‫جامعة بابل‬

‫كلية الطب‬

‫‪Hypotension‬‬

‫‪ :‬إعداد الطالب‬
‫محمد عبداالله زينل‬

‫‪ :‬إشراف الدكتور‬
 ‫زاهد محمد علي‬

Introduction
The heart
The heart is a muscle that is designed to pump a constant supply of blood around the
body. When your heart beats, it pushes the blood around your body through blood
vessels called arteries and capillaries. When your heart rests in between beats, the blood
flows back to your heart through a network of veins and capillaries.

Blood pressure
Blood pressure is a measure of the force of the blood on the walls of the arteries as the
blood flows through them. It is measured in millimeters of mercury (mmHg). When your
blood pressure is measured, two measurements are recorded during a single heartbeat.
The two measurements are known as the systolic pressure and the diastolic pressure.
systolic pressure - is the pressure when your heart beats and squeezes blood into your
arteries. At this stage, the pressure in your arteries is at its highest.
diastolic pressure - is the pressure when your heart rests in between beats and the blood
flows back to your heart through your veins. At this stage, the pressure in your arteries is
at its lowest.
Your blood pressure reading will be given as two numbers, with your systolic reading first,
followed by your diastolic reading. If your systolic blood pressure is 120 mmHg, and your
diastolic blood pressure is 80 mmHg, your blood pressure is 120 over 80, which is
commonly written as 120/80.
As a general guide, the normal blood pressure for a young, healthy adult is between
90/60 and 120/80. If you have a reading of 140/90, or more, you have high blood
pressure (hypertension). This puts you at greater risk of serious health conditions, such as
strokes or heart attacks.
Low blood pressure is also known as hypotension. People with a reading of around 90/60,
or less, are commonly regarded as having low blood pressure. Having a lower blood
pressure is good in most cases . But low blood pressure can sometimes make you feel
tired or dizzy. In those cases, hypotension can be a sign of an underlying condition that
should be treated.

Text body
Low blood pressure (hypotension)
When blood pressure is too low, not enough blood reaches all parts of the body. As a
result, cells do not receive enough oxygen and nutrients, and waste products are not
adequately removed. Thus, the affected cells and the organs they are in begin to
malfunction. Very low blood pressure can be life threatening because it can lead to shock,
in which organs are damaged by lack of blood flow.

Conditions that can cause low blood pressure

Medical conditions that can cause low blood pressure include:
• Pregnancy: Because the circulatory system expands rapidly during pregnancy, blood
pressure is likely to drop. This is normal, and blood pressure usually returns to your pre-
pregnancy level after you've given birth.
• Heart problems: Some heart conditions that can lead to low blood pressure include
extremely low heart rate (bradycardia), heart valve problems, heart attack and heart
failure.
• Endocrine problems: Thyroid conditions such as parathyroid disease, adrenal
insufficiency (Addison's disease), low blood sugar (hypoglycemia) and, in some cases,
diabetes can trigger low blood pressure.
• Dehydration: When your body loses more water than it takes in, it can cause weakness,
dizziness and fatigue. Fever, vomiting, severe diarrhea, overuse of diuretics and strenuous
exercise can lead to dehydration.
• Blood loss: Losing a lot of blood, such as from a major injury or internal bleeding,
reduces the amount of blood in your body, leading to a severe drop in blood pressure.
• Severe infection (septicemia): When an infection in the body enters the bloodstream, it
can lead to a life-threatening drop in blood pressure called septic shock.
• Severe allergic reaction (anaphylaxis): Common triggers of this severe and potentially
life-threatening reaction include foods, certain medications, insect venoms and latex.
Anaphylaxis can cause breathing problems, hives, itching, a swollen throat and a
dangerous drop in blood pressure.
• Lack of nutrients in your diet: A lack of the vitamin B-12, folate and iron can keep your
body from producing enough red blood cells (anemia), causing low blood pressure.

Medications that can cause low blood pressure

Some medications can cause low blood pressure, including:
• Water pills (diuretics): such as furosemide (Lasix) and hydrochlorothiazide (Microzide,
others).
• Alpha blockers: such as prazosin (Minipress).
• Beta blockers: such as atenolol (Tenormin) and propranolol (Inderal, Innopran XL,
others).
• Drugs for Parkinson's disease: such as pramipexole (Mirapex) or those containing
levodopa.
• Certain types of antidepressants (tricyclic antidepressants): including doxepin (Silenor)
and imipramine (Tofranil).
• Drugs for erectile dysfunction: including sildenafil (Revatio, Viagra) or tadalafil (Adcirca,
Alyq, Cialis), particularly when taken with the heart medication nitroglycerin (Nitrostat,
others).

