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Hypotension

Introduction

What should I know about Hypotension?

Hypotension is low blood pressure. It is diagnosed when the systolic reading (the top or first number in a blood pressure reading) is less than 90mmHg, or 40mmHg less than the patient’s usual blood pressure. (1) Maintaining blood pressure while in the standing position depends upon several factors; an adequate amount of blood, no problems for blood to return through the veins to the heart, and properly functioning nervous system.

A serious form of low blood pressure is called orthostatic hypotension. This occurs when one is lying down and gets up too quickly and then feels weak and dizzy from the sudden drop in blood pressure. Orthostatic (also called postural) hypotension can be a very disabling disorder. Patients often lose their job as a result, and often home health support for patients and psychological help for caregivers is essential.

A patient suffering from hypotension should have their current medications reviewed. A number of medications may cause postural hypotension, including diuretics (drugs that remove excess fluid), antihypertensives (medications that lower blood pressure), antidepressants, phenothiazines (drugs for psychiatric disorders), alcohol, narcotics, insulin, barbiturates, and beta-adrenergic and calcium channel blockers (heart drugs). Postprandial hypotension occurs as blood is moved to the abdominal circulation after a meal. Therefore, giving blood pressure lowering medications at meals should be done with caution to make sure that the blood pressure is not already significantly lowered just from eating a meal. Giving medication may lower it further, possibly harming the patient.

The rate of hypotension that happens during or immediately following dialysis ranges from 15 to 50 percent. (2) The cause is usually due to many factors, and includes taking blood pressure medications or food before or during dialysis, severe hypocalcemia (low calcium in the blood), and high amounts of magnesium in the dialysis solution.

Signs and Symptoms

The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.

Symptoms of hypotension can be very disabling and most often occur when getting up in the morning, or when standing up. Some patients have symptoms after eating a meal. The symptoms include dimming or loss of vision, feeling of lightheadedness or dizziness, sweating, reduced hearing (things may sound distant), skin color turns pale, feeling of weakness, and fainting may occur if the drop in blood pressure is enough to reduce blood flow to the brain.

General

  • Dimming or loss of vision
  • Feeling of lightheadedness or dizziness
  • Sweating
  • Reduced hearing (things may sound distant)
  • Skin color turns pale
  • Feeling of weakness
  • Fainting may occur if the drop in blood pressure is enough to reduce blood flow to the brain

Treatment Options

Conventional

Orthostatic hypotension only requires treatment if it causes symptoms. In the early stages, patients need to exercise good judgment and take a few precautions. Some examples may include; eating smaller meals (because they are better for patients with postprandial hypotension) and avoiding alcohol and excess outside temperatures that causes vasodilation (expanding of blood vessels) that may cause a sudden drop in blood pressure in some people. Drugs that affect blood pressure must be taken cautiously. Salt intake should be increased to the maximum possible, and sleeping with the head of the bed slightly elevated decreases postural hypotension.

Eventually, most patients require drug therapy for hypotension. The initial drug of choice is fludrocortisone, (a steroid). Potassium supplements are often necessary with chronic use because this drug can cause a person to have increased sodium in their body. Ibuprofen and similar drugs are also used. Other drugs have been tried, sometimes with success. If the person has other diseases, the choice of drugs to use may be limited.

Desmopressin (DDAVP) has been tried, as well as a drug called octreotide. Desmopressin keeps loss of body fluids to a minimum, which may play an important role in the hypotension seen in patients with problems with their autonomic (automatic) nervous system. Single doses of DDAVP as a nasal spray at bedtime decreases nocturia (getting up during the night to urinate) and morning postural hypotension. (3) , (4) Octreotide is given by injection, and acts to decrease the release of proteins in the gastrointestinal tract that dilate blood vessels and cause hypotention. They are usually released after a meal. Octreotide is therefore most effective in patients with postprandial hypotension.

Nutritional Suplementation


Vitamin B12

Although it is not very common, orthostatic hypotension is one of the symptoms that can occur in individuals with a deficiency of vitamin B12. (5) , (6)

Herbal Suplementation


Hawthorn

Hawthorn is used to dilate blood vessels and increase the circulation. (7) , (8) It has been used by doctors in Europe for a variety of heart and circulation conditions. It is used as a tonic, especially for the elderly, where mitral stenosis (a narrowing in the area of the mitral valve in the heart) and minor heart failure may be present. Studies have reported a decrease in blood pressure due to arteriosclerosis (hardening of the arteries) and chronic nephritis (inflammation of the kidney) with the use of hawthorn. (9) , (10) It is also used for Raynaud’s disease.

