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'''Associate Editor-In-Chief:''' {{CZ}}
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
{{Hypotension}}
{{CMG}}; {{AE}} {{CZ}}


{{Editor Help}}
{{SK}} low blood pressure; blood pressure low, systemic.


'''Hypotension''' refers to an abnormally low [[blood pressure]]. This is best understood as a physiologic state, rather than a disease.  It is often associated with [[Shock (medical)|shock]], though not necessarily indicative of it. Hypotension is not to be confused with [[hypertension]], which is [[high blood pressure]], the opposite of hypotension. Hypotension is a fairly rare problem, hypertension is a much more common problem. Hypotension is almost never  a serious problem, although in some very rare cases it can be life threatening.
==[[Hypotension overview|Overview]]==


==Normal physiology==
==[[Hypotension historical perspective|Historical Perspective]]==


Blood pressure is continuously regulated by the [[autonomic nervous system]], using an elaborate network of [[sensory receptors|receptors]], [[nerve|nerves]], and [[hormone|hormones]] to balance the effects of the [[sympathetic nervous system]], which tends to raise blood pressure, and the [[parasympathetic nervous system]], which lowers it. The vast and rapid compensation abilities of the [[autonomic nervous system]] allow normal individuals to maintain an acceptable blood pressure over a wide range of activities and in many disease states.
==[[Hypotension pathophysiology|Pathophysiology]]==


==Mechanisms and causes==
==[[Hypotension causes|Causes]]==


'''Reduced blood volume''', called [[hypovolemia]], is the most common mechanism producing hypotension. This can result from [[hemorrhage]], or blood loss; insufficient fluid intake, as in starvation; or excessive fluid losses from [[diarrhea]] or [[vomiting]].  Hypovolemia is often induced by excessive use of [[diuretic]]s. (Other medications can produce hypotension by different mechanisms.)
==[[Hypotension differential diagnosis|Differentiating Hypotension from other Diseases]]==


'''Decreased [[cardiac output]]''' despite normal blood volume, due to severe [[congestive heart failure]], large [[myocardial infarction]], or [[bradycardia]], often produces hypotension and can rapidly progress to [[cardiogenic shock]]. [[Arrhythmia]]s often result in hypotension by this mechanism. [[Beta blocker]]s can cause hypotension both by slowing the heart rate and by decreasing the pumping ability of the heart muscle. 
==[[Hypotension epidemiology and demographics|Epidemiology and Demographics]]==


'''Excessive [[vasodilation]],''' or insufficient constriction of the resistance blood vessels (mostly [[arterioles]]), causes hypotension.  This can be due to decreased sympathetic nervous system output or to increased parasympathetic activity occurring as a consequence of injury to the [[brain]] or [[spinal cord]] or of [[dysautonomia]], an intrinsic abnormality in autonomic system functioning. Excessive vasodilation can also result from [[sepsis]], [[acidosis]], or medications, such as [[Glyceryl trinitrate (pharmacology)|nitrate preparations]], [[calcium channel blockers]], or [[ACE inhibitors]].  Many anesthetic agents and techniques, including [[spinal anesthesia]] and most [[Inhalational anaesthetic|inhalational agents]], produce significant vasodilation.
==[[Hypotension risk factors|Risk Factors]]==


== Differential Diagnosis ==
==[[Hypotension natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


