Low Blood Pressure (Hypotension)

What is low blood pressure?

Hypotension, or low blood pressure, is when your blood pressure is much lower than expected. It can happen either as a condition on its own or as a symptom of a wide range of conditions. It may not cause symptoms. But when it does, you may need medical attention.

Types of low blood pressure

Hypotension has two definitions:

• Absolute hypotension: Your resting blood pressure is below 90/60 millimeters of mercury (mm Hg).
• Orthostatic hypotension: Your blood pressure stays low for longer than three minutes after you stand up from a sitting position. (It’s normal for your blood pressure to drop briefly when you change positions, but not for that long.) The drop must be 20 mm Hg or more for your systolic (top) pressure and 10 mm Hg or more for your diastolic (bottom) pressure. Another name for this is postural hypotension because it happens with changes in posture.

Measuring blood pressure involves two numbers:

• Systolic (top number): This is the pressure on your arteries each time your heart beats.
• Diastolic (bottom number): This is how much pressure your arteries are under between heartbeats.

What is considered low blood pressure?

Low blood pressure is below 90/60 mm Hg. Normal blood pressure is above that, up to 120/80 mm Hg.

How common is low blood pressure?

Because low blood pressure is common without any symptoms, it’s impossible to know how many people it affects. However, orthostatic hypotension seems to be more and more common as you get older. An estimated 5% of people have it at age 50, while that figure climbs to more than 30% in people over 70.

Who does low blood pressure affect?

Hypotension can affect people of any age and background, depending on why it happens. However, it’s more likely to cause symptoms in people over 50 (especially orthostatic hypotension). It can also happen (with no symptoms) to people who are very physically active, which is more common in younger people.

What are the symptoms of low blood pressure?

Low blood pressure symptoms include:

• Dizziness or feeling lightheaded.
• Fainting or passing out (syncope).
• Nausea or vomiting.
• Distorted or blurred vision.
• Fast, shallow breathing.
• Fatigue or weakness.
• Feeling tired, sluggish or lethargic.
• Confusion or trouble concentrating.
• Agitation or other unusual changes in behavior (a person not acting like themselves).

For people with symptoms, the effects depend on why hypotension is happening, how fast it develops and what caused it. Slow decreases in blood pressure happen normally, so hypotension becomes more common as people get older. Fast decreases in blood pressure can mean certain parts of your body aren’t getting enough blood flow. That can have effects that are unpleasant, disruptive or even dangerous.

Usually, your body can automatically control your blood pressure and keep it from dropping too much. If it starts to drop, your body tries to make up for that, either by speeding up your heart rate or constricting blood vessels to make them narrower. Symptoms of hypotension happen when your body can’t offset the drop in blood pressure.

For many people, hypotension doesn’t cause any symptoms. Many people don’t even know their blood pressure is low unless they measure their blood pressure.

What are the possible signs of low blood pressure?

Your healthcare provider may observe these signs of low blood pressure:

• A heart rate that’s too slow or too fast.
• A skin color that looks lighter than it usually does.
• Cool kneecaps.
• Low cardiac output (how much blood your heart pumps).
• Low urine (pee) output.

What causes low blood pressure?

Hypotension can happen for a wide range of reasons. Causes of low blood pressure include:

• Orthostatic hypotension: This happens when you stand up too quickly and your body can’t compensate with more blood flow to your brain.
• Central nervous system diseases: Conditions like Parkinson’s disease can affect how your nervous system controls your blood pressure. People with these conditions may feel the effects of low blood pressure after eating because their digestive systems use more blood as they digest food.
• Low blood volume: Blood loss from severe injuries can cause low blood pressure. Dehydration can also contribute to low blood volume.
• Life-threatening conditions: These conditions include irregular heart rhythms (arrhythmias), pulmonary embolism (PE), heart attacks and collapsed lung. Life-threatening allergic reactions (anaphylaxis) or immune reactions to severe infections (sepsis) can also cause hypotension.
• Heart and lung conditions: You can get hypotension when your heart beats too quickly or too slowly, or if your lungs aren’t working as they should. Advanced heart failure (weak heart muscle) is another cause.
• Prescription medications: Hypotension can happen with medications that treat high blood pressure, heart failure, erectile dysfunction, neurological problems, depression and more. Don’t stop taking any prescribed medicine unless your provider tells you to stop.
• Alcohol or recreational drugs: Recreational drugs can lower your blood pressure, as can alcohol (for a short time). Certain herbal supplements, vitamins or home remedies can also lower your blood pressure. This is why you should always include these when you tell your healthcare provider what medications you’re taking.
• Pregnancy: Orthostatic hypotension is possible in the first and second trimesters of pregnancy. Bleeding or other complications of pregnancy can also cause low blood pressure.
• Extreme temperatures: Being too hot or too cold can affect hypotension and make its effects worse.

