Sudden Steep Drop In Blood Pressure On Standing From Lying Down May Predict Atrial Fibrillation Years Later
Results of a Johns Hopkins-led study have identified a possible link between a history of sudden drops in blood pressure and the most common form of irregular heartbeat.
The study suggests that a bout of orthostatic hypotension a steep blood pressure drop that occurs when a person stands up after a period of lying down appears to be associated with an overall 40 percent increase in the risk of developing atrial fibrillation over the following two decades.
While a simple, inexpensive doctors office test can check for orthostatic hypotension, the researchers caution that the condition itself does not generally need treatment, nor have they demonstrated that it is a cause of atrial fibrillation.
They further note that because atrial fibrillation is often present without causing noticeable symptoms, some people may already have the rhythm disturbance before an episode of orthostatic hypotension, though they tried to exclude those subjects from the study.
We hope our research will sensitize physicians to a possible link between orthostatic hypotension and atrial fibrillation, and that they will go the extra step to see if something more serious is going on when patients experience rapid blood pressure fluctuations, says study leader Sunil K. Agarwal, M.D., M.P.H., Ph.D., a fellow in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine. We want this on their radar screens.
Research For Your Health
The NHLBI is part of the U.S. Department of Health and Human Services National Institutes of Health the Nations biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including problems associated with low blood pressure. Learn about current and future NHLBI efforts to improve health through research and scientific discovery.
How Anxiety Can Cause Low Blood Pressure
- Many people associate stress with high blood pressure, but it can also cause low blood pressure.
- The low blood pressure itself is typically not considered serious.
- Hyperventilation is one of several links between anxiety and low blood pressure.
- Its important to control anxiety over blood pressure some people find that their blood pressure changes give them anxiety, creating a cycle.
- It is healthy to get your blood pressure checked, but it is also important to decrease anxiety.
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What Is Low Blood Pressure/hypotension
Low blood pressure or hypotension is a condition where the systolic and diastolic pressure falls below 90 and 60 respectively. Blood pressure is usually measured in millimetres of mercury, and normal blood pressure is usually slightly less than 120/80 mm Hg.
To have low blood pressure is not always a concern however, chronic hypotension can cause a lack of blood flow to the brain, causing dizziness, blackouts or loss of consciousness, and may even be life-threatening in severe cases.
More often, low blood pressure is a symptom of a different concern, such as plaque build-up, a heart disorder or aging related medical conditions, making it necessary to pay attention to signs of low blood pressure in its initial stages.
Conditions That Can Cause Low Blood Pressure
Certain conditions can cause long periods of hypotension that can become dangerous if left untreated. These conditions include:
- pregnancy, due to an increase in demand for blood from both the pregnant person and the growing fetus
- impaired circulation caused by a heart attack or heart condition
- dehydration, for example if youre vomiting and cant keep liquids down, or have severe diarrhea
- endocrine disorders, such as diabetes, adrenal insufficiency, and thyroid disease
- autonomic dysfunction, damage to the nerves that control some bodily functions
- prolonged bed rest
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How Blood Pressure Is Measured And What The Readings Mean
Blood pressure is expressed as two numbers, with one “over” the other. The first, or top, number is the systolic blood pressure. This indicates the amount of pressure your blood exerts against the walls of your arteries when your heart contracts. The second, or bottom, number is the diastolic pressure, which refers to the amount of pressure in your arteries when your heart refills between beats.
Your healthcare provider typically measures your blood pressure using a stethoscope and an inflatable cuff that wraps around your upper arm. The cuff is inflated until it is tight enough to stop the blood from flowing, then it is slowly deflated. Through the stethoscope, your doctor or nurse will hear the whooshing sound of the blood returning this is the systolic pressure. The moment the whooshing sound disappears marks the diastolic pressure.
The commonly accepted ideal blood pressure for adults is 120/80 mm Hg or lower. But since blood pressure naturally rises with age, your BP might be higher than that without any cause for concern. For instance, according to a chart from Disabled World, a normal blood pressure reading for an 80-year-old woman could be 134/84 mm Hg.
So, what is considered low blood pressure in elderly people? Typically, the low blood pressure range is anything below 90/60 mm Hg. This is called hypotension. The Disabled World chart shows that a dangerous blood pressure level is 50/33 mm Hg.
Treatment Of Low Blood Pressure
Unless accompanied by other conditions, low blood pressure is usually easy to treat and does not require much medication. Often, a low blood pressure diet may be prescribed, or a change in lifestyle may become necessary. Common recommendations include:
Increased intake of water: Dehydration can cause an electrolyte imbalance resulting in signs of low blood pressure, and care towards adequate hydration would be important, especially in high temperature situations, during fevers or dysentery.
Increased sodium in diet: Salted nuts, cheeses and cured fish and meats are high in sodium content, and would help stabilize blood pressure in case it is very low. Care must be taken to not overdo it, however, and for a balance to be maintained.
