Hypotension

WHAT YOU SHOULD KNOW:

• Hypotension is a condition where your blood pressure (BP) is lower than it should be. Your BP is the pressure inside your blood vessel walls, created by the blood flowing through them. There are two measurements taken when checking your BP. Your systolic BP (SBP) is the highest number, and your diastolic BP (DBP) is the lowest number. Your SBP measures the pressure in your blood vessels as your heart pumps blood to your body. Your DBP measures the pressure in your blood vessels when your heart rests between beats. With hypotension, your SBP may drop below 90 to 110 millimeters of mercury (mmHg), or drop at least 20 mmHg. Your DBP may drop 10 mmHg or more.
  
  
• Acute (sudden onset) hypotension is the most serious type of hypotension. Acute hypotension may occur from severe (very bad) blood loss, a head injury, or sepsis (a life-threatening infection). Other common types of hypotension include constitutional, orthostatic (standing up), and postprandial (after eating) hypotension. Constitutional hypotension means your BP is low, most of the time, with no known medical cause. Causes of hypotension include certain health problems, such as problems with your autonomic nervous system (ANS). Dehydration (loss of body fluids) and some medicines can also cause hypotension. Hypotension is more common in the elderly and may be mild, serious (very bad), or even life-threatening.
  
  
• You may feel weak, dizzy, or lightheaded with hypotension. Your legs may give out and you may fall, or you may faint (pass out). Your caregiver will take your BP while you are sitting, standing, and lying down to diagnose your hypotension. Your caregiver may have you record your BP at different times during the day to help with your diagnosis. You may also need tests, such as a tilt table test or electrocardiogram (ECG). You may need intravenous (IV) fluids, medicines, and changes in your diet to treat your hypotension. Treatment may keep your BP at a normal level and decrease your risk for dizziness, fainting, and falls. Treating your hypotension may even save your life.

INSTRUCTIONS:

Medicines:

• Keep a current list of your medicines: Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists. Use vitamins, herbs, or food supplements only as directed.
  
  
• Take your medicine as directed: Call your primary healthcare provider if you think your medicine is not working as expected. Tell him about any medicine allergies, and if you want to quit taking or change your medicine.
  
  
• Alpha-adrenoreceptor agonists: These medicines may help increase your BP and decrease your symptoms. If you have supine hypertension, these medicines should not be taken within four hours of lying down. Supine hypertension means your BP becomes too high when you lie down. Take these medicines exactly as your caregiver tells you to.
  
  
• 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.
  
  
• Erythropoietin: This medicine increases the amount of red blood cells you have. More red blood cells increase your blood volume, and may increase your standing BP. This medicine may also treat anemia and problems with your ANS.
  
  
• 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.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

Avoid things that may make your hypotension worse:

• Avoid alcohol: Do not drink alcohol, because alcohol can make your condition worse. Talk with your caregiver if you drink alcohol and need help to stop drinking.
  
  
• 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: Hot temperatures can lead to drops in your BP and may worsen your symptoms of hypotension. Stay inside during very hot days, or limit the amount of time you are outside. Avoiding hot baths can also help prevent BP drops.

Change your position slowly:

Changing positions slowly can help decrease OH. Get out of bed by sitting up first, then slowly moving your legs to the side of your bed. If you are not having any symptoms, slowly rise to a standing position. If you have symptoms when changing positions or after standing for a long time, sit down right away.

Check your blood pressure:

Your caregiver may have you check your BP at home and record the readings in a diary. You may need to check your BP before breakfast and after each meal, when you are lying down and standing-up. You should also check your BP after taking your medicines, and before going to bed. Your caregiver may also have you wear a BP monitor to record your BP for up to 24 hours. You will wear the BP monitor while you do your normal daily activities. You will wear the monitor on a belt or a pouch. The monitor will take your BP every 15 to 30 minutes. Try to keep still while your BP is taken. Avoid heavy activity, such as exercise, while wearing the monitor.

Drink enough liquids:

You may need to drink more liquid each day to help keep your BP normal. You may need to drink between 2 to 3 liters of liquid each day. Drinking 500 milliliters (one-half liter) of liquid quickly in the morning or before meals may help increase your BP. Your caregiver may tell you to drink two cups of coffee with, or after, breakfast and lunch. The caffeine in the coffee can help prevent a drop in your BP. Your caregiver may also give you caffeine pills. Avoid caffeine in the evening, as it can increase your need to urinate during the night. Drinking caffeine late in the day can also make it hard for you to sleep at night. Ask your caregiver how much liquid you should drink each day.

Exercise and do physical counter maneuvers:

• Decreased activity, and lying down for long periods of time, can worsen your hypotension and symptoms. Exercises, such as swimming, rowing, and using an exercise bike, can help keep your BP normal. If your BP is normally low in the mornings, plan exercise and other activities for later in the day. Limit exercising to before meals or a few hours after meals. It is best to start exercising slowly, and do more as you get stronger. Talk with your caregiver before you start exercising. Together you can plan the best exercise program for you.
  
  
• Physical counter maneuvers can help prevent a drop in your BP. You can also do these movements if you begin to have symptoms of hypotension. Physical counter maneuvers include crossing your legs when sitting or standing, squatting, and bending at the waist. You can also rise up on your toes when standing and tighten your thigh muscles. Tightening your muscles helps increase the blood flow to your heart.

Manage your diet:

If your BP drops after eating large meals, try to eat smaller meals, more often. Eating foods low in carbohydrates and cholesterol may also help prevent BP drops after eating. You may need to increase the amount of sodium (salt) you eat each day. Sodium can help increase your BP and decrease your symptoms. You caregiver may tell you to increase the sodium you eat to at least six grams each day. Your caregiver may give you sodium tablets to take each day. Ask your caregiver what foods you should eat and always read the labels on the foods you buy.

Raise the head of your bed:

Raising the head of your bed 4 to 8 inches can help prevent morning BP drops. Raising the head of your bed can also help prevent the need to urinate during the night. It also helps prevent increases in your BP if you have supine hypertension.

CONTACT A CAREGIVER IF:

• You are sick, vomiting, or have diarrhea, and you cannot drink liquid.
  
  
• You have a fever.
  
  
• You have new or increased symptoms, such as dizziness, weakness, or fainting.
  
  
• You have new or more heart palpitations (fast, forceful heartbeats).
  
  
• Your legs, ankles, and feet are swollen, or you are gaining weight for no known reason.
  
  
• You have questions or concerns about your condition or treatment.

SEEK CARE IMMEDIATELY IF:

• You are feeling very confused or you have new trouble speaking.
  
  
• You are urinating very little or not at all.
  
  
• You have had a seizure.
  
  
• You have chest pain or trouble breathing.
  
  
• You have trouble seeing, or you cannot see at all.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Hypotension (Aftercare Instructions)