Hypotension

Definition

Hypotension is the medical term for low blood pressure.

Description

The pressure of the blood in the arteries rises and falls as the heart and muscles handle demands of daily living, such as exercise, sleep and stress. Some healthy people have blood pressure well below the average for their age, even though they have a completely normal heart and blood vessels. This is often true of athletes who are in superior shape. The term "hypotension" is usually used only when blood pressure has fallen so far that enough blood can no longer reach the brain, causing dizziness and fainting.

Causes and symptoms

Postural hypotension is the most common type of low blood pressure. In this condition, symptoms appear after a person sits up or stands quickly. In normal people, the cardiovascular system must make a quick adjustment to raise blood pressure slightly to account for the change in position. For those with postural hypotension, the blood pressure adjustment is not adequate or it doesn't happen. Postural hypotension may occur if someone is taking certain drugs or medicine for high blood pressure. It also happens to diabetics when nerve damage has disrupted the reflexes that control blood pressure.

Many people have a chronic problem with low blood pressure that is not particularly serious. This may include people who require certain medications, who are pregnant, have bad veins, or have arteriosclerosis (hardening of the arteries).

The most serious problem with low blood pressure occurs when there is a sudden drop, which can be life-threatening due to widespread ischemia (insufficient supply of blood to an organ due to blockage in an artery). This type of low blood pressure may be due to a wide variety of causes, including:

• trauma with extensive blood loss
• serious burns
• shock from various causes (e.g. anaphylaxis)
• heart attack
• adrenal failure (Addisonian crisis)
• cancer
• severe fever
• serious infection (septicemia)

Diagnosis

Blood pressure is a measure of the pressure in the arteries created by the heart contracting. During the day, a normal person's blood pressure changes constantly, depending on activity. Low blood pressure can be diagnosed by taking the blood pressure with a sphygmomanometer. This is a device with a soft rubber cuff that is inflated around the upper arm until it's tight enough to stop blood flow. The cuff is then slowly deflated until the health care worker, listening to the artery in the arm with a stethoscope, can hear the blood first as a beat forcing its way along the artery. This is the systolic pressure. The cuff is then deflated more until the beat disappears and the blood flows steadily through the open artery; this gives the diastolic pressure.

Blood pressure is recorded as systolic (higher) and diastolic (lower) pressures. A healthy young adult has a blood pressure of about 110/75, which typically rises with age to about 140/90 by age 60 (a reading now considered mildly elevated).

Treatment

Treatment of low blood pressure depends on the underlying cause, which can usually be resolved. For those people with postural hypotension, a medication adjustment may help prevent the problem. These individuals may find that rising more slowly, or getting out of bed in slow stages, helps the problem. Low blood pressure with no other symptoms does not need to be treated.

Prognosis

Low blood pressure as a result of injury or other underlying condition can usually be successfully treated if the trauma is not too extensive or is treated in time. Less serious forms of chronic low blood pressure have a good prognosis and do not require treatment.

BOOKS

Smeltzer, Suzanne C., and Brenda G. Bare. Brunner and Suddarth's Textbook of Medical and Surgical Nursing. 8th ed. Philadelphia: Lippincott-Raven Publishers, 1996.

Carol A. Turkington

KEY TERMS

Arteriosclerosis—A group of disorders that causes thickening and loss of elasticity in artery walls.