First Aid for Hypotension

Hypotension, or low blood pressure, means that blood isn’t being pumped around the body at a normal rate. While many people with hypotension may not need emergency treatment, symptoms such as dizziness, fainting, confusion, or extreme fatigue indicate that prompt action is necessary.

Blood pressure measures the force needed to pump blood throughout the vast network of blood vessels crisscrossing your body. That’s a 60,000-mile system of arteries, veins and smaller capillaries.

A blood pressure reading includes two numbers given in a unit of measurement called millimeters of mercury, or mmHg. (In case you were wondering, that’s a pressure unit equal to the pressure exerted by a column of mercury 1mm high at 0 degrees Celsius.)

These numbers indicate the pressure on blood vessels when your heart beats (systolic blood pressure) and rests (diastolic blood pressure). Systolic BP is always the first or top number.

Types of Hypotension

The following are some of the different types of low blood pressure:

1. Orthostatic hypotension: Orthostatic hypotension is also known as postural hypotension, and this drop in blood pressure occurs when a person stands after sitting or lying down. This could happen due to dehydration, pregnancy, certain medicines and medical conditions, and being on bed rest for a prolonged period of time. Orthostatic hypotension is usually seen in older adults.
2. Postprandial hypotension: Postprandial hypotension takes place about an hour or two after having a meal. This mostly affects older individuals, especially those who suffer from autonomic nervous system diseases such as Parkinson’s disease or high blood pressure. It occurs when a person’s nervous or cardiovascular system doesn’t react properly to sudden changes in position.
3. Neurally mediated hypotension: Neurally mediated hypotension can occur when you stand for a long time. Children and young adults are the ones who are usually affected by this kind of hypotension. It occurs due to miscommunication between the heart and the brain.
4. Multiple system atrophy with orthostatic hypotension: This is a rare disorder that affects the involuntary nervous system, which is responsible for controlling functions such as blood pressure, digestion, breathing, and heart rate.

What are the Symptoms of Hypotension?

Some of the symptoms of hypotension can be:

• Dizziness or lightheadedness
• Weakness
• Nausea
• Fainting
• Confusion
• Blurring or dimming of vision
• Lethargy or fatigue
• Pale, cold, or clammy skin
• Feeling agitated or having other changes in behavior
• Trouble concentrating
  When your blood pressure drops extremely low, your body may not receive enough oxygen to carry out all the essential functions. This can lead to breathing issues, causing you to lose consciousness. Your body can also go into shock, the symptoms of which include:
• Skin turning pale and cold
• Confusion
• Quick breathing
• Quick and weak pulse

Causes of Low Blood Pressure

There can be numerous causes of low blood pressure, and they are as follows:

• Central nervous system diseases or conditions, such as Parkinson’s disease, that affect the nervous system, which is responsible for controlling blood pressure. Anyone who suffers from such a condition can experience low blood pressure following a meal as their digestive systems utilize more blood once food is digested.
• Low blood volume, which can be caused due to dehydration or severe injuries.
• Lung and heart conditions can contribute to low blood pressure, as hypotension can be caused if a person’s lungs aren’t working properly or if the heart beats too slowly or too quickly. It can also occur due to advanced heart failure.
• Recreational drugs and alcohol can often cause a drop in blood pressure. Certain home remedies, vitamins, and herbal supplements can lower a person’s blood pressure as well.
• Extreme temperatures can negatively affect someone’s hypotension and worsen its effects.
• Pregnancy often leads to orthostatic hypotension during the first and second trimesters. There are certain pregnancy complications that lead to low blood pressure, such as bleeding.
• Some prescription medications can lower one’s blood pressure, many of which are related to treating heart failure, depression, neurological problems, and more. Therefore, always discuss with your healthcare provider before taking any medicines.
• Life-threatening conditions, such as pulmonary embolism (PE), collapsed lung, heart attacks, and irregular heart rhythms, can lead to hypotension.

Complications of Hypotension

The complications that one can develop as a result of hypotension include:

• Falls: Low blood pressure leads to dizziness, which can cause a person to faint or fall. This can also lead to serious injuries.
• Shock: When the blood pressure is too low, it can cause your body to go into shock due to lack of sufficient blood supply.
• Heart problems or stroke: In order to make up for the low blood pressure, the heart could end up pumping too fast or too hard, which can lead to stroke or heart failure.

First aid for symptomatic hypotension:

1. Assess the Situation

• Watch for Symptoms: Typical signs of low blood pressure include dizziness, lightheadedness, blurred vision, nausea, or a feeling of weakness. In extreme cases, the person may faint.
• Determine Severity: If the symptoms are sudden, severe, or accompanied by confusion, chest pain, or shortness of breath, consider this a medical emergency and call emergency services immediately.