In alphabetical order <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:92</ref> <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:204-205</ref>
==Diagnosis==
* [[Addison's Disease]]
[[Hypotension history and symptoms| History and Symptoms]] | [[Hypotension physical examination | Physical Examination]] | [[Hypotension laboratory findings|Laboratory Findings]] | [[Hypotension electrocardiogram|Electrocardiogram]] | [[Hypotension chest x ray|Chest X Ray]] | [[Hypotension CT|CT]] | [[Hypotension MRI|MRI]] | [[Hypotension echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Hypotension other imaging findings|Other Imaging Findings]] | [[Hypotension other diagnostic studies|Other Diagnostic Studies]]
* [[Adrenal insufficiency]]
* [[Adrenocortical insufficiency]]
* [[Adrenogenital syndrome]]
* [[Anaphylaxis]]
* [[Anemia]]
* [[Aortic Arch Syndrome]]
* Aortic Isthmus Stenosis
* [[Aortic Stenosis]]
* Autonomic failure
* [[Bartter's syndrome]]
* [[Cardiac valve]] defect
* [[Cardiogenic shock]]
* Carotid sinus syndrome
* [[Pericarditis|Constrictive pericarditis]]
* [[Dehydration]]
* [[Diabetes Insipidus]]
* Diabetic autonomic neuropathy
* [[Drug]]s
* During and after infections
* [[Dysrhythmias]]
* [[Ectopic Pregnancy]]
* Excessive fluid loss through dialysis
* [[Fatigue]]
* Fluid loss
* [[Guillain-Barre Syndrome]]
* [[Heart failure]]
* [[Heat]], [[Hypothermia]]
* [[Hemorrhage]] - [[Bleeding|bleeding]]
* Hemorrhagic shock
* [[Hepatitis]]
* [[Hyponatremia]]
* [[Hypothyroidism]]
* Idiopathic hypotension
* Insufficient fluid intake
* Internal bleeding
* Medications (hypotension secondary)
* Multiple cerebrovascular accidents (CVAs)
* [[Myocardial infarction]]
* [[Myocardial ischemia]]
* Neurogenic shock
* [[Orthostatic hypotension]]
* Overwhelming infection
* [[Paraplegia]]
* [[Parkinson's Disease]]
* [[Pericardial effusion]]
* [[Perimyocarditis]]
* Pituitary insufficiency
* [[Polyneuropathy]]
* [[Polyradiculitis]]
* Postprandial hypotension
* [[Pregnancy]]
* [[Pulmonary Embolism]]
* [[Septic shock]]
* [[Shy-Drager Syndrome]]
* Splenic rupture
* [[Syncope]], fainting
* [[Syringomyelia]]
* [[Tabes Dorsalis]]
* [[Trauma]]
* Vagal syncope
* [[Valsalva maneuver]]
* Volume depletion
 
==Syndromes==
 
'''[[Orthostatic hypotension]]''', also called "postural hypotension", is a common form of low blood pressure. It occurs after a change in body position, typically when a person stands up from either a seated or lying position. It is usually transient and represents a delay in the normal compensatory ability of the autonomic nervous system. It is commonly seen in [[hypovolemia]] and as a result of various medications. In addition to the classes of blood pressure-lowering medications listed above, many psychiatric medications, in particular [[antidepressant|antidepressants]], can have this side effect. Simple blood pressure and heart rate measurements while lying, seated, and standing can confirm the presence of orthostatic hypotension. 
 
'''[[Neurocardiogenic syncope]]''' is a form of dysautonomia characterized by an inappropriate drop in blood pressure while in the upright position. Neurocardiogenic syncope is related to [[vasovagal syncope]] in that both occur as a result of increased activity of the [[vagus nerve]], the mainstay of the parasympathetic nervous system.
 
Another, but rarer form, is '''[[Postprandial]] [[hypotension]]''', which occurs 30&ndash;75&nbsp;minutes after eating substantial meals. When a great deal of blood is diverted to the [[intestines]] to facilitate [[digestion]] and [[Digestion|absorption]], the body must increase [[cardiac output]] and peripheral [[vasoconstriction]] in order to maintain enough blood pressure to perfuse vital organs, such as the brain. It is believed that postprandial hypotension is caused by the [[autonomic nervous system]] not compensating appropriately, because of ageing or a specific disorder.
 
==Indicators==
 
For most individuals, a healthy [[blood pressure]] lies from 90/50&nbsp;mmHg to 135/90&nbsp;mmHg. A small drop in blood pressure, even as little as 20&nbsp;mmHg, can result in transient hypotension.
 
