Hypotension : Symptoms, Diagnosis, Treatment

Low blood pressure is termed as Hypotension.

◾General criteria- Systolic bp < 90mmHg, Diastolic bp < 60 mmHg

Etiology:-

• Low blood volume (hypovolemia)
• Hormonal changes
• Widening of blood vessels
• Anaemia
• Heart problems
• Endocrine problems
• Chronic use of alpha and beta- blockers and nitroglycerin (these are antihypertensive and using them for a long time lead to hypotension)
• Excessive vasodilation (from infection or acidosis) will lead to decreased sympathetic nervous system output or increased parasympathetic output (dysautonomia)

Symptoms:-

• Light headedness
• Dizziness (सिर चकराना)
• Fainting
• Chest pain
• Shortness of breath
• Irregular heart beat
• Fever (>101°F)
• Headache
• Stiffness in neck
• Severe upper back pain
• Cough with sputum
• Diarrhoea/ vomiting,
• Indigestion (dyspepsia)
• Dysuria (painful urination)
• Seizures,
• Loss of consciousness,
• Fatigue
• Temporary blurring
• Black tarry stools.

◾Orthostatic hypotension- It is change in bp that occurs with change of position (standing, sitting or lying) and is also known as postural hypotension. The main feature is delay in compensatory ability of Autonomic nervous system. Commonly seen in hypovolemia.

◾Vasovagal syncope- It is a form of dysautonomia (imbalanced activity of sympathetic and parasympathetic nervous system). Inappropriate drop in BP while in upright position as a result of increased activity of vagus nerve.

◾Postprandial hypotension- Sudden and major decrease in bp after substantial meals. It generally shows characteristics of cold hands and feet.

Diagnosis:-

• Sphygmomanometer
• Blood test
• ECG
• Echocardiogram
• Stress test
• Valsalva moneuver
• Tilt table test

Management:-

Treatment protocol-

1. Volume resuscitation of blood by crystalloid or blood products.
2. Blood pressure support with help of vasopressors.
3. Adequate tissue perforation should be maintained (Central venous oxygen saturation > 70).
4. Underlying problems like Infection, stent, etc. Should be dealt.

Medications-

1. Use of Fludrocortisone is the primary line of treatment. It increases intravascular volume.
2. Midodrine (Orvaten/ Promatin) results in increased peripheral vascular resistance.
3. Non-adrenaline and its precursor L-DOPS. This will correct primary Autonomic dysfunction and increase vascular tone.
4. Erythropoietin (increases vascular volume and viscosity)

Life style modifications:-

• Use more salt
• Drink more water
• Adding electrolytes to diet
• Morning dose of caffeine
• Dorsal decubitus position
• Lifting the legs
• Regular exercise to promote blood flow
• Wear compression stockings
• Avoid sitting with legs crossed
• Head of bed should be slightly elevated
• Small, low- carb meal should be taken
• Add vitamin B12 to diet.

Ayurvedic Approach:-

• To balance वात, as in case of poor blood circulation and weakness, use of garlic is highly effective. Along with this, we need to cope with constipation and nutrition.
• In case if increased पित्त (Poor liver function and anaemia), हरिद्रा खण्ड, आरोग्यवर्धिनी वटी, पुनर्नवा मण्डूर may be helpful.
• In congestion and reduced blood flow which is relatable to कफ, त्रिकटु with मधु may be planned.

• हिंग्वादि चूर्ण, वैश्वानर चूर्ण, अश्वगन्धा चूर्ण are generally clinically practiced for long time.
• Epsom salt bath (MgSO4 – 2-4 cups) may be advised.
• Wheatgrass powder (1tsf BD)
• Spirulina capsules (1-2 BD)
• Shilajeet capsules (1-2 BD)

Food habits:-

• Beetroot juice (चकुंदर स्वरस) should be advised 1 cup in morning and evening
• Soup of काले चने
• काश्मर्य (काशमिश) soaked overnight should be consumed.
• Use of मुनक्का, बादाम and तुलसी पत्र should be encouraged.
• Green leafy vegetables, fruits, milk, fish and egg should be added to diet.

योगा व प्राणायाम:-

• उत्तानासन
• पवनमुक्तासन
• शिशु आसन
• सर्वांगासन
• मत्स्यासन
• कपालभाति प्राणायाम
• भस्त्रिका प्राणायाम
• सूर्यभेदी प्राणायाम