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Low blood pressure (hypotension)

If you have low blood pressure (hypotension), this means that it’s lower than would usually be expected for you and may cause symptoms such as fainting. It's usually good for your health to have as low a blood pressure as possible. However, when it becomes too low it can reduce the blood flow to your vital organs.

Your blood pressure is a measure of the force that your blood puts on the walls of your arteries as it's pumped around your body. This is affected by the strength with which your heart pumps, and the size and flexibility of your arteries that carry the blood. Your blood pressure changes throughout the day. It’s lower when you sleep and rises when you wake up.

Blood pressure is expressed as two numbers, such as 120/80mmHg (millimetres of mercury). The first number shows the maximum pressure when your heart contracts – this is your systolic blood pressure. The second number shows the minimum pressure as your heart relaxes – this is your diastolic blood pressure.

If your blood pressure is too high (hypertension), you will be at greater risk of certain diseases, such as coronary heart disease and stroke. It's usually good to have low blood pressure, as this can reduce your risk of getting these conditions. The ideal blood pressure for adults is between 90/60 and 120/80mmHg.

There’s no recognised level for low blood pressure. If your systolic blood pressure is lower than 90, your GP may consider it to be low. However, blood pressure below this may be normal for some people, whereas others may develop symptoms of low blood pressure at a level above this. It also depends on other factors. For example, blood pressure is lower in pregnant women, particularly during the middle part of pregnancy. Low blood pressure problems are also more common as you get older. Low blood pressure is only considered to be a problem if you’re having symptoms.

If your blood pressure falls below what is usual for you, it may result in not enough blood being pumped around your body. This may mean that the supply of oxygen to your organs, including your brain, is restricted. This can lead to symptoms such as fainting.

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Having your blood pressure taken
If you have problems with your blood pressure, you may not always have any symptoms, so it's important to get it checked regularly

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  • Symptoms Symptoms of low blood pressure

    If your blood pressure is naturally low, you’re unlikely to have any symptoms and it's not something you should be concerned about.

    However, if your blood pressure becomes lower than usual for you, it can cause symptoms such as:

    • dizziness or light-headedness
    • fainting
    • chest pain
    • cold feet and hands
    • palpitations (you can feel your heart beating more forcefully)
    • feeling sick
    • blurred vision
    • feeling confused or unable to concentrate

    You may find that you mainly get these symptoms when you stand up from a sitting position or from lying down. This usually happens within the first few seconds or minutes. This is called postural (orthostatic) hypotension. If you tend to get symptoms after eating a meal, it's called postprandial hypotension.

    Seek medical advice as soon as possible if you have any of the symptoms of low blood pressure.

  • Diagnosis Diagnosis of low blood pressure

    Your GP will ask about your symptoms and examine you. He or she will measure your blood pressure using a device called a sphygmomanometer. This is usually an automated, digital device, consisting of a monitor attached to a cuff, which is wrapped around your upper arm. Your GP will press a button to inflate the cuff, and then it will automatically slowly deflate. A sensor in the cuff detects your pulse when the cuff is fully inflated. As it deflates it converts this into a measurement of blood pressure. The result is shown on the display screen. Your GP may decide to use a manual device instead. However, they both do the same job.

    If you have symptoms of postural hypotension, your GP may also measure the change in your blood pressure while you’re sitting (or lying) and then standing. If it’s much lower when you stand up compared with when you’re sitting down, this suggests you have postural hypotension.

    You might need to have a test called a ‘tilt test’ to understand what’s causing your symptoms. This usually happens in hospital. It involves being slowly tilted from lying down to an upright position on a table as your blood pressure, heart rate and rhythm are monitored. See our FAQs for more information.

  • Treatment Treatment of low blood pressure

    You’re unlikely to need any treatment if your blood pressure is naturally low and you don't have any symptoms. If you have symptoms, your treatment will depend on the cause of your low blood pressure. For example, if you’re taking water tablets (diuretics) and are causing your blood pressure to drop, your GP may suggest stopping or changing your medication. Your doctor will review any medicine you’re taking that could be making it worse or bringing it on.

    During your pregnancy, you will regularly have your blood pressure checked at your antenatal appointments. This is so any problems can be picked up. If you’re feeling dizzy or worrying about it, speak to your midwife.

    Self-help

    There are several self-help measures that can help if you have either type of hypotension.

    If you have postural hypotension, your GP may suggest some actions you can take which might help. These are listed below.

