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Hypotension

Hypotension is defined as low blood pressure, with a systolic pressure under 90 mm Hg or diastolic under 60 mm Hg. It can be caused by factors like low blood volume, medications, or certain syndromes. Symptoms include dizziness, fainting, fatigue, and blurred vision. Treatment depends on the severity and cause of hypotension. For mild asymptomatic cases, increasing fluid/electrolyte intake or caffeine may help. More severe cases may require medications to increase blood volume or vascular resistance. The goal of treatment is to maintain adequate tissue perfusion and address any underlying medical issues that are contributing to the low blood pressure.

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Cardiovascular Diseases•
HYPOTENSION SWATILEKHA DAS ASST. PROFESSOR RN, BSN, MSN
What is Hypotension? • Hypotension is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. • Blood pressure is indicated by two numbers, the systolic blood pressure (the top number) and the diastolic blood pressure (the bottom number), which are the maximum and minimum blood pressures, respectively. • A systolic blood pressure of less than 90 millimeters of mercury (mm Hg) or diastolic of less than 60 mm Hg is generally considered to be hypotension. • Severely low blood pressure can deprive the brain and other vital organs of oxygen and nutrients, leading to a life-threatening condition called shock.
CAUSES • Hypotension can be caused by low blood volume (hypovolemia), hormonal changes, widening of blood vessels, anemia, heart problems,or endocrine problems. • Some medications can also lead to hypotension. There are also syndromes that can cause hypotension in patients including orthostatic hypotension, vasovagal syncope, and other rarer conditions.
Signs and symptoms • 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 • Dyspepsia (indigestion) • Dysuria (painful urination) • Acute, life-threatening allergic reaction • Seizures • Loss of consciousness • Profound fatigue • Temporary blurring or loss of vision • Black tarry stools
Treatment • Chronic hypotension rarely exists as more than a symptom. • Asymptomatic hypotension in healthy people usually does not require treatment. • Adding electrolytes to a diet can relieve symptoms of mild hypotension. • A morning dose of caffeine can also be effective. In mild cases, where the patient is still responsive, laying the person in dorsal decubitus (lying on the back) position and lifting the legs increases venous return, thus making more blood available to critical organs in the chest and head.
1.Blood pressure support with a vasopressor (all seem equivalent with respect to risk of death, with norepinephrine possibly better than dopamine). 2.Trying to achieve a mean arterial pressure (MAP) of greater than 70 mmHg does not appear to result in better outcomes than trying to achieve a MAP of greater than 65 mm Hg in adults. 3.Ensure adequate tissue perfusion (maintain SvO2 >70 with use of blood or dobutamine) 4.Address the underlying problem (i.e., antibiotic for infection, stent or CABG (coronary artery bypass graft surgery) for infarction, steroids for adrenal insufficiency, etc...) 5.The best way to determine if a person will benefit from fluids is by doing a passive leg raise followed by measuring the output from the heart.
• Medication • Chronic hypotension sometimes requires the use of medications. Some medications that are commonly used include Fludrocortisone, Erythropoietin, and Sympathomimetics such as Midodrine and Noradrenaline . • Fludrocortisone is the first-line therapy (in the absence of heart failure) for patients with chronic hypotension or resistant orthostatic hypotension. It works by increasing the intravascular volume. • Midodrine is a therapy used for severe orthostatic hypotension, and works by increasing peripheral vascular resistance. • Noradrenaline is used for primary autonomic dysfunction by increasing vascular tone. • Erythropoietin is given to patients with neurogenic orthostatic hypotension and it works through increasing vascular volume and viscosity.
Hypotension