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Dr. Andrew Rynne

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What is the best advice for very low blood pressure ?

My mother is 75, is not overweight and has had triple heart bypass surgery (years ago) but she gets very low blood pressure and can feel very unwell. She won t tell me how low and won t go to the doctor because she does not want any more invasive treatment. is there anything she can do herself ?
Wed, 16 Dec 2009
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My Friend Here are some advices, precautions and other details about low blood pressure. May the GOD give your mom Health. People who have lower blood pressures have a lower risk of strokes, kidney disease, and heart diseases. Athletes, people who exercise regularly, people who maintain ideal body weights, and non-smokers, tend to have lower blood pressures. Therefore, low blood pressure is desirable as long as it is not low enough to cause symptoms and damage to organs in the body. What are low blood pressure signs and symptoms? When the blood pressure is not sufficient to deliver enough blood to the organs of the body, the organs do not work properly and may be permanently damaged. For example, if insufficient blood flows to the brain, brain cells do not receive enough oxygen and nutrients, and a person can feel light-headed, dizzy, or even faint. Going from a sitting or lying position to a standing position often brings out the symptoms of low blood pressure. This occurs because standing causes blood to “settle” in the veins of the lower body, and this can lower the blood pressure. If the blood pressure is already low, standing can make the low pressure worse to the point of causing symptoms. (The development of light-headedness, dizziness, or fainting upon standing caused by low blood pressure is called orthostatic hypotension. Normal individuals are able to compensate rapidly for the low pressure created by standing with the responses discussed previously and do not develop orthostatic hypotension.) When there is insufficient blood pressure to deliver blood to the coronary arteries (the arteries that supply blood to the heart’s muscle), a person can develop chest pain (angina) or even a heart attack. When insufficient blood is delivered to the kidneys, the kidneys fail to eliminate wastes from the body, for example, urea and creatinine, and an increase in their levels in the blood occur (e.g., elevations of blood urea nitrogen or BUN and serum creatinine, respectively). Shock is a life-threatening condition where persistently low blood pressure causes organs such as kidney, liver, heart, lung, and brain to fail rapidly. Just a few decades ago, doctors thought a blood pressure reading of 160/95 millimeters of mercury (mm Hg) was an acceptable target rate for most Americans. Today, those numbers are regarded as dangerously high, and blood pressure lower than 120/80 is considered optimal for good health. The ongoing downward revision of blood pressure standards had led some people to assume that just as you can't be too thin or too rich, your blood pressure can't be too low. But that's not always the case. Many people who have low blood pressure (hypotension) are healthy and have no signs or symptoms related to lower than normal readings. But for others, low blood pressure can cause dizziness and fainting or indicate serious heart, endocrine or neurological disorders. Severely low blood pressure can deprive the brain and other vital organs of oxygen and nutrients, leading to shock, a life-threatening condition. Signs and symptoms Some people with low blood pressure are in peak physical condition with strong cardiovascular systems and a reduced risk of heart attack and stroke. For these people, low blood pressure, rather than being a cause for concern, is a cause for celebration. But low blood pressure can also signal an underlying problem, especially when it drops suddenly or is accompanied by signs and symptoms such as: Dizziness or lightheadedness Fainting (syncope) Lack of concentration Blurred vision Nausea Cold, clammy, pale skin Rapid, shallow breathing Fatigue Depression Thirst Causes The heart is the prime mover of the circulatory system; with each beat it launches your blood on a journey through 60,000 miles of arteries, veins and capillaries, ultimately circulating about 2,000 gallons of blood each day. To do this, it contracts an average of 70 times a minute with the same amount of force you'd use to squeeze a tennis ball. Blood pressure is a measurement of the pressure in your arteries during the active and resting phases of each heartbeat. Here's what the numbers mean: Systolic pressure. The first number in a blood pressure reading, this is the amount of pressure your heart generates when pumping blood through your arteries to the rest of