Even moderate forms of low blood pressure can cause not only dizziness and weakness but also fainting and a risk of injury from falls.
And severely low blood pressure from any cause can deprive your body of enough oxygen to carry out its normal functions, leading to damage to your heart and brain.
No special preparations are necessary to have your blood pressure checked. You might want to wear a short-sleeved shirt to your appointment so that the blood pressure cuff can fit around your arm properly.
Don't stop taking any prescription medications that you think may affect your blood pressure without your doctor's advice.
Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
>Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet for a blood test.
>Write down any symptoms you're experiencing, including any that may seem unrelated to low blood pressure.
>Write down key personal information, including a family history of low blood pressure and any major stresses or recent life changes.
>Make a list of all medications, vitamins or supplements that you're taking.
>Take a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
>Be prepared to discuss your diet and exercise habits. If you don't already follow a diet or exercise routine, be ready to talk to your doctor about any challenges you might face in getting started.
>Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For low blood pressure, some basic questions to ask your doctor include:
What is likely causing my symptoms or condition?
What are other possible causes for my symptoms or condition?
What kinds of tests will I need?
What's the most appropriate treatment?
What foods should I eat or avoid?
What's an appropriate level of physical activity for me?
How often should I be screened for low blood pressure?
I have other health conditions. How can I best manage them together?
Are there any restrictions that I need to follow?
Should I see a specialist?
Is there a generic alternative to the medicine you're prescribing for me?
Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask any other questions you may think of during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
When did you begin experiencing symptoms?
Have your symptoms been continuous or occasional?
How severe are your symptoms?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Have you been diagnosed with any other health conditions?
What medications are you currently taking?
What is your typical daily diet?
How much exercise do you get in an average week?
Do you have a family history of heart disease?
The goal in testing for low blood pressure is to find the underlying cause. This helps determine the correct treatment and identify any heart, brain or nervous system problems that may cause lower than normal readings. To reach a diagnosis, your doctor may recommend one or more of the following tests:
Blood pressure test. Blood pressure is measured with an inflatable arm cuff and a pressure-measuring gauge.
A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).
Blood tests. These can provide information about your overall health as well as whether you have low blood sugar (hypoglycemia), high blood sugar (hyperglycemia or diabetes) or a low number of red blood cells (anemia), all of which can cause lower than normal blood pressure.
Electrocardiogram (ECG). During this painless, noninvasive test, soft, sticky patches (electrodes) are attached to the skin of your chest, arms and legs. The patches detect your heart's electrical signals while a machine records them on graph paper or displays them on a screen.
An ECG, which can be performed in your doctor's office, detects irregularities in your heart rhythm, structural abnormalities in your heart, and problems with the supply of blood and oxygen to your heart muscle. It can also tell if you're having a heart attack or if you've had a heart attack in the past.
Sometimes, heart rhythm abnormalities come and go, and an ECG won't find any problems. If this happens, you may be asked to wear a 24-hour Holter monitor to record your heart's electrical activity as you go about your daily routine.
Echocardiogram. This noninvasive exam, which includes an ultrasound of your chest, shows detailed images of your heart's structure and function.
Ultrasound waves are transmitted, and their echoes are recorded with a device called a transducer, which is held outside your body. A computer uses the information from the transducer to create moving images on a video monitor.
Stress test. Some heart problems that can cause low blood pressure are easier to diagnose when your heart is working harder than when it's at rest. During a stress test, you'll exercise, such as walking on a treadmill. You may be given medication to make your heart work harder if you're unable to exercise.
When your heart is working harder, your heart will be monitored with electrocardiography or echocardiography. Your blood pressure also may be monitored.
Valsalva maneuver. This noninvasive test checks the functioning of your autonomic nervous system by analyzing your heart rate and blood pressure after several cycles of a type of deep breathing: You take a deep breath and then force the air out through your lips, as if you were trying to blow up a stiff balloon.
