When Low Blood Pressure is An Emergency

A functional circulatory system is essential to your overall health and wellbeing.

More than 100,000 times a day, your heart pumps blood through a closed system of arteries, veins, and other blood vessels to the organs, tissues, and cells that make up your entire body.

Your blood picks up and distributes oxygen, nutrients, hormones, and other elements as it travels.

It also absorbs waste products and helps your body eliminate them. 

Blood pressure is a measurement that tells doctors how intensely your blood exerts force on the walls of your veins as your heart pumps blood through your circulatory system.

When you visit a healthcare provider, they record your blood pressure as two measurements: systolic blood pressure, the first number, and diastolic blood pressure, the second number. 

Systolic blood pressure is the amount of pressure in the arteries that your heart creates when it pumps and fills the arteries with blood.

Diastolic blood pressure is the amount of pressure in your veins when your heart is at rest.

Once doctors have both numbers, they can determine whether you have normal blood pressure, low blood pressure (hypotension), or high blood pressure (hypertension).

Blood pressure can change as you move through your day, but it can put you at risk for other serious health complications if it is chronically or excessively low or high.

Chronic low blood pressure can mean that your heart, lungs, brain, and other vital organs don’t receive enough blood to function correctly. 

If you have low blood pressure but don’t experience symptoms, your condition is not severe.

That said, for some people, low blood pressure can lead to feelings of dizziness, weakness, nausea, pale skin, vision changes, and other symptoms.

When someone experiences a sudden drop in blood pressure or has very low blood pressure, they may experience more severe symptoms like shock, low heart rate, shallow breathing, and clammy skin. 

In rare cases, low blood pressure can become a medical emergency.

If you are experiencing mental confusion, blue or pale skin, loss of consciousness, difficulty breathing, low pulse, or other severe symptoms, call 9-1-1 or go to your nearest emergency room for immediate medical attention. 

What is Low Blood Pressure (Hypotension)?

Blood pressure is the measurement that tells doctors about the force of blood in your circulatory system.

Your blood pressure reading is expressed as two numbers.

The first number, your systolic pressure, indicates how much pressure your heart creates when it beats, and your veins are full of blood.

The second number, your diastolic pressure, is the amount of pressure in your veins when your heart is at rest. 

Blood pressure can change throughout the day, depending on the person, physical activity, the stress they experience, and other factors. 

For most people, blood pressure levels remain within what doctors consider a “normal” range: 90/60 mm Hg and 120/80 mm Hg.

Anything higher than 120/80 mm Hg is elevated or high blood pressure (hypertension).

Anything lower than 90/60 mm Hg is low blood pressure (hypotension).

Four major types of low blood pressure are delineated based on the causes of low blood pressure, symptoms, and other factors. They include: 

• Orthostatic hypotension or postural hypotension: People with this condition experience a sudden drop in blood pressure when they stand up too quickly. It’s common in older adults but can affect younger people who have been sitting or squatting for a long time.

• Postprandial hypotension: People (mostly older adults) with this condition have a drop in blood pressure after they eat. It most commonly affects people with Parkinson’s disease and related disorders.

• Neurally mediated hypotension: Children and young adults experience this condition after standing for a long time. 

• Severe hypotension: People with this condition experience symptoms after a sudden and significant loss of blood, heart attack, infection, or allergic reaction.

Symptoms

Some people with chronic low blood pressure readings do not experience any symptoms.

In those cases, the condition may not require any treatment.

For others, however, low blood pressure can lead to severe symptoms or indicate an underlying problem.

Milder symptoms of low blood pressure include:

• Back pain 
• Blurry vision
• Confusion or difficulty concentrating.
• Dizziness
• Drowsiness
• Faded vision
• Feeling faint or lightheaded
• Headache
• Rapid or jumpy heartbeats

When blood pressure gets very low, very fast, your heart, brain, and other organs may not get the blood they need to function correctly, and you can go into shock.

Patients that have gone into shock may experience: 

• Clammy, blue, cold skin
• Rapid, shallow breathing 
• Sluggishness, sleepiness, or confusion
• Weak pulse or rapid pulse

Shock is a medical emergency and, in severe cases, can be fatal.

If you or someone you know has low blood pressure and is experiencing symptoms of shock, call 9-1-1 or go to the nearest emergency room immediately.

Causes

Patients can have or develop low blood pressure for many reasons.

Some people have naturally lower blood pressure than others.

As long as they don’t experience symptoms, doctors consider them healthy.

Specific health issues can cause low blood pressure for some patients.