Pathophysiology
Blood pressure is continuously regulated by the autonomic nervous system, using an
elaborate network of receptors, nerves, and hormones to balance the effects of the
sympathetic nervous system, which tends to raise blood pressure, and the
parasympathetic nervous system, which lowers it. The vast and rapid compensation
abilities of the autonomic nervous system allow normal individuals to maintain an
acceptable blood pressure over a wide range of activities and in many disease states.
Even small alterations in these networks can lead to hypotension.

Types of the hypotension

Hypotension exists in a number of forms, reflecting its diverse range of underlying
causes. It can be described as acute, chronic, orthostatic and post-prandial.
Acute hypotension
Acute hypotension is usually associated with shock, which may be hypovolemic (eg, due
to fluid loss in severe hemorrhage, burns or diarrhea and vomiting) septic, cardiogenic
(eg, following myocardial infarction), neurogenic or anaphylactic. It can also occur in
patients receiving epidural or spinal anesthesia (as a result of agents, such as bupivacaine,
blocking sympathetic nerves that maintain vascular tone) and in those undergoing
hemodialysis.
Chronic hypotension
Addison’s disease is one of the most common causes of chronic hypotension. Sufferers
fail to produce the level of endogenous steroids required to regulate sodium and water
retention.
Orthostatic hypotension
Orthostatic or postural hypotension is one of the most common forms of hypotension
and is defined as a reduction in blood pressure of >20/10mmHg within three minutes of
standing. In some cases orthostatic hypotension can result from disease states that
involve dysfunction of the autonomic nervous system. Information from the Malmo
Preventative Project suggests that orthostatic hypotension can be found in around 6 per
cent of middle aged individuals. Meanwhile rates among people with Parkinson’s disease
have been reported to be as high as 20 per cent and the prevalence of orthostatic
hypotension among elderly people living in residential-nursing care facilities appears
particularly high, with some sources reporting rates of up to 68 percent.
Recognizing the prevalence of orthostatic hypotension among the elderly and those with
diabetes, British Hypertension Society guidelines specifically recommend that blood
pressure should be measured in these groups after standing, in addition to the routine
sitting measurement. However, based on the high prevalence in those with Parkinson’s
disease or other autonomic disorders, it would appear logical to extend this
recommendation to these additional groups. Younger patients can also experience
problematic orthostatic hypotension. It can give rise to symptoms after prolonged periods
of crouching or bending, and is particularly common in pregnancy. No mention of
orthostatic hypotension can ignore the huge role that drug therapy plays in the condition.
Post-prandial hypotension
Post-prandial hypotension is common in the elderly, especially after consumption of
meals high in carbohydrates. It has been defined as a fall in blood pressure of 20mmHg
within two hours of eating, but in many cases the onset of hypotensive episodes can be
much sooner. The mechanisms underlying this form of hypotension are similar to those in
orthostatic hypotension, namely a failure of normal reflex responses to compensate, in
this case for the increase in blood supply to the gastrointestinal tract after eating.
Reference
1. Lahrmann H, Cortelli P. Hilz M, Mathias CJ, Struhal W, Tassinari M.EFNS guidelines
on the diagnosis and management of orthostatic hypotension.European Journal of
Neurology, 2006; 13: 930-936.
2. Fedorowski A, Stavenow L, Hedblad B, Berglund G, Nilsson PM and Melander O.
Orthostatic hypotension predicts all-cause mortality and coronary events in middle-
aged Individuals (The Malmo¨ Preventive Project) European Heart Journal
2010;31,85–91.
3. Shibao C, Grijalva CG, Raj SR, Biaggioni I and Griffin MR. Orthostatic hypotension-
related hospitalizations in the United States. AmericanAmerican Journal of
Medicine, 2007; 120: 975–80.
4. Kalkwarf, Kyle J.; Cotton, Bryan A. (December 2017). "Resuscitation for
Hypovolemic Shock". The Surgical Clinics of North America. 97 (6): 1307–1321.
doi:10.1016/j.suc.2017.07.011. ISSN 1558-3171. PMID 29132511.
5. Costanzo, Linda S., 1947- (March 15, 2017). Physiology. Preceded by: Costanzo,
Linda S., 1947- (Sixth ed.). Philadelphia, PA. ISBN 978-0-323-51189-6. OCLC
965761862.