    • Stand up slowly from sitting or lying down, especially when you first wake up.
    • Consider crossing your legs while standing, standing on tip toes and tensing your muscles. This can help your blood flow back to your heart quicker and reduce symptoms when standing up.
    • Take care getting out of hot baths or showers.
    • Make sure you drink enough fluid. If you drink alcohol, stick to the recommended daily limits (not regularly more than two to three units for women and three to four units for men).
    • Wear compression stockings to help stop blood staying in your legs.
    • Raise the head of your bed a little.

    Your GP may advise you to alter your diet so it includes more salt. However, don't do this unless your GP advises you to as it needs to be done in a controlled way.

    If you have postprandial hypotension, your GP may make the following suggestions.

    • Eat small meals with less carbohydrate (starchy foods such as rice, bread and pasta) more frequently, rather than fewer large meals with lots of carbohydrate.
    • Lie down after a meal.

    These measures may not be suitable for everyone. Ask your GP about what’s right for you.

    Medicines

    Occasionally, your GP or a specialist may prescribe medicines if self-help measures don’t stop your symptoms of low blood pressure. These may include medicines that:

    • increase how much salt is in your body
    • make your veins constrict

    Your GP may refer you to a specialist for further tests before prescribing these medicines, or if they are not helping.

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  • Causes Causes of low blood pressure

    If your blood pressure has been described as low but you don't have any symptoms, there‘s unlikely to be any underlying problem. It means that this is a healthy blood pressure for you.

    It’s not uncommon to get an occasional sudden, temporary drop in blood pressure that causes symptoms, such as fainting. The medical term for this is syncope. Around half of us will get this at some point in our lifetime. A number of things can cause this, for example:

    • standing for a long time in a hot environment
    • being dehydrated
    • pain
    • strong emotions
    • phobias – for example fear of the sight of blood

    If you have low blood pressure that is regularly causing symptoms, the mechanisms that control blood pressure in your body might not be working properly. They are causing your blood pressure to drop.

    If you have postural hypotension, your body doesn't respond quickly enough when you stand up, causing blood to stay in your legs. This means that less blood goes back to your heart so there isn’t as much for it to pump out, causing your blood pressure to fall. Postprandial hypotension happens when blood flows to your digestive system after you eat a meal. Your body doesn't respond in the usual way to maintain blood pressure in the rest of your body. Both of these conditions are more common in older people.

    There may be an underlying condition that‘s causing your low blood pressure. Some examples include:

    • injury or burns, leading to blood or fluid loss
    • dehydration
    • severe infection
    • a severe allergic reaction (anaphylaxis)
    • heart conditions, such as heart failure, heart attack and arrhythmia
    • certain medicines, including those for heart conditions and high blood pressure, and some antidepressants
    • conditions that affect your nervous system, such as Parkinson's disease and both type 1 and type 2 diabetes (see our FAQ for further information).
    • conditions involving your hormones, for example addison’s disease in which your body doesn’t produce enough of the hormone cortisol
    • long periods of bed rest
  • FAQs FAQs

    What happens in a tilt test?

    Answer

    In a tilt test, you lie on a special table and are slowly tilted upwards. This is so a doctor can monitor your blood pressure and heart rate as you move from lying down into an upright position.

    Explanation

    A tilt test can help to find out what may be causing symptoms such as fainting and dizziness. A tilt test is usually done as an outpatient appointment. This means you will go to hospital to have the test but you won't need to stay overnight.

    When you go for the test, you will be asked to lie down on the tilt table and safety belts will be placed around your body to keep you secure. Wires, called electrodes, will be attached with sticky patches to your chest so that your heart rate and rhythm can be monitored. A small cuff will be placed around your arm to monitor your blood pressure.

    Your blood pressure and heart rhythm are recorded while you’re lying down on the table. The table will then be gradually tilted until you’re almost in an upright position. You will probably stay like this for up to 45 minutes while your blood pressure and heart rhythm are monitored. However, your doctor may stop the test earlier if your blood pressure or heart rate falls. You may also be given a medicine to help improve the accuracy of the test.

    At the end of the test, you will be lowered back down into a lying position.

    You may start to get symptoms during the test, such as sweating or feeling light-headed or sick. It’s also possible that you may faint during the test. If this happens, the bed will be returned to a flat position so allow you to recover, which is usually quite quickly.

    The results of your test will be reported to your doctor so they can discuss them with you at your next appointment.

    Why can diabetes cause postural hypotension?

    Answer

    Having diabetes can cause damage to your nerves. When this affects the nerves in the part of the nervous system that regulates blood pressure, it can cause postural hypotension. This is a drop in blood pressure when you stand up.

