Hypotension – Blood pressure is the force exerted by the pumping blood on the walls of the arteries. Blood pressure is indicated by the top number (Maximum BP), systolic blood pressure & the bottom number (Minimum BP), diastolic blood pressure. (Eg: x/y)
A systolic BP of less than 90 mm Hg or diastolic BP of less than 60 mm Hg is an indication of hypotension also called low blood pressure.
Hypotension is a physiological condition, being a prominent symptom in many diseases.
TYPES OF HYPOTENSION
- Orthostatic – The drop in blood pressure that occurs when you transition from sitting or lying down to standing. It is common in people of all ages.
- Vasovagal Syncope – an inappropriate drop in blood pressure, while standing in an upright position. Caused due to malfunction of the vagus nerve.
- Postprandial – A drop in blood pressure after consumption of a meal due to which more blood is directed to the intestines, however not usual.
LOW BLOOD PRESSURE IN PEDIATRIC PATIENTS
| Age | Systolic Pressure |
|---|---|
| Term Neonates | <60 mmHg |
| Infants | <70 mmHg |
| Children 1 – 10 years | <70 + (age in years x 2) mmHg |
| Children >10 years | <90 mmHg |
SIGNS & SYMPTOMS OF HYPOTENSION
- Chest pain
- Shortness of breath
- Irregular heartbeat
- Fever higher than 38.3 °C (101 °F)
- Headache
- Stiff neck
- Severe upper back pain
- Cough with sputum
- Prolonged diarrhea or vomiting
- Indigestion
- Faint or unconsciousness
- Profound fatigue
- Temporary blurring or loss of vision
- Black tarry stools
CAUSES & RISK FACTORS OF HYPOTENSION
- Low blood volume called hypovolemia due to;
- Internal bleeding or hemorrhage
- Starvation or low intake of fluid
- Severe diarrhea & vomiting
- Heat stroke
- Due to medications like, diuretics (water pills), high blood pressure medications, drugs for Parkinson’s disease (Dopamine), drugs used for Erectile dysfunction.
- Blood pressure is likely to drop in pregnancy
- Heart conditions, like low heart rate & pumping volume
- Endocrine disorders
- Septic shock
- Severe allergic reaction (Anaphylactic shock)
- Use of illicit drugs.
- Low blood sugar
COMPLICATIONS
- Fainting & loss of consciousness
- Therefore injury
- Hypovolemic shock
- Less oxygen will be supplied to essential organs like brain, liver, kidneys, lungs.
- Arrhythmia
- Seizures
DIAGNOSIS
- Blood tests must be done to determine low blood sugar or a low red blood cell count, which contributes to low blood pressure.
- Using a sphygmomanometer to measure the systolic & diastolic blood pressure.
- In addition an arterial catheter may be implied to measure the Mean Arterial Pressure (MAP). If MAP <65 mmHg, it is diagnosed as low blood pressure.
- Similarly, an ECG, is done to determine the electrical signals of the heart, therefore giving the inference whether something is wrong with the pumping of the heart.
TREATMENT FOR HYPOTENSION
- Medications used to treat Hypotension;
- Corticosteroids
- Vasopressors
- Norepinephrine injections or medications similar to it.
- Volume resuscitation by blood products.
- If low blood pressure is a secondary cause due to a disease, infection, allergy, inury or disorder, in other words, the primary condition should be addressed.
- Fluid intake, ORS.
PREVENTION & MANAGEMENT
- Staying hydrated
- Taking foods that are high in Vit B12
- In addition, foods that are high in folate
- Addition of more salt in the diet
- Licorice tea for instance has showed support by countering medications that may reduce blood pressure
- Similarly coffee has provided some evidence in increasing blood pressure.
- However consumption of too much coffee & alcohol should be kept in check.
- Paying attention to body posture.
- Avoiding medications that may lead to hypotension, after talking to your physician.