Hypotension, commonly referred to as “low blood pressure,” is a medical condition in which the blood pressure in the arteries is lower than normal (when the blood pressure reading is lower than 90/60mmHg). There are various types of hypotension, each with different causes, symptoms, and treatments. As a nurse, it is important to be aware of the different types of hypotension and their management in order to provide safe and effective care to your patients.
Orthostatic hypotension
Orthostatic hypotension is a type of hypotension that occurs when a person changes position from lying down or sitting to standing up. This can cause a sudden drop in blood pressure, leading to symptoms such as dizziness, lightheadedness, and fainting. Orthostatic hypotension is common in older adults, especially those with underlying medical conditions such as Parkinson’s disease, diabetes, or autonomic neuropathy.
The management of orthostatic hypotension involves lifestyle modifications, such as avoiding sudden changes in position, staying hydrated, and wearing compression stockings. Medications such as fludrocortisone, midodrine, and droxidopa may also be prescribed to help raise blood pressure.
Neurally mediated hypotension.
Neurally mediated hypotension also known as the fainting reflex, neurocardiogenic syncope, vasodepressor syncope, the vaso-vagal reflex, and autonomic dysfunction is a type of hypotension that occurs in response to certain triggers, such as standing for a long time or exposure to heat. It is caused by a malfunction of the autonomic nervous system, which regulates blood pressure and heart rate. Neurally mediated hypotension can cause symptoms such as dizziness, nausea, and fainting. Other symptoms may include confusion, muscle aches, headaches, and chronic fatigue.
The treatment of neurally mediated hypotension involves avoiding triggers and increasing fluid and salt intake.
Severe hypotension
Severe hypotension is a medical emergency that requires immediate treatment. It is characterized by a sudden and severe drop in blood pressure, which can lead to organ damage and even death if not promptly addressed. Severe hypotension can be caused by various conditions, such as sepsis, anaphylaxis, or a heart attack.
The management of severe hypotension involves identifying and treating the underlying cause. This may involve administering intravenous fluids, medications such as vasopressors or inotropes, and oxygen therapy. In severe cases, mechanical ventilation or extracorporeal membrane oxygenation (ECMO) may be necessary.
Postprandial hypotension
It is common in older adults and those with underlying medical conditions such as diabetes, Parkinson’s disease, or autonomic neuropathy. Postprandial hypotension is a type of hypotension that occurs after eating a meal. After eating, the heart rate ramps up to send blood flowing to the digestive system, but with this type of low blood pressure, the mechanism fails, resulting in dizziness, lightheadedness, and fainting.
The management of postprandial hypotension involves eating smaller, more frequent meals and avoiding large meals high in carbohydrates or fats. Medications such as acarbose, midodrine, and caffeine may also be prescribed.