What are the complications of low blood pressure?

Complications that can happen because of hypotension include:

• Falls and fall-related injuries: These are the biggest risks with hypotension because it can cause dizziness and fainting. Falls can lead to broken bones, concussions and other serious or even life-threatening injuries. If you have hypotension, preventing falls should be one of your biggest priorities.
• Shock: When your blood pressure is low, that can affect your organs by reducing the amount of blood they get. That can cause organ damage or even shock (where your body starts to shut down because of limited blood flow and oxygen).
• Heart problems or stroke: Low blood pressure can cause your heart to try to compensate by pumping faster or harder. Over time, that can cause permanent heart damage and even heart failure. It can also cause problems like deep vein thrombosis (DVT) and stroke because blood isn’t flowing like it should, causing clots to form.

How is low blood pressure diagnosed?

Hypotension itself is easy to diagnose. Taking your blood pressure is all you need to do. But figuring out why you have hypotension is another story. If you have symptoms, a healthcare provider will likely use a variety of tests to figure out why it’s happening and if there’s any danger to you because of it.

What tests will be done to diagnose low blood pressure?

Your provider may recommend the following tests:

Lab testing

Tests on your blood and pee (urine) can look for any potential problems, like:

• Diabetes.
• Vitamin deficiencies.
• Thyroid or hormone problems.
• Low iron levels (anemia).
• Pregnancy (for anyone who can become pregnant).

Imaging

If providers suspect a heart or lung problem is behind your hypotension, they’ll likely use imaging tests to see if they’re right. These tests include:

• X-rays.
• Computed tomography (CT) scans.
• Magnetic resonance imaging (MRI).
• Echocardiogram or similar ultrasound-based tests.

Diagnostic testing

These tests look for specific problems with your heart or other body systems.

• Electrocardiogram (ECG or EKG).
• Exercise stress testing.
• Tilt table test (can help in diagnosing orthostatic hypotension).

How is low blood pressure treated?

Low blood pressure treatment usually starts with finding out why it’s happening. If a provider can treat that cause directly, hypotension will usually get better on its own. For example, hypotension can happen because of an injury and blood loss. Repairing that injury and replacing the lost blood with a blood transfusion will stop hypotension as long as the repair to the injury holds.

If you take medications that affect your blood pressure, your healthcare provider may change your dosage or have you stop taking that medication entirely.

If the cause remains a mystery, it’s also possible to treat it directly. However, curing hypotension is only possible if there’s an underlying cause that’s curable.

What medications and treatments are used?

The most important thing for a provider treating low blood pressure is to find the underlying cause and correct it. Treatments can range from simple IV fluids to antibiotics to surgery or even a heart transplant. Some people with low blood pressure need a hospital stay.

Treating hypotension directly usually happens in one of three ways:

• Increasing blood volume: This method, also known as fluid resuscitation, involves infusing fluids into your blood. Examples include intravenous (IV) fluids or plasma or blood transfusions.
• Making blood vessels constrict: Just as there are medications that lower your blood pressure by relaxing blood vessels in your body, there are also medications that have the opposite effect.
• Changing how your body handles fluids: Your kidneys are responsible for maintaining the fluid balance in your body. Certain medications can make your kidneys keep fluid and salt in your body, which can help with low blood pressure.

