the skin draws more blood to the surface and increases the risk of lowered blood pressure. Avoid prolonged exposure to hot water, such as hot showers and spas. If you get dizzy, sit down. It may be helpful to keep a chair or stool in the shower in case you need to sit; to help prevent injury, use a chair or stool that is specifically designed for showers or bath tubs. |
Physical Supports and Devices| | If needed, use elastic support (compression) stockings that cover the calf and thigh. These may help restrict blood flow to the legs, thus keeping more blood in the upper body. |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link | | | May do some good | | | Likely to help |
GLOSSARY
Adrenal (Adrenal Gland, Adrenal Glands, Adrenals)
The adrenal glands sit on top of each kidney and consist of an outer cortex and an inner medulla. Of the 50 or so hormones the adrenals make, only cortisone and adrenaline are recognized by most people. Some of these hormones must be produced to preserve life, while others help resist stress. Other hormones from the adrenals control normal energy output (along with the thyroid) and govern the breakdown of stored energy into quick energy sources. The medulla produces epinephrine and norepinephrine, which are specifically designed to help the body deal with stressful situations. The adrenals control the body's potassium/sodium balance, which is vital for energy production. They also produce sex hormones in minute amounts, which is important for later years when the gonads drop or cease their production.
Allergy (Allergies)
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Anesthesia
Loss of sensation caused by neurological dysfunction or a pharmacological depression of nerve function.
Anti-inflammatory (Antiinflammatory)
Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.
Atherosclerosis
Common form of arteriosclerosis associated with the formation of atheromas which are deposits of yellow plaques containing cholesterol, lipids, and lipophages within the intima and inner media of arteries. This results in a narrowing of the arteries, which reduces the blood and oxygen flow to the heart and brain as well as to other parts of the body and can lead to a heart attack, stroke, or loss of function or gangrene of other tissues.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. The body also needs calcium to carry nerve signals, keep the heart functioning, contract muscles, clot blood and maintain healthy skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Cardiovascular
Pertaining to the heart and blood vessels.
Central Nervous System (CNS)
A collective term for the brain, spinal cord, their nerves, and the sensory end organs. More broadly, this can even include the
neurotransmitting hormones instigated by the CNS that control the chemical nervous system, the endocrine glands.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Cup (Cups)
A unit of volume measurement equal to 8 fluid oz, or roughly 250ml. It also equals 1/2 pint, 1/4 quart and 1/16 gallon.
Diabetes Mellitus (Diabetes, Diabetic, Diabetics)
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Diuretic (Diuretics)
An agent increasing urine flow, causing the kidneys to excrete more than the usual amount of sodium, potassium and water.
Herbs (Herb, Herbal)
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.
Hg
The chemical symbol for mercury, often used to indicate pressure measurements in either inches or millimeters.
Hypertension
High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.
Hypotension
Low blood pressure.
Kidneys (Kidney, Renal)
Bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage. The kidneys are sophisticated reprocessing machines, each day handling about 50 gallons of blood to sift out about half a gallon of waste products and extra water. The waste and extra water become urine, which flows to the bladder through tubes called ureters. The actual filtering occurs in tiny units inside the kidneys called nephrons. Every kidney has about a million nephrons. In a nephron, a glomerulus -- which is a tiny blood vessel, or capillary -- intertwines with a tiny urine-collecting tube called a tubule. A complicated chemical exchange takes place, as waste materials and water leave your blood and enter your urinary system. The kidneys recycle chemicals such as sodium, phosphorus, and potassium and thus regulate their levels. Renal: Pertaining to the kidneys.
Lung (Lungs, Pulmonary)
Organ of the body, located in the chest cavity which is designed to bring oxygen from the air into the blood stream, while also expelling carbon dioxide and other waste gases out of the body. Pulmonary: Related to the lungs.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Milliliter (mL)
0.001 or one thousandth of a liter.
Millimeter (Millimeters, mm)
A metric unit of length equaling one thousandth of a meter, or one tenth of a centimeter. There are 25.4 millimeters in one inch.
Monoamine Oxidase (MAO)
An enzyme catalyzing the removal of an amine group from a variety of substrates, including norepinephrine and dopamine. MAO inhibitors block the action of MAO, thus raising the levels of the monoamine neurotransmitters such as norepinephrine, epinephrine, dopamine, and serotonin - which have significant effects on mood and behavior. Epinephrine, norepinephrine and serotonin are normally deactivated by MAO-A while dopamine and phenylethylamine are normally metabolized by MAO-B.
Narcotic (Narcotics)
A substance that depresses central nervous system function, bringing sleep and lessening pain. By definition, narcotics can be toxic in excess.
Nervous System
A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.
Neuropathy
A group of symptoms caused by abnormalities in motor or sensory nerves. Symptoms include tingling or numbness in hands or feet followed by gradual, progressive muscular weakness.
Over-The-Counter (OTC, Over The Counter)
A drug or medication that can legally be bought without a doctor's prescription being required.
Pancreas (Pancreatic)
Opposite the liver and behind the stomach, the pancreas has two main functions - to manufacture various enzymes for digestion, and to release hormones to help control the body's use of carbohydrates. It releases insulin to help each cell absorb glucose to burn as energy. In this way, insulin controls the amount of sugar (glucose) in the blood. Proper pancreatic function is very important: too much, too little, or no insulin production can be life-threatening. Some of the chemicals released by the pancreas are not hormones, but stimulate other glands to make hormones. Once again, balance is necessary. Nutritional requirements for the pancreas are many. Research indicates that chromium vitamins C, E, B-complex, calcium, magnesium and potassium are especially important.
Postprandial
Following a meal.
Potassium
A mineral that serves as an electrolyte and is involved in the balance of fluid within the body. Our bodies contain more than twice as much potassium as sodium (typically 9oz versus 4oz). About 98% of total body potassium is inside our cells. Potassium is the principal cation (positive ion) of the fluid within cells and is important in controlling the activity of the heart, muscles, nervous system and just about every cell in the body. Potassium regulates the water balance and acid-base balance in the blood and tissues. Evidence is showing that potassium is also involved in bone calcification. Potassium is a cofactor in many reactions, especially those involving energy production and muscle building.
Sodium
An essential mineral that our bodies regulate and conserve. Excess sodium retention increases the fluid volume (edema) and low sodium leads to less fluid and relative dehydration. The adult body averages a total content of over 100 grams of sodium, of which a surprising one-third is in bone. A small amount of sodium does get into cell interiors, but this represents only about ten percent of the body content. The remaining 57 percent or so of the body sodium content is in the fluid immediately surrounding the cells, where it is the major cation (positive ion). The role of sodium in the extracellular fluid is maintaining osmotic equilibrium (the proper difference in ions dissolved in the fluids inside and outside the cell) and extracellular fluid volume. Sodium is also involved in nerve impulse transmission, muscle tone and nutrient transport. All of these functions are interrelated with potassium.
Stroke (Stroke-Type Event)
A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
TID
Three times a day.
Tincture
An alcohol or water-alcohol solution, usually referring to a preparation from herbal materials.
Last updated: Jul 19, 2008
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