What does low blood pressure mean and what causes it?

Question

Is it dangerous?

Answer 1

MEANING OF LOW BLOOD PRESSURE:
Low blood pressure is defined primarily by signs and symptoms of low blood flow. In fact, some individuals may have a blood pressure of 90/50 and have no signs or symptoms of low blood pressure, and, therefore, not have low blood pressure while others who normally have a blood pressure of 130/80 may develop symptoms and signs of low blood pressure if their blood pressure drops to 100/60.

CAUSES:
Low blood pressure due to low blood volume:

* Dehydration is common among patients with diarrhea who lose large amounts of water in their stool, particularly when drowsiness limits their drinking of fluids or is associated with nausea and vomiting. Dehydration also can occur with prolonged vomiting of any cause because of the loss of water in the vomitus. Other causes of dehydration include exercise, sweating, fever, and heat exhaustion or heat stroke. Individuals with mild dehydration may experience only thirst and dry mouth. Moderate to severe dehydration may cause orthostatic hypotension (manifest by light-headedness, dizziness or fainting upon standing). Protracted and severe dehydration can lead to shock, kidney failure, confusion, acidosis (too much acid in the blood), coma, and even death. For more, please read the Dehydration article.

* Moderate or severe bleeding can quickly deplete an individual’s body of blood, leading to low blood pressure or orthostatic hypotension. Bleeding can result from trauma, surgical complications, or from gastrointestinal abnormalities such as ulcers, tumors, or diverticulosis. Occasionally, the bleeding may be so severe and rapid (for example, bleeding from a ruptured aortic aneurysm) that it causes shock rapidly.

* Severe inflammation of organs inside the body such as acute pancreatitis can cause low blood pressure. In acute pancreatitis, fluid leaves the blood to enter the inflamed tissues around the pancreas as well as the abdominal cavity, depleting the volume of blood.

Causes of low blood pressure due to heart disease

* Weakened heart muscle can cause the heart to fail and reduce the amount of blood it pumps. One common cause of weakened heart muscle is the death of a large portion of the heart’s muscle due to a single, large heart attack or repeated smaller heart attacks (please read the Heart Attack article for more). Other examples of conditions that can weaken the heart include medications that are toxic to the heart, infections of the muscle of the heart by viruses (myocarditis), and diseases of the heart’s valves such as aortic stenosis.

* Pericarditis is an inflammation of the pericardium (the sac surrounding the heart). Pericarditis can cause fluid to accumulate within the pericardium and around the heart, restricting the ability of the heart to pump blood.

* Pulmonary embolism is a condition in which a blood clot in a vein (a condition called deep vein thrombosis) breaks off and travels to the heart and eventually the lung. A large blood clot can block the flow of blood into the left ventricle from the lungs and severely diminish the ability of the heart to pump blood. Pulmonary embolism is a life-threatening emergency. For more, please read the Deep Vein Thrombosis and Pulmonary Embolism article.

* A slow heart rate (bradycardia) can decrease the amount of blood pumped by the heart. The resting heart rate for a healthy adult is between 60 and 100 beats/minute. Bradycardia (resting heart rates slower than 60 beats/minute) does not always cause low blood pressure. In fact, some highly trained athletes can have resting heart rates in the 40’s and 50’s without any symptoms. (The slow heart rates are offset by more forceful contractions of the heart that pump more blood than in non-athletes.) But in many patients bradycardia can lead to low blood pressure, light-headedness, dizziness, and even fainting.

One example of bradycardia, sick sinus syndrome, occurs common in the elderly. This syndrome is due to degeneration of the sinus node (SA node), an area in the heart that generates electrical signals that cause the heart to beat regularly. In the sick sinus syndrome, the diseased SA node cannot generate signals fast enough to maintain a normal heart rate. Another condition that causes bradycardia is heart block. Electrical signals from the SA node must travel to the rest of the heart’s muscle to cause the heart to contract and pump blood. Normally these electrical signals are transmitted along special tissues in the heart. Heart block occurs when these specialized tissues are damaged by heart attacks, degeneration that occurs with aging, and medications. Heart block prevents some or all of the electrical signals generated by the SA node from reaching the rest of the heart, and this prevents the heart from contracting as rapidly as it otherwise would.

