Symptoms
Low blood pressure does not necessarily cause symptoms and often remains asymptomatic. Possible symptoms include:
- Pale and cold skin, cold hands and feet, sweating.
- Visual disturbances: Blackening in front of the eyes, flickering, parts of the visual field fail
- Concentration disorders
- Rapid pulse, palpitations
- Ringing in the ears
- Dizziness
- Weakness, fatigue, lack of performance
- Fainting, brief loss of consciousness (syncope).
Unconsciousness can lead to falls, accidents, injuries and fractures. A very low blood pressure can damage the organs because they are no longer supplied with sufficient blood and oxygen. However, arterial hypotension is not only considered a negative, but is thought to contribute to a longer life expectancy.
Causes
In hypotension, blood pressure is momentarily or persistently below normal. In the literature, different information can be found about this. Values below 90 (-105) mmHg systolic and below 60 (-65) mmHg diastolic are usually classified as too low. Possible causes and risk factors include:
- Primary hypotension (constitutional), for example, in tall and slender people, at puberty.
- Numerous drugs can lower blood pressure, for example, antihypertensives, nitrates, phosphodiesterase-5 inhibitors, psychotropic drugs, sedatives, and opioids
- Alcohol, intoxicants
- Dialysis
- Pregnancy
- Prolonged standing, chronic venous insufficiency.
- High temperatures, sun exposure
- Cardiovascular disease, e.g. heart failure, aortic stenosis.
- Diseases of the nervous system
- Stress
- Fear of syringes or blood, vasovagal reaction
- Endocrine disorders, e.g., hypothyroidism, adrenal insufficiency, hypopituitarism
- Immobilization
- Fluid loss, dehydration
- Large blood loss
- Anaphylaxis
- Infectious diseases, sepsis
Diagnosis
Low blood pressure can be a manifestation of a serious illness and should be sought medical attention if the symptoms are acute and severe or recur chronically.
Nonpharmacologic treatment
Treatment should be directed at the cause if possible and is usually necessary only if symptoms occur. Nonpharmacologic measures should precede pharmacotherapy:
- Exercise regularly
- Cold and warm showers, Kneipp
- Sauna, brush massage
- Finger gymnastics
- High salt diet, soups
- Sufficient liquid to take
- Wear compression stockings
- Adjusting the medication
- Slowly stand up
Drug treatment
Sympathomimetics bind to alpha and, in some cases, beta adrenoceptors, causing constriction of blood vessels and increasing peripheral resistance. Some additionally increase myocardial contractility. They are not without controversy because of the potential adverse effects:
- Etilefrin (Effortil)
- Midodrine (Gutron)
- Severe hypotension: e.g., phenylephrine, ephedrine, dopamine, norepinephrine.
- Oxedrine (Sympalept), pholedrine and norfenefrine (Ortho-Maren) are no longer on the market in many countries
- Oxilofrin (Carnigen, out of trade).
Ergot alkaloids constrict the capacity vessels (veins) without affecting the resistance vessels. As a result, the blood is redistributed. This group of drugs is also controversial because of the possible side effects. Approval for this indication has been withdrawn in many countries:
- Dihydroergotamine (Dihydergot tablets, Effortil plus, both off-label).
Blood circulation stimulants:
- Capsaicin, rheumatism ointments, warming hand creams, heat bags, for cold hands and feet.
Nicethamide (gly-coramine) is used off-label to treat low blood pressure. It is no longer officially approved for this purpose. Infusion solutions for volume stabilization in severe conditions, such as shock. Mineralocorticoids such as fludrocortisone acetate (Florinef) for adrenal insufficiency and Addison’s disease. Herbal antihypotensives:
- Caffeine, coffee, black tea, guarana, mate, energy drinks.
- Hawthorn
- Ginkgo
- Rosemary, for example, in the form of ointments or as a bath, Ceres drops.
- Camphor
Alternative medicine:
- E.g. Anthroposophika such as Cardiodoron Weleda, Schüssler salts 2 and 5, Hömopathika, Spagyrika.