Evaluating [[neurocardiogenic syncope]] is done with a [[tilt table test]].
 
==Symptoms==
 
The cardinal symptom of hypotension is [[lightheadedness]] or [[dizziness]].
 
If the blood pressure is sufficiently low, [[fainting]] and often [[seizure]]s will occur.
 
Hypotension, depending on one's own body chemistry and genetics, may often cause mild [[depression]], mostly in regard to taking other medications which do not fit one's personal unique needs.   
 
Low blood pressure is often accompanied by: 
 
(Most of these are related to causes rather than effects of hypotension.)
 
* [[Chest pain]]
* [[Shortness of breath]]
* [[Irregular heartbeat]]
* [[Fever]] higher than 101&nbsp;°F (38.3&nbsp;°C)
* [[Headache]]
* Stiff neck
* Severe [[upper back pain]]
* [[Cough]] with [[phlegm]]
* Prolonged [[diarrhea]] or [[vomiting]]
* [[Dysphagia|Inability to eat]] or drink
* [[Dysuria|Burning with urination]]
* Foul-smelling [[urine]]
* Adverse effect of [[medications]]
* Acute, life-threatening [[allergic reaction]]
* [[Dizziness]], or [[light-headedness]], particularly when suddenly standing up from sitting down
* [[Seizures]]
* [[Loss of consciousness]]
* Profound [[fatigue (physical)|fatigue]]
 
== Laboratory Findings ==
 
* [[Complete blood count]] ([[CBC]])
* [[Blood urea nitrogen]] ([[BUN]]) / [[creatinine]]
* [[Calcium]]
* [[Glucose]]
* [[Urinalysis]]
* [[Blood culture]]
* [[Cortisol]] level
 
=== Electrocardiogram ===
* [[ECG]]
 
=== Other Diagnostic Studies ===
 
* [[Swan-Ganz catheterization]]


==Treatment==
==Treatment==
[[Hypotension medical therapy|Medical Therapy]] | [[Hypotension surgery|Surgery]] | [[Hypotension primary prevention|Primary Prevention]] | [[Hypotension secondary prevention|Secondary Prevention]] | [[Hypotension cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hypotension future or investigational therapies|Future or Investigational Therapies]]


The treatment for hypotension depends on its cause. Asymptomatic hypotension in healthy people usually does not require treatment. Severe hypotension needs to be aggressively treated because reduced [[blood]] flow to critical organs including the [[brain]], [[heart]] and [[kidneys]] may cause organ failure and can ultimately lead to [[death]]. Treatment options include [[systemic]] [[vasoconstrictors]] and other drugs.
==Case Studies==
* Increase salt and water intake
[[Hypotension case study one|Case #1]]
* [[Caffeine]]
* Fluid replacement
* Remove harmful/offending medications
* Educate patient
 
=== Acute Pharmacotherapies ===
 
* [[Fludrocortisone acetate]]
* [[Sympathomimetic agent]]s
* [[Nonsteriodal anti-inflammatory drug]]s ([[NSAID]]s)
* [[Erythropoietin]]
* IV [[hydrocortisone]]
 
==References==
{{Reflist}}


{{Circulatory system pathology}}
{{Circulatory system pathology}}
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[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
[[Category: Overview complete]]
[[Category: Physical examination]]
 


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[[fr:Hypotension artérielle]]
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[[nl:Hypotensie]]
[[no:Hypotensjon]]
[[pl:Hipotonia]]
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[[pt:Hipotensão]]
[[pt:Hipotensão]]
[[ru:Артериальная гипотензия]]
[[ru:Артериальная гипотензия]]
[[sq:Hipotensioni]]
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[[tr:Düşük tansiyon]]
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[[zh:低血壓]]
[[zh:低血壓]]

Latest revision as of 13:41, 9 June 2015



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Overview

Historical Perspective

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Causes

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Risk Factors

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Physical Examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Synonyms and keywords: low blood pressure; blood pressure low, systemic.

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Hypotension from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1


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