Blood Pressure Basics: Blood pressure, measured in millimeters of mercury (mm Hg), comprises systolic (when the heart beats) and diastolic (when the heart is at rest) values. Normal blood pressure is around 120/80 mm Hg.

Hypotension Defined: Hypotension is generally a reading below 90/60 mm Hg, with orthostatic hypotension causing a significant drop upon standing.

Classification: Mild hypotension involves readings slightly below normal, while severe hypotension indicates a notable drop leading to symptoms.

Causes of Hypotension:

1. Dehydration:
   • Insufficient fluid levels reduce blood volume, causing a drop in blood pressure.
2. Heart Problems:
   • Conditions like bradycardia or cardiomyopathy can result in reduced pumping efficiency.
3. Endocrine Issues:
   • Hormonal imbalances, as seen in adrenal insufficiency or thyroid disorders, can affect blood pressure regulation.
4. Severe Infections (Septic Shock):
   • Widespread infection triggers a severe drop in blood pressure, leading to shock.
5. Blood Loss:
   • Trauma or internal bleeding can cause significant blood loss, leading to hypotension.
6. Allergic Reactions (Anaphylaxis):
   • Severe allergic reactions can lead to a sudden drop in blood pressure, causing anaphylactic shock.

Symptoms and Manifestations:

1. Dizziness and Lightheadedness:
   • Feeling dizzy or lightheaded upon standing is common in orthostatic hypotension.
2. Fainting (Syncope):
   • Severe drops in blood pressure may result in fainting or passing out.
3. Blurred or Narrowed Vision:
   • Hypotension can affect blood flow to the eyes, leading to visual disturbances.
4. Fatigue and Weakness:
   • Inadequate blood flow can result in fatigue and weakness.
5. Nausea and Lack of Concentration:
   • Hypotension may cause nausea and difficulties concentrating.

Diagnosis of Hypotension:

1. Blood Pressure Measurement:
   • Orthostatic testing measures blood pressure in various positions.
   • Ambulatory blood pressure monitoring offers continuous 24-hour monitoring.
2. Medical History and Physical Examination:
   • Examining the patient’s medical history and conducting a physical examination helps identify potential contributors to low blood pressure.
3. Laboratory Tests:
   • Complete blood count assesses anemia or blood loss.
   • Electrolyte levels are checked for imbalances contributing to hypotension.
4. Electrocardiogram (ECG or EKG):
   • Evaluating the heart’s electrical activity helps identify abnormalities.

Treatment Approaches:

1. Increasing Fluid Intake:
   • Adequate fluid intake helps increase blood volume and blood pressure.
2. Salt Supplementation:
   • Increasing salt intake can help retain water, positively impacting blood pressure.
3. Wearing Compression Stockings:
   • Compression stockings reduce blood pooling in the legs, minimizing symptoms upon standing.
4. Gradual Changes in Position:
   • Getting up slowly helps mitigate orthostatic symptoms.
5. Medications:
   • Fludrocortisone increases blood volume.
   • Midodrine stimulates blood vessel constriction, raising blood pressure.
6. Addressing Underlying Causes:
   • Treating infections with antibiotics or antiviral medications.
   • Managing hormonal deficiencies through hormone replacement.

Complications and Considerations:

1. Syncope and Falls:
   • Individuals with hypotension, particularly orthostatic hypotension, are at a higher risk of fainting and falls.
2. Impact on Organ Function:
   • Prolonged low blood pressure can compromise organ function.
3. Link to Cardiovascular Events:
   • Hypotension may be associated with an increased risk of cardiovascular events.

Prevention and Lifestyle Considerations:

1. Hydration and Healthy Diet:
   • Consuming a well-rounded diet with adequate fluid intake.
2. Regular Exercise:
   • Engaging in regular physical activity supports cardiovascular function.
3. Avoiding Alcohol and Caffeine:
   • Limiting substances that can contribute to dehydration.

Research and Advancements:

1. Orthostatic Hypotension Research:
   • Ongoing studies aim to elucidate the underlying mechanisms of orthostatic hypotension.
2. Pharmacological Innovations:
   • Research into novel medications with fewer side effects for managing hypotension.

Patient Education and Support:

1. Symptom Recognition:
   • Educating individuals about recognizing symptoms and seeking timely medical attention.
2. Lifestyle Modifications:
   • Encouraging patients to follow prescribed treatment regimens.