Definition

Hypotension is a medical term that refers to low blood pressure. Blood pressure is the pressure that blood exerts to pass through the walls of arteries. Blood pressure can fluctuate depending on the activity, such as after exercise or while resting.

Blood pressure consists of two pressures, namely systolic pressure and diastolic pressure.

• Systolic blood pressure is the pressure measured as blood passes through the arteries while the heart chambers (ventricles) contract to pump blood around the body
• Diastolic blood pressure is the minimum pressure measured just before the next contraction of the heart chambers or during a resting period

Systolic blood pressure is measured as the heart pumps blood into the body. Diastolic blood pressure, on the other hand, refers to the period during which the heart fills with blood and receives oxygen.

Blood pressure is considered normal when it is between 90/60 mmHg and 120/80 mmHg. When you measure your blood pressure, you will get two measurements: systolic and diastolic. Systolic blood pressure is the upper value, while diastolic blood pressure is the lower value. For example, a blood pressure of 120/80 mmHg means that 120 is the systolic blood pressure, while 80 is the diastolic blood pressure.

In hypotension or low blood pressure, you will sometimes feel easily tired or dizzy. In most cases, hypotension can be a sign of a medical condition that needs to be treated.

Causes

Blood pressure can drop at any time in all people. The body's internal regulation of blood flow can sometimes result in lower-than-normal blood pressure. Most people have low blood pressure at all times without any clinical symptoms. The cause of this type of hypotension or low blood pressure is currently unknown. A sudden drop in blood pressure can result from several conditions, including:

• Suddenly standing up or getting up quickly from a sleeping position
• Eating certain foods
• Suddenly feeling scared
• Experience an unexpected event
• Bleeding or losing a lot of blood

In addition, some special conditions can cause hypotension over a long period of time and can be dangerous if left untreated. Some of these special conditions include:

• Pregnancy (increased blood requirements for mother and fetus)
• Poor circulation caused by a heart attack or other heart disease
• Dehydration due to vomiting or diarrhea
• Endocrine diseases such as diabetes or thyroid gland disorders
• Anaphylactic shock due to severe allergic reactions
• Blood infection
• Prolonged bed rest

Some medications can cause blood pressure to be too low or hypotensive. These include beta blockers and nitroglycerin used for heart disease. Diuretics that increase urine output, antidepressants, or erectile dysfunction drugs can also cause low blood pressure.

Risk Factor

• Consumption of certain medications that have the effect of lowering blood pressure
• Lack of vitamin B-12, folic acid, and iron intake. This condition can cause the body to not be able to produce enough red blood cells (anemia)
• Having certain diseases, such as diabetes or Parkinson's disease, which can increase the risk of lowered blood pressure (hypotension)
• Age factor

Symptoms

Hypotension does not always cause symptoms in the sufferer. However, when blood pressure is low, vital organs do not receive adequate blood flow. This causes the patient to become tired quickly or to feel tired.  Patients may complain of a variety of other symptoms associated with hypotension, such as:

• Easily tired (sensation of feeling no energy for activity)
• Spinning dizziness
• Nausea
• Decreased consciousness (fainting)
• Blurred vision (unfocused or foggy vision)

Diagnosis

The diagnosis of hypotension can be made using medical interviews, physical examinations, and other supporting examinations as needed.

During the medical interview, the doctor will inquire about the patient's current symptoms. Because symptoms can indicate a specific disease, you must express them as completely as possible, along with when they began. This information is necessary for the doctor to make an accurate medical diagnosis. If your symptoms point to hypotension, your doctor will conduct a physical examination as well as any additional tests that may be required.

Supporting examinations are performed when the tools are available and required by the doctor. Supportive examination also helps to establish or confirm the diagnosis of the underlying disease that causes hypotension. These tests include:

• A complete blood test is done to assess your overall health and to identify any other diseases that may be underlying your hypotension
• Thyroid hormone tests such as TSH (thyroid-stimulating hormone) or free T4 if the doctor suspects a problem with your thyroid gland
• An electrocardiogram (ECG) is done to detect any abnormalities in one of the circulatory system's organs, specifically the heart
• Tilt table test. In this test, you will lie on a table that is tilted to elevate your upper body. This test is used to determine how the body reacts to changes in position. In cases of orthostatic or postural hypotension, the patient will experience hypotension a few minutes after changing body positions

Management

Treatment for hypotension is determined by the underlying cause. The doctor will determine the type of hypotension you have and the specific conditions that may be causing it. People who have low blood pressure but no symptoms will typically receive no specific treatment. In cases where treatment is required, the doctor will typically recommend lifestyle changes, specific medications, or a combination of both.

Broadly speaking, there are three ways to treat hypotension directly, namely:

• Increasing blood volume

This method is also known as fluid resuscitation. This method is done by introducing fluids into your blood through an IV. Examples include IV fluids, as well as plasma transfusions or blood transfusions

• Narrowing the blood vessels

This is done by giving drugs to narrow the blood vessels. When the size of the blood vessels becomes narrower, this can cause blood pressure to rise

• Changes the way the body handles fluids

The human kidneys regulate the amount of water in the body. Adequate water intake can help correct low blood pressure.  This process is done by administering certain types of medication that will make the kidneys retain more salt and water in the body, thereby overcoming the hypotension

Complications

The potential complications of low blood pressure vary. Hypotension can result in fainting or loss of consciousness. In elderly patients, this can lead to fractures in the hip or spine area due to decreased consciousness due to hypotension. When this happens, the health and quality of life of the patient will be reduced.

A sudden and severe drop in blood pressure can cause other organs to lack oxygen from the blood. This can cause damage to the heart, brain, and other organs. This type of hypotension can be life-threatening if not treated properly.

Prevention

Some steps that can be taken to help prevent hypotension from occurring are as follows:

• Drinking plenty of water 
• Getting up slowly after being in a sitting or sleeping position
• Not drinking alcohol
• Not standing for long periods of time
• Wearing compression socks so that blood does not pool under the feet

When to See a Doctor?

If you suspect that your existing low blood pressure is causing you to lose consciousness, you should seek further medical attention. You can consult an internal medicine specialist or a heart and blood vessel specialist. The doctor will conduct a medical interview, a physical examination, and certain supporting examinations to determine the exact diagnosis and appropriate management.

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