Tilt table test. If you have low blood pressure on standing, or from faulty brain signals (neurally mediated hypotension), your doctor may suggest a tilt table test, which evaluates how your body reacts to changes in position.
During the test, you lie on a table that's tilted to raise the upper part of your body, which simulates the movement from horizontal to a standing position.
In a tilt table test, you lie on a table that adjusts your body position from horizontal to vertical to simulate standing up. The test can tell your doctor if faulty brain signals are causing low blood pressure.
Low blood pressure that either doesn't cause signs or symptoms or causes only mild symptoms, such as brief episodes of dizziness when standing, rarely requires treatment.
If you have symptoms, the most appropriate treatment depends on the underlying cause, and doctors usually try to address the primary health problem — dehydration, heart failure, diabetes or hypothyroidism, for example — rather than the low blood pressure itself.
When low blood pressure is caused by medications, treatment usually involves changing the dose of the medication or stopping it entirely.
If it's not clear what's causing low blood pressure or no effective treatment exists, the goal is to raise your blood pressure and reduce signs and symptoms. Depending on your age, health status and the type of low blood pressure you have, you can do this in several ways:
Use more salt. Experts usually recommend limiting the amount of salt in your diet because sodium can raise blood pressure, sometimes dramatically. For people with low blood pressure, that can be a good thing.
But because excess sodium can lead to heart failure, especially in older adults, it's important to check with your doctor before increasing the salt in your diet.
Drink more water. Although nearly everyone can benefit from drinking enough water, this is especially true if you have low blood pressure.
Fluids increase blood volume and help prevent dehydration, both of which are important in treating hypotension.
Wear compression stockings. The same elastic stockings commonly used to relieve the pain and swelling of varicose veins may help reduce the pooling of blood in your legs.
Compression stockings, also called support stockings, compress your legs, promoting circulation. A stocking butler may help you put on the stockings.
Medications. Several medications, either used alone or together, can be used to treat low blood pressure that occurs when you stand up (orthostatic hypotension).
For example, the drug fludrocortisone is often used to treat this form of low blood pressure. This drug helps boost your blood volume, which raises blood pressure.
Doctors often use the drug midodrine (Orvaten) to raise standing blood pressure levels in people with chronic orthostatic hypotension. It works by restricting the ability of your blood vessels to expand, which raises blood pressure.
LIFESTYLE AND HOME REMEDIES
Depending on the reason for your low blood pressure, you may be able to take certain steps to help reduce or even prevent symptoms. Some suggestions include:
Drink more water, less alcohol. Alcohol is dehydrating and can lower blood pressure, even if you drink in moderation. Water, on the other hand, combats dehydration and increases blood volume.
Follow a healthy diet. Get all the nutrients you need for good health by focusing on a variety of foods, including whole grains, fruits, vegetables, and lean chicken and fish.
If your doctor suggests using more salt but you don't like a lot of salt on your food, try using natural soy sauce or adding dry soup mixes to dips and dressings.
Go slowly when changing body positions. You may be able to reduce the dizziness and lightheadedness that occur with low blood pressure on standing by taking it easy when you move from a prone to a standing position.
Before getting out of bed in the morning, breathe deeply for a few minutes and then slowly sit up before standing. Sleeping with the head of your bed slightly elevated also can help fight the effects of gravity.
If you begin to get symptoms while standing, cross your thighs in a scissors fashion and squeeze, or put one foot on a ledge or chair and lean as far forward as possible. These maneuvers encourage blood to flow from your legs to your heart.
Eat small, low-carb meals. To help prevent blood pressure from dropping sharply after meals, eat small portions several times a day and limit high-carbohydrate foods such as potatoes, rice, pasta and bread.
Your doctor also may recommend drinking caffeinated coffee or tea with meals to temporarily raise blood pressure. But because caffeine can cause other problems, check with your doctor before drinking more caffeinated beverages.