Hypotension is a condition characterized by the presence of systolic blood pressure <90 mm Hg and diastolic blood pressure <60 mm Hg. Blood pressure is physiologically lower at night and rises suddenly upon waking up from sleep and can vary during the day depending on body position, respiratory rate, food and fluid intake.
What are the symptoms of hypotension
Diagnosis of arterial hypotension
Treatment in arterial hypotension
What is hypotension
Hypotension is a condition characterized by the presence of systolic blood pressure <90 mm Hg and diastolic blood pressure <60 mm Hg. Blood pressure is physiologically lower at night and rises suddenly upon waking up from sleep and can vary during the day depending on body position, respiratory rate, food and fluid intake.
The main types of arterial hypotension are represented by:
- Postural hypotension (orthostatic hypotension): occurs when suddenly adopting the orthostatic position
- Postprandial hypotension: occurs after food intake
- Neurally mediated hypotension: defective transmission of nerve impulses from the brain to the heart
- Shy Drager syndrome: lesions of the autonomic nervous system that modulate the electrical activity of the heart, respiratory rate and digestive system
- The risk factors that predispose to the decrease of blood pressure values are represented by the drug therapy used to treat arterial hypertension (alpha-blockers), age >65 years and certain pre-existing heart diseases (valvular diseases, heart failure, acute myocardial infarction, sinus node disease ), diabetes or Parkinson’s disease
Why does hypotension occur?
Hypotension can be caused by:
- Pregnancy
- Heart diseases
- Endocrine diseases (hypothyroidism, parathyroid disease, Addison’s disease)
- Dehydration due to fluid losses (vomiting, diarrhea, extensive burns, abuse of diuretics)
- Hemorrhages
- Septicemia
- Anaphylactic shock
What are the symptoms of hypotension
The sudden drop in blood pressure values causes the following symptoms to appear:
- The feeling of dizziness
- Syncope (loss of consciousness)
- Blurry vision
- Nausea
- Concentration difficulties
- Hypersweating
- Increased respiratory rate
- Fatigability
Diagnosis of arterial hypotension
The diagnosis of arterial hypotension is established by the cardiologist based on the anamnesis, the patient’s clinical examination and the repeated measurement of the blood pressure values during 3 different clinical consultations (the blood pressure is measured at the level of both upper limbs to exclude the diagnosis of coarctation of the aorta). Additionally, the specialist doctor can recommend holter monitoring (holter EKG) for a period of 24 hours, with the help of which serial automatic measurements of the patient’s blood pressure are made, during daily activities and at night.
The tilt table test or tilt test is used to detect neurally mediated orthostatic hypotension, while the EKG examination, echocardiography and stress test are useful for a more detailed cardiac examination and have a diagnostic role for many of the cardiovascular diseases that cause changes in blood pressure values.
Treatment in arterial hypotension
In situations where the low blood pressure values are due to a treatment prescribed to reduce hypertension, it is necessary to adjust the doses, change the medication or stop its administration according to the recommendation of the attending physician.
Non-drug treatment options for arterial hypotension include the adoption of a healthy lifestyle that includes daily physical exercises to stimulate blood circulation, an optimal water intake that corresponds to the needs of the body and a balanced diet.
References:
- Arterial hypotension in chronic hemodialyzed patients – https://www.sciencedirect.com/science/article/pii/S0085253815341375
- Significance of arterial hypotension after resuscitation from cardiac arrest – https://journals.lww.com/ccmjournal/Abstract/2009/11000/Significance_of_arterial_hypotension_after.5.aspx
- Nocturnal Arterial Hypotension and Its Role in Optic Nerve Head and Ocular Ischemic Disorders – https://www.sciencedirect.com/science/article/abs/pii/S0002939414700674
