What is hypotension?

Hypotension is a condition that causes your blood pressure (BP) to drop lower than it should be. Hypotension may be mild, serious, or life-threatening.

What are the most common types of hypotension?

• Acute: Acute hypotension is a sudden drop in your BP that may be life-threatening.
• Constitutional: Constitutional hypotension means your BP is lower than it should be most or all of the time. This is a chronic condition that occurs with no known medical cause.
• Orthostatic: Orthostatic hypotension normally occurs when you stand up from a sitting or lying position. It is also called postural hypotension.
• Postprandial: Postprandial hypotension means your BP becomes too low after you eat a meal. Your BP may drop within 2 hours after you eat, and is more common when you eat meals high in carbohydrates.

What causes hypotension?

• Anemia or blood loss
• Nervous system, heart, or adrenal disorders
• Dehydration from not drinking enough liquids, frequent vomiting, diarrhea, or severe burns
• Some medicines, such as those used to treat high blood pressure, heart conditions, pain, depression, or cancer
• A blood infection (sepsis)

What increases my risk for hypotension?

• Increasing age
• Drug and alcohol use
• Being bedridden for a long period of time
• Low body weight
• Hemodialysis
• Medical conditions such as diabetes, Parkinson disease, and Alzheimer disease

What are the signs and symptoms of hypotension?

• Feeling anxious, nauseated, tired, or weak
• Lightheadedness, dizziness, or fainting
• Increased sweating, palpitations (fast, forceful heartbeats), tremors, or a seizure
• Headache or pain in your neck, shoulders, chest, lower back, buttocks, or legs
• Blurred vision or changes in vision
• Confusion, decreased memory, or inability to pay attention

How is hypotension diagnosed?

Your healthcare provider will ask about your symptoms, health conditions, and medicines. Tell your provider how often you have symptoms, and if they change during the day. Tell your provider if you recently have had diarrhea, vomiting, or blood loss. Your provider will examine you, listen to your heart, and may check your eyes. Your body movements and sensations (ability to feel something that touches you) may also be checked. You may also need the following:

• Blood pressure testing: This may be done while you lie down, sit, and stand. You may need to wear a BP monitor to record your BP for up to 24 hours.
• Tilt table testing: You are secured on a table that changes your position. Your BP is checked when the table moves you into each position.

Which tests may help find the cause of my hypotension?

Many times, hypotension is a symptom of another condition. You may need any of the following tests to find the cause of your hypotension:

• Blood tests: A sample of your blood or urine may be checked for anemia or other conditions causing your hypotension.
• EKG: This test records the electrical activity of your heart. It is used to check for damage or other heart problems that may be causing your hypotension.
• Autonomic nervous system tests: Your healthcare provider may check for changes in how fast your heart beats when you take deep breaths. Your provider may also check for changes in your BP while you put your hand in ice cold water.
• 24 hour urine test: During this test you will need to collect all of your urine for 24 hours. You will urinate into a container and the urine will be put into a jug. The jug will need to be kept cold. If you urinate during the night, you will need to save that urine. Healthcare providers will measure and record how much you urinate. At the end of 24 hours, the urine will be sent to a lab for tests.
• Echocardiogram: This is a type of ultrasound, also called an echo. An ultrasound uses sound waves to show pictures of your heart on a monitor. An ultrasound may be done to show how your heart moves when it beats.

How is hypotension treated?

Your healthcare provider will work with you to find the cause of your hypotension and help treat your symptoms. You may need the following:

• Compression stockings or abdominal binder: These may help blood return to your heart and decrease your hypotension.
• IV fluids: These may be used to increase your BP if you are dehydrated or have blood loss or sepsis.
• Medicines:
  • Alpha-adrenoreceptor agonists: These medicines may increase your BP and decrease your symptoms.
  • Steroids: This medicine helps prevent salt loss from your body. Steroids may also help increase the amount of fluid in your body and raise your BP.
  • Vasopressors: These medicines help constrict (make smaller) your blood vessels and increase your BP. Vasopressor medicines may increase the blood flow to your brain and help decrease your symptoms.
  • Antidiuretic hormone: This medicine helps control your BP and helps decrease your need to urinate during the night.
  • Antiparkinson medicine: This medicine may help increase your standing BP and decrease your symptoms.

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

• midodrine
• Levophed
• Orvaten
• Northera
• Vazculep

View more treatment options

What are the risks of hypotension?

Without treatment, your symptoms may get worse. You may faint or fall often, which can lead to injuries, such as a broken bone. You may be at increased risk for depression, confusion, and memory problems. Hypotension may cause decreased blood flow to your brain and heart. This may lead to a stroke or heart attack and can be life-threatening. Sepsis-related hypotension is life-threatening without treatment.

How can I manage my symptoms?

• Change your position slowly: When you get out of bed, sit up first, then slowly move your legs to the side of the bed. If you are not having any symptoms, slowly stand up. If you have symptoms, sit down right away.
• Avoid straining: Activities and movements that cause you to strain can cause a drop in your BP. Activities to avoid include lifting, coughing, and other movements that increase the feeling of pressure in your chest.
• Avoid the heat: This can cause a decrease in your BP. Stay inside during very hot days, or limit the amount of time you are outside. Do not take hot baths.
• Exercise and do physical counter maneuvers: Ask your healthcare provider about the best exercise plan for you. Physical counter maneuvers may help to increase your BP and increase blood flow to your heart. They include crossing your legs, squatting, and bending at the waist. You can also rise up on your toes while you are standing, and tighten your thigh muscles.
• Drink liquids as directed: Ask your healthcare provider how much liquid to drink each day and which liquids are best for you. Drink 500 milliliters (½ liter) of liquid quickly in the morning or before meals to help increase your BP. Your healthcare provider may tell you to drink 2 cups of coffee with, or after, breakfast and lunch. The caffeine in the coffee can help prevent a drop in your BP. Your healthcare provider may also give you caffeine pills.
• Change how you eat meals: If your BP drops after you eat large meals, try to eat smaller meals more often. Eat foods low in carbohydrates and cholesterol to help prevent BP drops after you eat. Ask if you need to increase the amount of sodium (salt) you eat each day.
• Raise the head of your bed: Raise the head of your bed 4 to 8 inches. This can help prevent morning BP drops and decrease the need to urinate during the night.
• Do not drink alcohol: Alcohol can make your symptoms worse. Ask for information if you need help quitting.

When should I contact my healthcare provider?

• You vomit several times or have diarrhea, and you cannot drink liquid.
• You have a fever.
• You have new or increased symptoms, such as dizziness, weakness, or fainting.
• Your legs, ankles, and feet are swollen, or you gain weight for no known reason.
• You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

• You become confused or cannot speak.
• You urinate very little or not at all.
• You have a seizure.
• You have chest pain or trouble breathing.
• You have changes in vision or cannot see.

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