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.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Medicines used to treat hypotension may cause weight gain and swelling in your legs and feet. Some medicines may cause you to lose needed salts from your body, such as potassium. You may urinate more during the night, or you may not be able to empty your bladder completely. Medicines may cause you to have high blood pressure and pain and pressure behind your eyes. Your head may feel numb (loss of feeling) and you may get goose bumps on your skin. You may also be at risk for water poisoning (too much water in your blood). Erythropoietin must be given as an injection (shot) that can cause soreness at the injection site. More red blood cells may increase your risk for high BP, a stroke, or a heart attack.
  
  
• Without treatment, your symptoms, such as weakness, dizziness, and tiredness, may get worse. You may faint or fall often, which can lead to injuries, such as bone fractures (breaks). Your risk for depression increases when your hypotension is not treated. Decreased blood flow to your brain may cause confusion and memory problems. Decreased blood flow to your brain can lead to a stroke and death. Untreated hypotension may decrease the blood flow to your heart and cause a heart attack. If you have sepsis-related hypotension, you may die without proper treatment. Talk with your caregiver if you have questions or concerns about your condition or treatment.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

IV:

An IV is a tube placed in your vein that is used to give you medicine or liquids.

Arterial line:

An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.

CVP line:

A CVP line, also called a central line, is an IV catheter or tube. It is put into a large blood vessel near your collarbone, in your neck, or in your groin. The CVP line may be used to give medicines or IV fluids. It may also be hooked up to a monitor to take pressure readings. This information helps caregivers check your heart.

Heart monitor:

This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

Intake and output:

For intake and output (I and O), caregivers keep track of the amount of liquid you get. They may also measure how much you urinate. You may need to have more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.

Medicines:

You may have any of the following medicines:

• Alpha-adrenoreceptor agonists: These medicines may help decrease your symptoms of hypotension.
  
  
• Antibiotics: Antibiotics are germ-killing medicines that may be given if an infection is causing your hypotension.
  
  
• Antidiuretic hormone: This medicine helps control your BP and helps decrease how often you 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.

Tests:

You may have the following tests to help plan your treatment:

• Autonomic nervous system tests: Tests may be done to check the function of your ANS. Your caregiver may check for changes in how fast your heart beats when you take deep breaths. Your caregiver may also check for changes in your BP while you put your hand in ice-cold water.
  
  
• Blood tests: You may need blood taken for tests. Blood tests can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Echocardiogram: This type of ultrasound is also called an echo. An echo uses sound waves to show the size and shape of your heart. An echo also shows how your heart moves when it is beating. These pictures are seen on a TV-like screen. You will lie down on your back during the echo. Clear jelly is squirted on your chest to help the ultrasound sensor slide easily. The sensor is moved across your chest to see your heart from different angles. You may hear a whooshing noise, which is the sound of your blood flow.
  
  
• Transesophageal echocardiogram: A transesophageal echo (TEE) may be done if your heart cannot be seen well during a regular echo. You are given medicine to relax you during a TEE. Caregivers put a tube in your mouth that moves down into your esophagus (food pipe). The tube has a small ultrasound sensor on the end. Since your esophagus is right next to your heart, your caregiver can see your heart clearly.
  
  
• 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. Caregivers will measure and record how much you urinate. At the end of 24 hours, the urine will be sent to a lab for tests.

Treatment options:

• Blood transfusion: You will get whole or parts of blood through an IV during a transfusion. Blood is tested for diseases, such as hepatitis and HIV, to be sure it is safe.
  
  
• Compression stockings or an abdominal binder: Compression stockings are tight elastic stockings that help prevent blood from pooling in your legs. An abdominal binder (tight wrap worn around your stomach) can help decrease blood pooling. Compression stockings and an abdominal binder may help promote blood return to your heart and decrease your hypotension.
  
  
• IV fluids: IV fluids are given to increase your BP if you are dehydrated. You may also get IV fluids if sepsis or blood loss is causing your hypotension.

Copyright © 2012. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

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 (Inpatient Care)