Low Blood Pressure: When Your Numbers Drop Too Low

Symptoms of Low Blood Pressure

Some people with lower numbers feel fine and do not require any treatment. But when blood pressure drops too low, your body may not get the blood flow it needs. That can lead to symptoms such as:

• Blurred or fading vision
• Dizziness or lightheadedness
• Fainting or nearly fainting
• Fatigue or weakness
• Heart palpitations
• Nausea
• Neck or back pain
• Trouble concentrating

In more severe cases, a sudden and significant drop in blood pressure can lead to shock. Signs of shock include cold, clammy skin, rapid and shallow breathing, a weak, fast pulse and confusion, especially in older adults.

Call 911 immediately if you experience signs of shock, including sudden confusion, difficulty breathing, a weak pulse, or cold, clammy skin. Extreme low blood pressure can deprive the heart and brain of oxygen and requires emergency care.

Types of Low Blood Pressure

Low blood pressure can happen in different situations. Knowing the type can help your physician find the cause and choose the right treatment.

• Orthostatic hypotension is a drop in blood pressure when you stand up. It is most common in older adults and can be triggered by dehydration, prolonged bed rest, certain medications and other health conditions.
• Postprandial hypotension is blood pressure that drops after you eat. It is most common in older adults and people with Parkinson's disease or diabetes. Eating smaller, low-carbohydrate meals and avoiding alcohol can help manage symptoms.
• Neurally mediated hypotension is blood pressure that drops after you stand for a long time. It often affects children and younger adults. Signal problems between the heart and the brain may cause it.

What Causes Low Blood Pressure?

Low blood pressure has many possible causes. In some cases, it is simply a normal variation with no underlying problem. In others, it signals a condition that needs attention.

Medical Conditions

Several health conditions can lead to low blood pressure, including:

• Heart conditions — A heart attack, heart failure, an abnormally slow heart rate (bradycardia) or heart valve problems can all reduce the heart's ability to pump enough blood.
• Dehydration — When your body loses more fluids than it takes in — from fever, vomiting, severe diarrhea or overexertion — blood volume drops, which can lower blood pressure.
• Pregnancy — Blood pressure often drops during the first 24 weeks of pregnancy as blood vessels expand to support the growing baby. It typically returns to normal after delivery.
• Hormone-related problems — Conditions such as Addison’s disease, underactive thyroid and low blood sugar can disrupt the hormonal signals that regulate blood pressure.
• Severe infections — When an infection spreads into the bloodstream, it can cause a dangerous drop in blood pressure known as septic shock.
• Severe allergic reaction — Anaphylaxis can cause a sudden and extreme drop in blood pressure that requires immediate emergency treatment.
• Blood loss — Significant blood loss from trauma or internal bleeding can cause blood pressure to fall rapidly.
• Low levels of nutrients — Low levels of vitamins such as B-12, folate and iron can lead to anemia, which reduces the number of healthy red blood cells and can lower blood pressure.

Medications

Low blood pressure is a side effect of some medications, including:

• Blood pressure medications, including diuretics, alpha blockers and beta blockers
• Medications for Parkinson’s disease
• Tricyclic antidepressants
• Erectile dysfunction medications, particularly when combined with nitroglycerin
• Certain anxiety and heart medications

If you take any of these and experience symptoms, call your physician. Do not stop taking your medication without speaking with your physician first. They can review your current medications and adjust the dose or switch to an alternative if needed.

How Is Low Blood Pressure Diagnosed?

Your physician will start by reviewing your symptoms, medical history and the medications you currently take. A physical exam and blood pressure measurements help identify whether your blood pressure is dropping and under what circumstances. Additional diagnostic tests may include:

• Blood tests — To check for anemia, low blood sugar, vitamin deficiencies or signs of infection.
• Electrocardiogram (EKG) — To evaluate your heart rhythm and look for abnormalities that could affect blood pressure.
• Echocardiogram — To assess heart function.
• Tilt table test — To measure how your blood pressure responds to changes in body position, especially when your physician suspects orthostatic hypotension.

Managing and Treating Low Blood Pressure

Treatment for low blood pressure depends on the cause. For many people, especially those who are young and healthy with no symptoms, no treatment is needed. “Treatment for low blood pressure is not one size fits all,” said Dr. Musso. “We focus on identifying the underlying cause and tailoring a plan that improves how the patient feels while keeping their overall health in balance.”

Lifestyle Changes

Simple changes in your daily habits can help you manage low blood pressure. Try the following tips:

• Drink more water — Staying well hydrated helps maintain blood volume. Drink plenty of water throughout the day, especially before prolonged periods of standing or physical activity.
• Get up slowly — When getting up from a lying or seated position, take your time. Sit on the edge of the bed for a moment before standing. This gives your body time to adjust.
• Eat smaller, more frequent meals — Large meals, especially high-carbohydrate ones, can trigger a drop in blood pressure. Smaller, low-carbohydrate meals help prevent postprandial hypotension.
• Limit alcohol intake — Alcohol causes dehydration and can worsen low blood pressure. Limit or avoid it, especially if you are already prone to symptoms.
• Increase your salt intake carefully — In some cases, a physician may recommend increasing salt intake to help raise blood pressure. Do not do this on your own, as excessive salt intake carries its own risks.
• Wear compression stockings — For orthostatic hypotension, compression stockings can help reduce blood pooling in the legs and improve circulation.
• Get regular exercise — Gentle cardiovascular exercise can strengthen the heart and improve blood flow. Talk to your physician about what types and levels of activity are appropriate for you.

Medications

When lifestyle changes are not enough, your physician may prescribe medication. The type of medication depends on the cause and type of low blood pressure. Options may include medications to increase blood volume, narrow blood vessels or address the underlying condition driving the pressure drop.

If a medication is causing low blood pressure, your physician may adjust your dose or switch you to a different drug.

When to Talk to Your Physician

Not every low blood pressure reading requires a visit to your physician. But there are times when you should not wait. Talk to your provider if you:

• Frequently feel dizzy or lightheaded, especially when standing
• Have a chronic condition like diabetes, Parkinson's disease or heart disease and are experiencing new symptoms
• Have fainted or come close to fainting
• Notice your symptoms are getting worse or happening more often
• Think a medication may be affecting your blood pressure

If you have symptoms of low blood pressure or concerns about your heart health, a Catholic Health physician can help. Our cardiologists and primary care physicians work with you to understand what is going on and choose the care you need.