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Is low blood pressure a disease?
No, not usually – but it can be. We will explain.
Low blood pressure, or hypotension, can be a complex condition to diagnose and manage.
Definition: Hypotension is generally defined as a systolic blood pressure (SBP) below 90 mmHg or a diastolic blood pressure (DBP) below 60 mmHg.
However, it’s essential to consider the patient’s baseline blood pressure and clinical context.
- Primary hypotension: This refers to hypotension without an identifiable cause, often seen in young, healthy individuals.
- Secondary hypotension: This type is caused by an underlying condition or medication, such as:
- Dehydration or blood loss (pre-renal acute kidney injury, AKI)
- Adrenal insufficiency (Addisons Disease) or other endocrine disorders
- Medications (e.g. over treatment with antihypertensive drugs, sedatives)
- Cardiac conditions (e.g. heart failure, arrhythmias)
- Neurological disorders (e.g. autonomic dysfunction).
Note. In an acute setting, consider sepsis/septic shock and anaplylaxis as well. In either context, the patient will be extremely unwell.
Clinical Features
- Dizziness or lightheadedness
- Fainting or syncope
- Fatigue
- Nausea and vomiting
- Shortness of breath.
Management
- Assessment: Evaluate the patient’s haemodynamic stability and identify potential causes.
- Address underlying causes: Treat the underlying condition and/or adjust medications (stop anti-hypertensive agents).
- Fluid resuscitation: Give IV fluids for hypovolaemia or dehydration.
- Medications: Use vasopressors or inotropes (e.g. adrenaline) in specific situations, such as sepsis/septic shock.
When to investigate further
- Persistent or severe hypotension
- Signs of organ hypoperfusion (e.g. decreased urine output (pre-renal AKI), confusion or drowsiness)
- Suspicion of underlying cardiac or endocrine disorders.
In conclusion, low blood pressure can be a sign of an underlying issue, and a thorough assessment and management plan are crucial to prevent complications.