Hawthorn is reported to be able to regulate both low and high blood pressure. Its active ingredients reportedly dilate blood vessels. (11) It is also used to decrease angina attacks. Hawthorn affects the circulation in the heart and increases the force of the heartbeat. (12) , (13) Hawthorn flower and leaf has a slight diuretic effect (removes fluid from the body) which may help lower high blood pressure, so the berry may be preferred in managing hypotension. Laboratory studies have reported that hawthorn berry may also remove atherosclerotic plaque (responsible for hardening of the arteries). (14)


Panax Ginseng (Asian)

Asian ginseng is one of the most frequently purchased herbal supplements in the United States. It has been used for a variety of health conditions, especially for its tonic effects for people fatigued or under stress. (15) Asian ginseng, or panax ginseng, is an adaptogen. It increases the body’s ability to cope with stress, therefore decreasing chances for getting sick.

Because of its chemical makeup, American ginseng (Panax quinquifolius) may be more suitable for individuals who are coffee drinkers, overweight, on prescription drugs, or those that suffer from insomnia. Asian ginseng (Panax ginseng) may be more suitable for individuals who do not have high blood pressure, are athletes, fatigued, or persons with high stress jobs.

Panax ginseng reportedly can lower blood sugar in diabetic mice and yet have no effect on normally functioning lab animals. (16) Studies report that panax ginseng also plays a part in insulin regulation. Panax ginseng may offer some positive benefits as a general tonic for improved stamina and overall health, especially for stressful conditions, fatigue, concentration, and recovery from illness.

References

  1. View Abstract: American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care med. 1992;20:864.
  2. Matzke GR, Bailie GR. Hemodialysis and peritoneal dialysis. In: DiPiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy, A Pathophysiologic Approach, 4th ed. Stamford, CT: Appleton & Lange; 1999:802-803.
  3. View Abstract: Cannon A. Desmopressin in the treatment of nocturnal polyuria in the male. BJU Int. Jul1999;84(1)20-4.
  4. View Abstract: Mathias CJ. The effect of desmopressin on nocturnal polyuria, overnight weight loss, and morning postural hypotension in patients with autonomic failure. Br Med J (Clin Res Ed). Aug1986;293(6543):353-4.
  5. View Abstract: Girard P, Lebrun C, Peyrade F, Brunetto JL, Chatel M. Orthostatic hypotension revealing vitamin B12 deficiency. Rev Neurol (Paris). May1998;154(4):342-4.
  6. View Abstract: Healton EB, Savage DG, Brust JC, Garrett TJ, Lindenbaum J. Neurologic aspects of cobalamin deficiency. Medicine (Baltimore). Jul1991;70(4):229-45.
  7. View Abstract: Schüssler M. Myocardial effects of flavonoids from Crataegus species. Arzneimittelforschung. Aug1995;45(8):842-5.
  8. View Abstract: Weikl A. Crataegus Special Extract WS 1442. Assessment of objective effectiveness in patients with heart failure (NYHA II). Fortschr Med. Aug1996;114(24):291-6.
  9. Racz-Kotilla E, et al. Salidiuretic and Hypotensive Action of Ribes-Leaves. Planta Medica. 1980;29:110-14.
  10. View Abstract: Garjani A. Effects of extracts from flowering tops of Crataegus meyeri A. Pojark. on ischaemic arrhythmias in anaesthetized rats. Phytother Res. Sep2000;14(6):428-31.
  11. Wagner H, et al. Cardioactive Drugs IV. Cardiotonic Amines from Crataegus oxyacantha. Planta Medica. 1982;45:99-101.
  12. View Abstract: Taskov M. On the Coronary and Cardiotonic Action of Crataemon. Acta Physiol Pharmacol Bulg. 1977;3(4):53-57.
  13. View Abstract: Weikl A. Crataegus Special Extract WS 1442. Assessment of objective effectiveness in patients with heart failure (NYHA II). Fortschr Med. Aug1996;114(24):291-6.
  14. View Abstract: Wergowski J, et al. The Effect of Procyanidolic Oligomers on the Composition of Normal and Hypercholesterolemic Rabbit Aortas. Biochem Pharm. 1984;33:3491-97.
  15. Bradley PR, ed. British Herbal Compendium, vol 1. Bournemouth: British Herbal Medicine Association; 1992:115-17.
  16. View Abstract: Ng TB, et al. Hypoglycemic Constituents of Panax Ginseng. Gen Pharmacol. 1985;16(6):549-52.