    Explanation

    When you stand up your body has to make some changes to stop your blood staying in the lower half of your body. These are quite normal and include an increase in your heart rate and constriction (narrowing) of the blood vessels in your legs. If the nerve supply to the blood vessels in your legs isn’t working properly then they can’t constrict as well as they should. This means that blood stays (pools) in your legs, reducing the amount that reaches your brain and causing symptoms such as fainting and dizziness. This is postural hypotension.

    Both type 1 and type 2 diabetes can damage your nerves, which carry signals from your brain to all parts of your body. This is called diabetic neuropathy. One type of diabetic neuropathy can affect the nerves to your blood vessels, so preventing them from constricting when you stand. So if you have diabetes you may be more likely to get the symptoms of postural hypotension.

    Doctors don't fully understand why diabetes damages nerves – there are probably several factors involved. If you have diabetes which isn’t well controlled then you will have high levels of glucose (sugar) in your blood. This can cause chemical changes in your nerves, affecting how they transmit signals.

    This is one of the reasons why it's important that you take care to control your diabetes properly.

    Why is it beneficial to have low blood pressure?

    Answer

    Having low blood pressure means you're less likely to get conditions of the heart and blood vessels, such as stroke and coronary heart disease.

    Explanation

    High blood pressure puts an increased strain on your arteries (these are the blood vessels that carry blood around your body).

    Over time, this affects how well your arteries work and can restrict blood flow to the organs in your body, such as your brain and heart. This may lead to stroke, heart disease, kidney failure, and eye conditions.

    The lower your blood pressure, the less likely you are to suffer from these problems. There are a number of factors that increase your risk of getting high blood pressure. These include:

    • not doing enough physical activity
    • being overweight or obese
    • having too much salt in your diet
    • drinking too much alcohol

    Even if your blood pressure is not high now, making some changes to your lifestyle may help prevent it being too high in the future. Keeping your blood pressure low will help you reduce your chance of getting serious conditions like heart disease and stroke later on.

  • Resources Resources

    Further information

    Sources

    • What is low blood pressure? Blood Pressure Association. www.bloodpressureuk.org, published 2008
    • Assessment of hypotension. BMJ Best Practice. www.bestpractice.bmj.com, published June 2013
    • Hypotension. PatientPlus. www.patient.co.uk/patientplus.asp, published 2013
    • What is hypotension? National Heart, Lung and Blood Institute. www.nhlbi.nih.gov, published 2010
    • Low blood pressure. American Heart Association. www.heart.org, published March 2014
    • Orthostatic hypotension. The Merck Manuals. www.merckmanuals.com, published May 2007
    • Pocock G, Richards C. Human physiology: The basis of medicine. Oxford: Oxford University Press; 1999
    • Kumar P, Clark M. Clinical medicine. 8th ed. Edinburgh: Saunders; 2012.
    • Blood pressure chart. Blood pressure UK. www.bloodpressureuk.org, accessed 13 May 2014
    • Blood pressure measurement devices. Medicines and Healthcare Products Regulatory Agency (MHRA). www.mhra.gov.uk, published December 2013
    • Diagnosis and management of hypertension. National Institute for Health and Care Excellence (NICE). 17 June 2014. pathways.nice.org.uk
    • Syncope. Medscape. www.emedicine.com, published April 2014
    • The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). Guidelines for the diagnosis and management of syncope (version 2009). European Heart Journal (2009) 30, 2631–71. doi:10.1093/eurheartj/ehp298
    • Postural and postprandial hypotension. Medscape. www.medscape.com, published 2007
    • Tilt table testing. The Merck Manuals. www.merckmanuals.com, published 2012
    • Orthostatic intolerance. Medscape. emedicine.medscape.com, published 2011
    • Tilt table test. Syncope Trust And Reflex anoxic Seizures. www.stars.org.uk, published May 2014
    • Orthostatic hypotension. BMJ Best Practice. www.bestpractice.bmj.com, published June 2013
    • Diabetic neuropathy. Medscape. www.emedicine.medscape.com, published July 2012
    • Blood pressure. British Heart Foundation. www.bhf.org.uk, accessed 8 August 2012
    • What is high blood pressure? Blood pressure UK. www.bloodpressureuk.org, accessed 13 May 2014
    • High Blood Pressure. The Merck Manuals. www.merckmanuals.com, published 2013
    • The Pregnancy Book. Department of Health. www.dh.gov.uk, updated 30 June 2010
       
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    Reviewed by Natalie Heaton, Bupa Health Information Team, June 2014.

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