The most common causes include:

• Adrenal insufficiency
• Age-associated blood pressure regulation decline
• Alcoholism
• A history of heart attack, heart failure, arrhythmias, or other heart problems
• Diabetes
• Heat exhaustion or heat stroke
• Hypothyroidism
• Lack of fluids (dehydration) 
• Liver disease
• Low blood sugar
• Nerve damage 
• Nutritional deficiencies like a lack of iron (anemia), folic acid, and vitamin B12
• Parathyroid disease
• Parkinson’s disease
• Pregnancy
• Severe allergic reactions (anaphylaxis)
• Severe blood loss from traumatic injury or internal bleeding 
• Severe infections (septicemia)

Some prescription medications, over-the-counter treatment options, and street drugs can also put patients at greater risk of developing low blood pressure. For example:

• Alpha-blockers and other high blood pressure medications
• Beta-blockers and other heart medications
• Erectile dysfunction medications 
• High blood pressure medications 
• Narcotics
• Tricyclic antidepressants 

When Hypotension is an Emergency

For most people, hypotension, or low blood pressure, is a condition that patients can manage with lifestyle changes and medicine.

However, in extreme cases, a patient with low blood pressure may develop severe symptoms that require immediate medical attention.

Underlying Conditions

Sometimes, low blood pressure can indicate the presence of severe conditions that are dangerous or even life-threatening.

For example, patients experiencing a heart attack or heart failure can develop low blood pressure, as can people with severe infections.

A severe allergic reaction or anaphylactic shock is one of the causes of low blood pressure.

Those who experience a loss of significant blood volume due to traumatic injury, burn, or internal bleeding can also develop symptoms of low blood pressure as a result.

If you are experiencing chest pain, rapid or shallow breathing, loss of consciousness, or seeing a blue tinge on your skin, these could be signs that you need immediate medical attention.

Call 9-1-1 or go to your nearest emergency room.

Sudden drops

Even when it’s small, a sudden drop in blood pressure can be a serious health problem.

If blood pressure drops sharply, the brain doesn’t receive enough blood to function correctly.

Even a drop of 20 mm Hg within a few minutes can cause dizziness, lightheadedness, and other uncomfortable symptoms. 

Risks of low blood pressure 

Patients can experience dizziness, fainting, and falls, a dangerous complication for older adults.

In serious cases, severe drops in blood pressure can decrease the blood flow to the heart and brain so much that they damage the organ’s ability to function.

Severe hypotension has been linked to stroke, shock, and cardiovascular issues.

When to Go to the ER

Low blood pressure can be a serious, even life-threatening condition.

If you or someone you know is experiencing extreme symptoms, call 9-1-1 or go to your nearest emergency room for treatment right away. 

Emergency symptoms may include: 

• Cold, clammy, or sweaty skin 
• A bluish tint to the skin 
• Chest pain
• Rapid breathing 
• Shallow breathing 
• Vision changes 
• Confusion 
• Loss of consciousness

If you experience symptoms after taking medication or have been diagnosed with low blood pressure and are experiencing an increased frequency in even mild symptoms, call your doctor to discuss your condition and next steps.

How to Treat Hypotension

If you have low blood pressure that doesn’t cause symptoms or only occasionally causes mild lightheadedness, you may not need to treat your condition.

If you have more significant symptoms, your doctor might suggest several lifestyle and medication changes for you to use to regulate your blood pressure better and improve your overall health and wellbeing.

Lifestyle changes

There are a few changes you can make to reduce the signs and symptoms of low blood pressure. They include: 

• Eating more salt: Increasing dietary sodium may help raise your blood pressure and keep it more regulated. 

• Drinking water: Increasing your intake of fluids can increase the blood you have in your body and help raise your blood pressure.

• Avoiding alcoholic beverages: Alcohol lowers blood pressure and should be avoided by patients who struggle with symptoms. 

• Eating small meals: Enjoying smaller meals more frequently can help you avoid the extreme eating-associated changes in blood pressure that can occur with heavier meals.

• Wearing compression socks or elastic abdominal binders: Compression socks and abdominal binders are designed to maintain blood flow and reduce swelling, which can help address the root cause of postural hypotension.

• Move slowly: Changing posture positions quickly can lead to drops in blood pressure. Avoid sitting or standing up too suddenly.

Medication changes

If you have made lifestyle changes and still experience symptoms related to low blood pressure, talk to your doctor about medication changes you can make to regulate your circulatory system better. 

Medications that can help address low blood pressure include: 

• Fludrocortisone (Florinef)
• Midodrine (Orvaten)

If you have been prescribed a medication that puts you at risk for low blood pressure, or if you experience symptoms like lightheadedness or feeling faint after taking a medication, talk to your doctor about switching to a treatment option that you can better tolerate.

When to See a Doctor

Low blood pressure can lead to health complications if left untreated.

If you suspect you have low blood pressure or are experiencing any symptoms that you think might be related to blood pressure, call your doctor to make an appointment.

If you or someone you know is experiencing severe symptoms, including difficulty breathing, chest pain, clammy or blue skin, loss of consciousness, or confusion, that may indicate a medical emergency.

Call 9-1-1 or go to your nearest emergency room immediately.

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