Limiting alcohol consumption: Alcohol consumption can cause fluctuation in heart rate and limiting its consumption for some time will help alleviate symptoms of low blood pressure in otherwise healthy individuals.
Exercise: Light exercises not involving much strain to the body help improve circulation of blood throughout, and keep the heart healthy. In cases of low blood pressure, it is important to be aware of its symptoms such as palpitations and cold skin so that exercising does not aggravate the condition.
Ceasing any aggravating medication:If intake of certain medication is seen to cause dips in blood pressure, your doctor may recommend a substitute for the drug, or even stopping its consumption till pressure is stabilized.
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What Procedures And Tests Diagnose Low Blood Pressure
In some people, particularly relatively healthy ones, symptoms of weakness, dizziness, and fainting raise the suspicion of low blood pressure. In others, an event often associated with low blood pressure, for example, a heart attack, has occurred to cause the symptoms.
Measuring blood pressure in both the lying and standing positions usually is the first step in diagnosing low blood pressure. In patients with symptomatic low blood pressure, there often is a marked drop in blood pressure upon standing, and patients may even develop orthostatic symptoms. The heart rate often increases. The goal is to identify the cause of the low blood pressure. Sometimes the causes are readily apparent . At other times, the cause may be identified by testing:
How Is Low Blood Pressure Treated
If there is an underlying cause for your low blood pressure, and it is giving you problems, you may need treatment for that underlying cause. But if it isnt causing you problems, treatment wont be needed.
Your doctor may advise you to take precautions to prevent episodes of low blood pressure, such as avoiding dehydration, hot showers or standing up too quickly.
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How Anxiety Causes Low Blood Pressure
Because high blood pressure is associated with stress, most people assume that low blood pressure must be a symptom of something else – something more dangerous. But low blood pressure is also a fairly common anxiety symptom, especially in those that suffer from panic and anxiety attacks. This is because, with those conditions , a person is much more likely to suffer from hyperventilation.
How Does Blood Pressure Work
During relaxation of the heart , the left ventricle of the heart fills with blood returning from the lungs. The left ventricle then contracts and pumps blood into the arteries . The blood pressure in the arteries during contraction of the ventricle is higher because blood is being actively ejected into the arteries. It is lower during relaxation of the ventricle when no blood is being ejected into the arteries. The pulse we feel when we place our fingers over an artery is caused by the contraction of the left ventricle and the ejection of blood.
Blood pressure is determined by two factors:
Generally, blood pressure tends to be higher if more blood is pumped into the arteries or if the arterioles are narrow and/or stiff. Narrow and/or stiff arterioles, by resisting the flow of blood, increase blood pressure. Arterioles may become narrower when the muscles surrounding them contract. Arterioles may become stiff and narrow when older patients develop atherosclerosis.
Blood pressure tends to be lower if less blood is being pumped into the arteries or if the arterioles are larger and more flexible and, therefore, have less resistance to the flow of blood.
The heart rate increases and the forcefulness of the heart’s contractions increase, pumping more blood through the heart.
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Sudden Drop In Blood Pressure
Hypotension, or simply low blood pressure, is a condition whereby your blood pressure is not as high as it should be at your age. Blood pressure would normally be less than 120/80 mm Hg according to most physicians. There are people whose blood pressure is normally lower than average. In other people, it could be as a result of a medical condition or medication they are taking. You need not worry if you have low blood pressure as long as you do not exhibit any symptoms. However, experiencing a sudden drop in blood pressure could be dangerous because it affects the blood flow in the body. Seek medical attention immediately when this happens as it could lead to shock, which is a fatal condition.
What To Do If You Experience A Sudden Drop In Blood Pressure
A single low blood pressure reading is no cause to be concerned unless you experience other symptoms.
A sudden drop in blood pressure as little as a drop from 120 to 100 in your systolic number can be dangerous if it triggers dizziness and fainting. Such symptoms can be a sign of an underlying problem that may need medical attention.
You should keep a record of your activities and when symptoms happen to discuss them with your doctor. If you experience any low blood pressure symptoms related to shock, you should seek immediate medical attention.
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What To Do After Fainting
A person who has experienced VVS may feel tired, weak, and nauseated when they come round. It is important that they rest before getting up and continuing with their day.
In some cases, people should seek emergency medical attention after a fainting episode, especially if they have additional symptoms that overlap with signs of a heart attack.
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Medication Used To Treat Low Blood Pressure
In cases of more severe or recurrent symptoms of low blood pressure, doctors may prescribe drugs to stabilize the system. These may include:
Fludrocortisone: It is a steroid that is prescribed when the body is unable to produce enough by itself, and is often prescribed in conjunction with other steroids such as hydrocortisone. It reduces inflammation in the body and causes the body to retain more sodium. It may cause some water retention, but this is not a cause for concern since it is necessary to build blood pressure. To maintain the sodium-potassium balance, a doctor might recommend consumption of potassium-rich foods such as apricot, bananas, spinach and broccoli while on this prescription. Once the effects of low blood pressure are no longer witnessed, you may be asked to discontinue the steroid, while maintaining lifestyle and diet changes.