your body. Diastolic pressure. Diastolic pressure. The second number in a blood pressure reading, this refers to the amount of pressure in your arteries when your heart is at rest between beats. Although you can get an accurate blood pressure reading at any given time, blood pressure isn't static. It can vary considerably in a short amount of time — sometimes from one heartbeat to the next, depending on your body position, breathing rhythm, stress level, physical condition, the medications you take, what you eat and drink, and even the time of day. Blood pressure is usually lowest at night and rises sharply on waking. Blood pressure: How low can you go? Current guidelines identify normal blood pressure as lower than 120/80 — many experts think 115/75 is optimal. Higher readings indicate increasingly serious risks of cardiovascular disease. Even blood pressures formerly considered healthy — 120 to 139 systolic and 80 to 89 diastolic — are now believed to increase the risks. Low blood pressure, on the other hand, is much harder to quantify. Some experts define low blood pressure as readings lower than 90 systolic or 60 diastolic — you need have only one number in the low range for your blood pressure to be considered lower than normal. In other words, if your systolic pressure is a perfect 115, but your diastolic pressure is 50, you're considered to have lower than normal pressure. Yet this can be misleading because what constitutes low blood pressure is highly relative, varying considerably from one person to another. For that reason, doctors often consider chronically low blood pressure too low only if it causes noticeable signs and symptoms. On the other hand, a sudden fall in blood pressure can be dangerous. A change of just 20 mm Hg — a drop from 130 systolic to 110 systolic, for example — can cause dizziness and fainting when the brain fails to receive an adequate supply of blood. And precipitous plunges, especially those caused by uncontrolled bleeding, severe infections or allergic reactions can, be life-threatening. How low blood pressure gets that way Low blood pressure can be a boon when it results from a healthy lifestyle. Athletes and people who exercise regularly, for example, tend to have lower blood pressure than do people who aren't as fit. So, in general, do nonsmokers and people who eat well and maintain a normal weight. But in some instances, low blood pressure can be a sign of serious, even life-threatening disorders. And although the reason for lower than normal blood pressure isn't always clear, doctors know that the following factors can cause or contribute to low and sometimes to dangerously low readings: Pregnancy. Because a woman's circulatory system expands rapidly during pregnancy, blood pressure is likely to drop. In fact, during the first 24 weeks of pregnancy, systolic pressure commonly drops by five to 10 points and diastolic pressure by as much as 10 to 15 points. Medications. A number of drugs can cause low blood pressure, including diuretics and other drugs that treat hypertension; heart medications such as beta blockers; drugs for Parkinson's disease; tricyclic antidepressants; Viagra, particularly in combination with nitroglycerine; narcotics, and alcohol. Other prescription and over-the-counter medications may cause low blood pressure when taken in combination with high blood pressure drugs. Heart problems. Among the heart conditions that can lead to low blood pressure are an extremely low heart rate (bradycardia), problems with heart valves, heart attack and heart failure. These are conditions in which your heart may not be able to circulate enough blood to meet your body's needs. Endocrine problems. These include an underactive or overactive thyroid (hypothyroidism and hyperthyroidism), adrenal insufficiency (Addison's disease) low blood sugar and in some cases, diabetes. Dehydration. Fever, vomiting, severe diarrhea, overuse of diuretics, and strenuous exercise can all lead to dehydration, a potentially serious condition in which your body loses more water than you take in. Even mild dehydration, a loss of as little as 1 percent to 2 percent of body weight, can cause weakness, dizziness and fatigue. Far more serious is hypovolemic shock, a life-threatening complication of dehydration. It occurs when low blood volume causes a sudden drop in blood pressure and a corresponding reduction in the amount of oxygen reaching your tissues. If untreated, severe hypovolemic shock can cause death within a few minutes or hours. Blood loss. A significant loss of blood from major trauma or severe internal bleeding reduces blood volume, leading to a severe drop in blood pressure. Severe infection (septic shock). Septic shock can occur when bacteria leave the original site of an infection — most often in the lungs, abdomen or urinary tract — and enter the bloodstream. The