* An abnormally fast heart rate (tachycardia) also can cause low blood pressure. The most common example of tachycardia causing low blood pressure is atrial fibrillation. Atrial fibrillation is a disorder of the heart characterized by rapid and irregular electrical discharges from the muscle of the heart (instead of the SA node), causing the ventricles to contract irregularly and (usually) rapidly. The rapidly contracting ventricles do not have enough time to fill maximally with blood before the each contraction, and the amount of blood that is pumped decreases, in spite of the faster heart rate. Other abnormally rapid heart rhythms such as ventricular tachycardia also can produce low blood pressure, sometimes even life-threatening shock. For more, please read the Atrial Fibrillation article.

Medications that cause low blood pressure

* Medications such as calcium channel blockers, beta blockers, and digoxin (Lanoxin) can slow the rate at which the heart contracts. Some elderly people are extremely sensitive to these medications since they are more likely to have diseased SA nodes and electrical conduction tissues. In some individuals, the heart rate can become dangerously slow even with small doses of these medications.

* Medications used in treating high blood pressure (such as ACE inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers, and alpha-blockers) can excessively lower blood pressure and result in symptomatic low blood pressure especially among the elderly.

* Diuretics (water pills) such as furosemide (Lasix) can decrease blood volume by causing excessive urination.

* Medications used for treating depression, such as amitriptyline (Elavil), Parkinson’s disease, such as levodopa-carbidopa (Sinemet), erectile dysfunction (impotence), such as sildenafil (Viagra) when used in combination with nitroglycerine, can cause low blood pressure

* Alcohol and narcotics also can cause low blood pressure.

Other condition s that cause low blood pressure

* Vasovagal reaction is a common condition in which a healthy person temporarily develops low blood pressure, slow heart rate, and sometimes fainting. A vasovagal reaction typically is brought on by emotions of fear or pain such as having blood drawn or starting an intravenous infusion. Vasovagal reactions are caused by the involuntary (autonomic) nervous system releasing hormones that slow the heart and widen the blood vessels.

* Postural (orthostatic) hypotension, as discussed previously, is a sudden drop in blood pressure when an individual stands up from a sitting, squatting, or supine (lying) position. When a person stands up, gravity causes blood to settle in the veins in the legs, hence less blood reaches the heart for pumping, and, as a result, the blood pressure drops. The body normally responds automatically to the drop in blood pressure by increasing the rate at which the heart beats and by narrowing the veins to return more blood to the heart. In patients with postural hypotension, this compensating reflex fails to occur, resulting in symptomatic low blood pressure. Postural hypotension can occur in persons of all ages but is much more common among the elderly, especially in those on medications for high blood pressure and/or diuretics. Other causes of postural hypotension include dehydration, adrenal insufficiency (discussed shortly), prolonged bed rest, diabetes that has caused damage to the autonomic nerves, alcoholism with damage to the autonomic nerves, and certain rare neurological syndromes (e.g., Shy-Drager syndrome) that damage the autonomic nerves.

* Another form of postural hypotension occurs typically in young healthy individuals. After prolonged standing, the individual’s heart rate and blood pressure drops, causing dizziness, nausea and often fainting. In these individuals, the autonomic nervous system wrongly responds to prolonged standing by directing the heart to slow down and the veins to dilate.

* Micturition syncope is a temporary drop in blood pressure and loss of consciousness brought about by urinating. This condition typically occurs in elderly patients and may be due to the release by the autonomic nerves of hormones that lower blood pressure.

* Adrenal insufficiency, for example, due to Addison’s disease, can cause low blood pressure. Addison’s disease is a disorder in which the adrenal glands (small glands next to the kidneys) are destroyed. The destroyed adrenal glands can no longer produce sufficient adrenal hormones (specifically cortisol) necessary for to maintain normal bodily functions. Cortisol has many functions, one of which is to maintain blood pressure and the function of the heart. Addison’s disease is characterized by loss of weight, muscle weakness, fatigue, low blood pressure, and, sometimes, darkening of the skin.

* Septicemia is a severe infection in which bacteria (or other infectious organisms such as fungi) enter the blood. The infection typically originates in the lungs (as pneumonia), bladder, or in the abdomen due to diverticulitis or gallstones. The bacteria then enter the blood where they release toxins and cause life-threatening and profound low blood pressure (septic shock), often with damage to several organs.

* Anaphylaxis (anaphylactic shock) is a potentially fatal allergic reaction to medications such as penicillin, intravenous iodine used in some x-ray studies, foods such as peanuts, or bee stings. In addition to a profound drop in blood pressure, individuals may also experience hives, wheezing, and a swollen throat with difficulty breathing.
YES IT'S DANGEROUS AND CAN BE LIFE THREATENING IF THE CAUSE IS NOT TREATED.

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