2. Position the Person

• Lie Down Safely: Have the person lie flat on their back. This position helps improve blood flow to the brain.
• Elevate the Legs: If possible, raise the person’s legs about 12 inches using pillows or by resting the legs on a raised surface. Elevation helps promote venous return (blood flowing back to the heart), which can raise blood pressure.
• Stay Calm and Reassuring: Encourage the person to remain calm. Anxiety and panic can further lower blood pressure in some cases.

3. Hydration and Electrolyte Support

• Offer Fluids: If the person is conscious and not nauseated, have them drink water. For some low blood pressure episodes caused by dehydration, rehydrating can be very helpful.
• Add a Bit of Salt: A small amount of salt can help raise blood pressure by increasing blood volume. If the person is not on a salt-restricted diet, you might suggest a salty snack or a glass of water with a pinch of salt dissolved in it.
  • Note for Diabetics or Those on Medications: Ensure that salt intake or fluids are appropriate; if in doubt, seek medical advice.
• Oral Rehydration Solutions (ORS): In cases where dehydration is likely, and if available, an oral rehydration solution can provide a balanced mix of water, salt, and sugar to help restore normal blood pressure.

4. Monitor and Reassess

• Keep a Close Eye: Stay with the person and monitor their symptoms. Look for improvements or any worsened condition such as increased confusion or inability to stay awake.
• Avoid Sudden Movements: When the person feels better, encourage them to get up slowly. Rapid changes in position may cause a renewed drop in blood pressure (orthostatic hypotension).

5. When to Seek Medical Help

• Persistent or Worsening Symptoms: If the low blood pressure symptoms don’t improve within a few minutes after taking these steps or if the person continues to show signs of confusion, weakness, or fainting, call a healthcare professional.
• Underlying Causes: Recurrent hypotension episodes may signal an underlying medical condition (like heart issues, dehydration, or medication side effects), so ensure the person gets a comprehensive evaluation by a healthcare provider.

Treatment for Hypotension

The treatment for hypotension depends on the cause behind it. Your doctor could either recommend making lifestyle changes or prescribe medications to you, and at times, it can also be a combination of the two.

There are certain first aid measures you can take to bring your hypotension under control, and those steps are:

• Stay hydrated and drink plenty of water so as to prevent dehydration, which can cause low blood pressure.
• When you’re getting up after being seated for a while, make sure to do it slowly.
• Make sure to have small and frequent meals. Sitting still or lying down following a meal is also often helpful.
• If standing for a long time causes you to have low blood pressure, then try moving around and flexing your leg muscles.
• Don’t stand or sit for prolonged periods.
• Follow a diet that is higher in salt.
• Limit your intake of alcohol.
• Exercise regularly so as to promote blood flow and avoid working out in humid and hot conditions.
• If your doctor has prescribed you medications related to your condition, then ensure to consume them as advised.
• Avoid situations where you may experience being exposed to hot water for a long time, such as spas and hot showers.

Prevention

Preventing low blood pressure involves making lifestyle changes and monitoring your health. Here are some tips to help prevent hypotension:

• Stay Hydrated: Regularly drinking water and staying hydrated can prevent dehydration, a common cause of low blood pressure.
• Eat a Balanced Diet: Ensure your diet includes a variety of nutrients, including fruits, vegetables, lean proteins, and whole grains. A balanced diet can help maintain healthy blood pressure levels.
• Avoid Alcohol: Alcohol can lower blood pressure, so it’s best to avoid or limit alcohol consumption.
• Exercise Regularly: Regular physical activity can help improve circulation and maintain healthy blood pressure levels. Aim for at least 30 minutes of moderate exercise most days of the week.
• Manage Stress: Chronic stress can affect blood pressure. Engage in relaxation techniques such as meditation, deep breathing exercises, and yoga to manage stress effectively.

REFERENCES

1. Sheikh AB, et al. Blood pressure variability in clinical practice: Past, present and the future. Journal of the American Heart Association. 2023; doi:10.1161/JAHA.122.029297.
2. Laughlin EA, et al. Increased salt intake for orthostatic intolerance syndromes: A systematic review and meta-analysis. The American Journal of Medicine. 2020; doi:10.1016/j.amjmed.2020.05.028.
3. Rosei EA, et al. How important is blood pressure variability? European Heart Journal Supplements. 2020; doi:10.1093/eurheartj/suaa061.
4. Firstaidrenewal, Dealing With Low Blood Pressure, https://firstaidrenewal.ca/dealing-low-blood-pressure/

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