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Low Blood Pressure (Hypotension) - Causes & Treatment

Low blood pressure (hypotension) occurs when blood pressure falls below 90/60 mmHg. It can cause dizziness, fatigue, and fainting in affected individuals.

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Things worth knowing about "Low blood pressure"

Low blood pressure (hypotension) occurs when blood pressure falls below 90/60 mmHg. It can cause dizziness, fatigue, and fainting in affected individuals.

What is low blood pressure?

Low blood pressure, medically known as hypotension, is defined as a systolic blood pressure consistently below 90 mmHg and a diastolic pressure below 60 mmHg. While some people with low blood pressure experience no symptoms at all, others may suffer from significant discomfort and reduced quality of life. Hypotension is generally classified into several types, including primary (essential) hypotension, secondary hypotension, and orthostatic hypotension.

Causes

Low blood pressure can result from a variety of causes:

Primary (essential) hypotension: No identifiable organic cause; commonly seen in slim, young women and often considered constitutional.
Dehydration: Insufficient fluid intake, vomiting, diarrhea, or excessive sweating can lower blood pressure.
Heart conditions: Heart failure, arrhythmias, or heart valve disorders may reduce the pumping capacity of the heart.
Endocrine disorders: Conditions such as Addison disease, hypothyroidism, or low blood sugar (hypoglycemia) can lead to a drop in blood pressure.
Medications: Blood pressure-lowering drugs, diuretics, antidepressants, or sedatives may cause blood pressure to fall too low as a side effect.
Orthostatic hypotension: A sudden drop in blood pressure when standing up from a lying or sitting position.
Pregnancy: Blood pressure can naturally decrease during pregnancy, especially in the first and second trimesters.

Symptoms

The most common symptoms of low blood pressure include:

Dizziness and light-headedness, especially when standing up
Fatigue and general weakness
Difficulty concentrating
Headaches
Blurred vision or spots before the eyes
Heart palpitations
Fainting or loss of consciousness (syncope)
Cold and pale hands and feet

Diagnosis

Low blood pressure is primarily diagnosed through blood pressure measurement. This may involve a single reading or a 24-hour ambulatory blood pressure monitoring. Additional investigations may include:

Blood tests (e.g., electrolytes, hormone levels, blood glucose)
ECG to assess heart function
Schellong test: blood pressure measured lying down and standing up to diagnose orthostatic hypotension
Echocardiography if a heart condition is suspected

Treatment

Treatment depends on the underlying cause and severity of hypotension. For primary hypotension without an organic cause, non-pharmacological measures are the first line of approach:

General measures

Adequate fluid intake (at least 2 litres per day)
Increased salt intake (only under medical supervision)
Regular physical activity to strengthen the cardiovascular system
Rising slowly from lying or sitting positions
Contrast showers and hydrotherapy to stimulate circulation
Small, frequent meals to prevent postprandial hypotension
Wearing compression stockings for orthostatic hypotension

Pharmacological treatment

When non-pharmacological measures are insufficient, medication may be considered. Drugs such as etilefrine or midodrine can be prescribed to raise blood pressure. In cases of secondary hypotension, treating the underlying condition is the primary goal.

When to see a doctor?

Medical advice should be sought if fainting episodes are frequent, dizziness is severe, weakness is persistent, or if blood pressure drops suddenly without an apparent cause. In older adults, hypotension-related falls can be particularly dangerous.

References

World Health Organization (WHO) - Cardiovascular diseases: prevention and management. Available at: https://www.who.int
Fauci, A.S. et al. - Harrison's Principles of Internal Medicine, 21st edition. McGraw-Hill, 2022.
Lahrmann, H. et al. - Orthostatic hypotension. Frontiers in Neurology, 2011. Available via PubMed: https://pubmed.ncbi.nlm.nih.gov

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