Midodrine: A counter to blood vessel dilation, midodrine is a what is called a vasopressor and constricts small blood vessels to increase blood pressure. It is usually prescribed in cases of postural hypotension and the dosage is gradually increased over time to prevent side effects.
Q What Can Cause Low Blood Pressure
- Pregnancy
- Nutrition deficiency in the diet
- Certain antidepressants
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A Reaction To Medication
An adverse reaction to prescribed or over-the-counter medicine can drop blood pressure unexpectedly. Diuretics and other drugs designed to treat hypertension, some anti-depressants, and medication to help with erectile dysfunction can lower blood pressure to unsafe levels. You can also experience a drop in blood pressure if you combine high blood pressure medications with others.
Symptoms Of Low Blood Pressure
Most doctors will only consider chronically low blood pressure as dangerous if it causes noticeable signs and symptoms, such as:
- Dizziness or lightheadedness
- Fainting
- Dehydration and unusual thirst
- Dehydration can sometimes cause blood pressure to drop. However, dehydration does not always cause low blood pressure. Fever, vomiting, severe diarrhea, overuse of diuretics and strenuous exercise can all lead to dehydration, a potentially serious condition in which your body loses more water than you take in. Even mild dehydration can cause weakness, dizziness and fatigue.
- Lack of concentration
- Depression
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Low Blood Pressure In A Teenage Girl
Sometimes, teenage girls tend to have hypotension and episodes of unconsciousness during menstruation. This could be triggered due to pain or heavy bleeding during menstruation, or due to vasovagal syncope.
Vasovagal syncope is a reflex disorder that leads to transient loss of consciousness. This is characterized by symptoms, such as acute visual disturbance, auditory disturbance, cognitive slowing, followed by hypotension with lightheadedness and loss of consciousness. However, studies found that the severity of lightheadedness changes during the menstrual cycle and was found to be similar in both VVS patients and healthy individuals.
Also, VVS patients were not found to have any greater risk of gynecological abnormalities and pregnancy complications when compared to otherwise healthy individuals. .
A few changes in lifestyle, such as taking adequate fluids and salts plus moderate exercise, can help manage this condition. However, if your teenager is having frequent episodes of lightheadedness during her periods, then it is best to schedule an appointment with a gynecologist.
Observe the symptoms to know if everything is alright with the child. The next section talks about diagnostic methods for low blood pressure in children.
What Are The Treatments For Low Blood Pressure
The treatments for low blood pressure depend on what caused the condition. Your doctor will work with you to address the cause of the hypotension. In severe cases of hypotension, your doctor may give you IV fluids to raise your blood pressure.
Depending on a variety of factors, such as your age and the type of hypotension, your doctor may recommend one or more of the following: dietary changes, lifestyle changes and/or medications.
To make dietary changes, your doctor might tell you to:
- Stay hydrated by drinking more water throughout the day.
- Drink less alcohol.
- Increase your salt intake slightly because sodium raises blood pressure.
- Eat smaller, healthy meals and limit carbohydrates.
You can take several steps to avoid a sudden drop in blood pressure. Your doctor may recommend that you make the following lifestyle changes:
- Wear compression stockings.
- Get up slowly after youve been sitting or lying down.
- Avoid standing for long periods of time.
- Sit up and breathe deeply for a few minutes before getting out of bed.
Your doctor might prescribe medications like:
- Fludrocortisone, which increases blood volume.
- Midodrine, which increases blood pressure.
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When To Worry About Low Blood Pressure
We all know that high blood pressure can be dangerous. But what about low blood pressure
Also called hypotension, low blood pressure is not a problem if youre healthy and show no signs or symptoms of the condition. However, abnormally low blood pressure can cause problems such as dizziness and fainting and can be a sign that other serious conditions, such as heart disease, are present.
Dizzy After Eating Feeling Lightheaded From A Meal Could Be Postprandial Hypotension
What is postprandial hypotension? Do you sometimes feel dizzy or lightheaded after eating a meal? If so, you could have a common condition called postprandial hypotension that affects up to one-third of older men and women.
Digestion is a complicated job that requires precise coordination between the digestive, nervous, and circulatory systems. An early task is rerouting extra blood to the stomach and small intestine. To compensate for this diversion, the heart beats faster and harder while blood vessels far from the digestive system narrow. These two actions maintain blood pressure and blood flow to the brain, legs, and everywhere in between.
In some people, the heart and blood vessels don’t respond as they should. That causes blood pressure to decrease everywhere but the digestive system. The sudden drop usually announces itself as dizziness or lightheadedness. Postprandial hypotension causes some people to fall, others to faint. It can trigger the chest pain known as angina, disturb vision, or cause nausea. It has even been reported to trigger the mini-strokes known as transient ischemic attacks.
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