If your healthcare provider diagnoses you with hypotension, they may do the following:

• Advise you to change your diet: Increasing your salt intake can often help increase your blood pressure.
• Teach you how to recognize and react to symptoms: Knowing what hypotension feels like is one way to help you avoid problems with it. Your provider can teach you what to do when you feel it start.

Complications/side effects of the treatment

The complications of treatment depend on the exact medication or treatment you receive. Your healthcare provider can best explain the possible complications or side effects. That’s because they can consider your specific circumstances, including other health conditions, medications you take and more.

How soon after treatment will I feel better?

Depending on the cause of your hypotension, you may feel better as you receive treatment. In some cases, it may take longer — days or even weeks — for medication or other treatments to help you feel better consistently.

How can I lower my risk of low blood pressure?

It’s usually not possible to reduce your risk of or prevent hypotension. The only exception is avoiding circumstances or actions that can lead to it, such as taking recreational drugs or supplements/herbal remedies that can lower your blood pressure.

Eating smaller meals with fewer carbohydrates may help you avoid having low blood pressure after meals.

What can I expect if I have low blood pressure?

If you have hypotension, what you can expect depends on what causes it and if you have symptoms. If you don’t have symptoms, it’s unlikely that hypotension will be a problem for you.

If you have symptoms, hypotension can interfere with your ability to stand up, care for yourself, cook, drive and do many other activities. That’s why understanding low blood pressure and following a healthcare provider’s guidance are so important to minimizing this condition’s impact on your life.

How long low blood pressure lasts

How long this condition lasts depends on what caused it. If you have hypotension because of normal aging, it’ll probably be a lifelong concern.

Outlook for low blood pressure

If you have low blood pressure but don’t have symptoms, this condition usually isn’t harmful and shouldn’t impact your life.

If you do have symptoms, the underlying cause is usually what determines the outlook for this condition. Your healthcare provider is the best person to tell you what to expect from this condition and what you can do to manage those effects.

How do I take care of myself?

If you have hypotension with symptoms, the best thing you can do is follow your healthcare provider’s guidance on managing this condition. Their recommendations may include any of the following:

• Managing your diet: Following diet recommendations, especially how much salt you should have in your diet, can help prevent symptoms of hypotension.
• Taking your medication: These can help you avoid the disruptive symptoms and effects of low blood pressure.
• Dressing up: Compression socks, which put light pressure on your legs and feet, can push blood upward and raise your blood pressure.
• Taking it slow: Avoid standing up too quickly, especially with orthostatic hypotension. That can help you avoid the dizziness and fainting effects of hypotension.
• Having a seat: If you notice yourself feeling dizzy or lightheaded, sit down. Falling from a standing height can put you at risk for severe or even catastrophic injuries, such as a broken hip, concussion, skull fracture or broken ribs.

What can/can’t I eat/drink with low blood pressure?

If you have low blood pressure, you should:

• Drink more water.
• Drink alcohol in moderation.
• Add salt to your diet.

Be sure to talk with your provider before making these changes. They can give you more specific guidance.

When should I see my healthcare provider?

If you know you have hypotension, you should see your healthcare provider if you start to notice symptoms affecting your life or disrupting your usual routine and activities.

If you don’t know you have hypotension, you should see a healthcare provider if you have repeated dizziness or fainting episodes. This is especially important because those symptoms are possible with many other health conditions, some of which are dangerous.

When should I go to the ER?

If you have hypotension, you should go to the hospital when you:

• Have chest pain.
• Pass out or faint.
• Fall because of lightheadedness and hit your head (especially if you’re taking any blood-thinning medications). You should also go to the hospital if you injure yourself because of a fall from passing out.
• Have any symptoms of shock, such as feeling cold, being sweaty, breathing fast or having a fast heart rate. You may also have a blue tint to the skin of your lips or under your fingernails.

What questions should I ask my doctor?

Questions you should ask your provider include:

• Do you know the cause of my low blood pressure?
• Do I need treatment?
• What’s the best treatment for me?
• How often should I check my blood pressure?