Hypotension - Low Blood Pressure

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Hypotension - Low Blood Pressure
Hypotension - Low Blood Pressure

Video: Hypotension - Low Blood Pressure

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Video: What is Hypotension (Low Blood Pressure)? | Ausmed Explains... 2023, January
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Low blood pressure (hypotension)

According to the World Health Organization (WHO), normal blood pressure in adults is below 120/80 mmHg. Values ​​below 90/60 mmHg are defined as low arterial blood pressure. Some people have persistent low blood pressure that does not cause discomfort and therefore does not require treatment. However, low blood pressure can also be associated with serious illnesses and can even trigger life-threatening symptoms.

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What types and causes of arterial hypotension are there?

A basic distinction is made between so-called chronic asymptomatic hypotension, which is not considered to be a disease, and other types of hypotension, which cause symptoms. In these types, the blood pressure suddenly drops sharply to low values ​​and causes more or less severe symptoms. The three main types are orthostatic hypotension, neural mediated hypotension, and so-called severe hypotension.

Chronic asymptomatic hypotension

Here, people have permanently low blood pressure without complaints and without the need for treatment. Young, slim people (especially girls and women) and gaunt elderly people are often affected. Usually no cause can be determined, then one speaks of primary hypotension. Pregnancy often results in low blood pressure, which levels off again after birth.

Orthostatic hypotension

This occurs when getting up from sitting or lying down. It occurs when the body is unable to adjust blood pressure and blood distribution quickly enough to change position. The drop in blood pressure usually only lasts a few seconds or minutes and quickly returns to normal. Orthostatic hypotension can occur in all age groups, but is more common in older people, especially those who are frail or sick. It can be a symptom of another illness.

Neural mediated hypotonia (LMWH)

This occurs when the brain and heart do not communicate properly with each other. It can occur after long periods of standing, but also as a reaction to exciting or frightening situations. This type is more common in children and young adults than in older people.

Severe hypotension

This form is often associated with shock. The blood pressure drops so sharply that the brain, kidneys and other vital organs are not supplied with enough blood to perform their functions. In extreme cases, a life-threatening state of shock occurs. Possible causes include:

  • Cardiovascular diseases: e.g. acute coronary syndrome, acute heart failure, heart valve defects, cardiac arrhythmias;
  • Diseases that reduce the heart's output capacity: eg effusion or tamponade of the pericardium, pneumothorax, pulmonary embolism;
  • Conditions which lead to decreased peripheral vascular constriction and changed blood distribution: for example stroke, diabetes mellitus, Parkinson's disease, chronic liver diseases;
  • low fluid volume (hypovolaemia) as a result of heavy bleeding or large fluid losses: e.g. vomiting, diarrhea, kidney disease, certain medications such as diuretics, profuse sweating, extensive burns, ascites;
  • Infections;
  • Medicines: e.g. antihypertensive drugs such as beta blockers
  • hormonal diseases: e.g. hypofunction of the adrenal cortex (Addison's disease), hypothyroidism
  • allergic reaction;
  • Poisoning.

What are the symptoms of low blood pressure?

Often, low blood pressure does not cause any symptoms. It is not a disease in itself and it is not dangerous. On the contrary: A permanently low blood pressure with no recognizable cause of the disease protects the heart and circulation and is considered to be beneficial in the long term. However, low blood pressure can also cause a variety of symptoms related to decreased blood flow to the brain. These include:

  • Fatigue,
  • Lack of concentration,
  • Tinnitus,
  • Paleness,
  • cold hands and feet,
  • Sweat,
  • Tremble,
  • Insomnia,
  • Visual disturbances (blackness of the eyes, blurred vision)
  • A headache,
  • Racing heart (tachycardia)
  • Dizziness,
  • Nausea,
  • Tendency to collapse and brief loss of consciousness (especially when blood pressure drops very quickly).

These complaints can especially increase the risk of falls and related injuries. A shock caused by a massive and rapid drop in blood pressure is a life-threatening emergency.

How is the diagnosis made?

As part of the anamnesis, the doctor will determine, among other things, whether signs of hypotension have occurred earlier, whether there is a pregnancy, previous illnesses are known, certain medications are taken and in which situations symptoms caused by low blood pressure occur.

Basic diagnostics include blood pressure measurement (if necessary several times while sitting and / or lying down), long-term blood pressure measurement, EKG and the examination of various circulatory functions. Corresponding examinations are then carried out to identify a possible cause, eg laboratory tests, ultrasound or X-rays, echocardiography, stress tests, PET.

How is hypotension treated?

The therapy is based on the type of hypotension and the severity of the symptoms. The goals are to normalize blood pressure, relieve symptoms, and treat underlying diseases.

In healthy people, low blood pressure that does not cause relevant symptoms does not need treatment.

Note If you experience symptoms that indicate low blood pressure, you should lie down and raise your legs at an angle of about 45 degrees, or at least sit down and raise your legs.If the symptoms do not go away quickly, you should consult a doctor or, in an acute case, the rescue team will be notified. If there are signs of shock, the emergency doctor should be called immediately. For more information, see Emergency: Shock and Emergencies and First Aid.

Medication

If the symptoms are not sufficiently improved with lifestyle or behavioral measures, additional medications such as mineralocorticoids (fludrocortisone) or betamimetics (etilefrine) can be used.

What can I do about hypotension myself?

The focus is on lifestyle measures that those affected can carry out themselves. Sufficient improvement can be achieved with this in many cases. Measures to prevent and treat low blood pressure include:

  • Kneipp treatments,
  • Brush massages (towards the heart),
  • regular exercise,
  • balanced diet with increased salt content (contrary to the recommendation for high blood pressure),
  • Sufficient fluid intake (at least 2.5 to three liters, e.g. water or sports drinks with sodium and potassium) - if you have kidney disease, consult your doctor about this,
  • little or no alcohol,
  • do not sit cross-legged,
  • Recognizing and avoiding situations that lower blood pressure (e.g. overtiredness and overwork, getting up quickly after sitting or lying down for a long time, excitement, stress)
  • Relaxation techniques to better manage stress,
  • Compliance with rules of conduct or participation in therapy for underlying diseases.

Whom can I ask?

If you have low blood pressure, you can contact:

  • General Practitioner,
  • Specialist in internal medicine.

Depending on the underlying cause, other disciplines can also be consulted. If there are signs of shock, the emergency doctor should be called immediately.

How are the costs going to be covered?

All necessary and expedient steps for diagnosis and therapy are taken over by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. However, you may have to pay a deductible with certain health insurance providers (BVAEB, SVS, SVS, BVAEB).

However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic.

You can find more information under Costs and Deductibles and on the website of the social security agency.

When hospitalization is required

If a state of shock occurs, a hospital stay is sometimes necessary. Here, the hospital costs are billed. The patient has to pay a daily contribution to the costs.

For more information, see What does a hospital stay cost?

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