bacteria then produce toxins that affect your blood vessels, leading to a profound and life-threatening decline in blood pressure. Allergic reaction (anaphylaxis). Anaphylactic shock is a sometimes fatal allergic reaction that can occur in people who are highly sensitive to drugs such as penicillin, to certain foods such as peanuts, or to bee or wasp stings. This type of shock is characterized by breathing problems, hives, itching, a swollen throat and a sudden, dramatic fall in blood pressure. Postural (orthostatic) hypotension. This is a sudden decrease in systolic pressure, usually at least 20 mm Hg, when you stand up from a sitting or prone position. Ordinarily, blood pools in your legs whenever you stand, but your body compensates for this by increasing your heart rate and constricting blood vessels, thereby ensuring that enough blood returns to your brain. But in people with postural hypotension, this compensating mechanism fails and blood pressure falls, leading to dizziness, lightheadedness, blurred vision and even fainting. Postural hypotension can occur for a variety of reasons including dehydration, prolonged bed rest, diabetes, heart problems, burns, excessive heat, large varicose veins, adrenal insufficiency, and certain neurological disorders such as diabetic autonomic neuropathy and alcoholic polyneuropathy. A number of medications can also cause postural hypotension, particularly drugs used to treat high blood pressure — diuretics, beta blockers, calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors — as well as antipsychotics, tricyclic antidepressants and drugs for Parkinson's disease. Ironically, people with postural hypotension due to neurological disorders usually have high blood pressure when they're lying down, even during sleep, when blood pressure typically falls to its lowest levels. Postural hypotension is especially common in older adults who are more likely to use antihypertensive drugs and to have problems with blood pressure regulation than younger people are. But it can also affect young, otherwise healthy people who stand up suddenly after sitting with their legs crossed for long periods or after working for a time in a squatting position. Multiple system atrophy with orthostatic hypotension. Also called Shy-Drager syndrome, this rare disorder causes progressive damage to the autonomic nervous system, which controls involuntary functions such as blood pressure, heart rate, breathing and digestion. Although multiple system atrophy can involve muscle tremors, slowed movement, problems with coordination and speech, and incontinence, its main characteristic is severe orthostatic hypotension in combination with very high blood pressure when lying down. Multiple system atrophy can't be cured and usually proves fatal within seven to 10 years of diagnosis. Postprandial hypotension. A problem that almost exclusively affects older adults, postprandial hypotension is a sudden drop in blood pressure after a meal. Just as gravity pulls blood to your feet when you stand, a large amount of blood flows to your digestive tract after you eat. Ordinarily, your body counteracts this by increasing your heart rate and constricting certain blood vessels to help maintain normal blood pressure. But in some people these mechanisms fail, leading to dizziness, faintness, and falls. Postprandial hypotension is more likely to affect people with high blood pressure or autonomic nervous system disorders such as Parkinson's disease. Lowering the dose of antihypertensive drugs and eating small, low-carbohydrate meals may help reduce symptoms. Neurally mediated hypotension. Unlike orthostatic hypotension, this disorder causes blood pressure to drop after standing for long periods, leading to symptoms such as dizziness, nausea and fainting. Although the end result is similar, neurally mediated hypotension differs from orthostatic hypotension in other important respects: It primarily affects young people, for instance, and rather than resulting from failed blood pressure regulation, it seems to occur because of a miscommunication between the heart and the brain. When you stand for extended periods, your blood pressure falls as blood pools in your legs. Normally, your body then makes adjustments to normalize your blood pressure. But in people with neurally mediated hypotension, nerves in the heart's left ventricle actually signal the brain that blood pressure is too high, rather than too low, and so the brain lessens the heart rate, decreasing blood pressure even further. This causes more blood to pool in the legs and less blood to reach the brain, leading to lightheadedness and fainting. Nutritional deficiencies. A lack of the essential vitamins B-12 and folic acid can cause anemia, which in turn can lead to low blood pressure.
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