TEMPO.CO, Jakarta – Do you often feel dizzy, blurred vision, or even faint when changing positions from sitting to standing or getting up from sleep? If you experience it, watch out for symptoms hypotension or low blood pressure.
A lecturer at the Faculty of Medicine and Health Sciences (FKIK) at the University of Muhammadiyah Makassar, South Sulawesi, Dito Anurogo, said blood pressure can change throughout the day, depending on many things. Among them, physical condition, body position, breathing rhythm, stress level, drugs consumed, food and drink, and time of day, morning, afternoon, evening, or night.
Blood pressure is regulated continuously through the autonomic nervous system as a balance between the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system is responsible for increasing blood pressure by increasing heart rate and constricting arterioles. Meanwhile, the parasympathetic nervous system lowers blood pressure by lowering the heart rate and relaxing the arterioles to increase the diameter of blood vessels.
“Postural hypotension or orthostatic hypotension is a decrease in blood pressure due to a change in position. For example, from sitting and standing, or from a lying position and standing up,” said Dito Anurogo to Tempo. Under normal conditions, gravity causes blood to flow to the legs when a person is standing. The body then compensates by increasing the heart rate and constricting the blood vessels. Thus, it can be ascertained that there is enough blood available to the brain.
In patients low blood pressure -including postural or orthostatic hypotension, these compensatory mechanisms do not occur. As a result, blood pressure decreases, then triggers various symptoms, such as dizziness, sensation of falling, spinning, blurred vision, and even fainting in some cases. Some of the differential diagnoses or health problems that resemble low blood pressure are benign hypotension, distributive shock, cardiogenic shock, hypovolemic shock, obstructive shock, and combined type hypotensive shock.
# Source of Hypotension Problems
In general, the problem of hypotension can be sourced from the heart and blood vessels. In hypotension originating from the heart or cardiac, due to low output. This condition can be found in arrhythmia (irregular heart rhythm). Types include bradycardia (slowed heart rate), tachycardia (rapid heart rate), and fibrillation.
There is also a structural heart disease, such as valve disease heart, ischemic heart disease, pericardial disease, cardiac tamponade, congenital disease, obstructive cardiomyopathy, dilated cardiomyopathy, primary pulmonary hypertension. It can also be hypovolemia or decreased blood volume with bleeding conditions (hemorrhage), diarrhea, dehydration (lack of body fluids), orthostatic volume shifts, and diuretic drugs.
Hypotension originating from blood vessels or vascular is divided into two, namely systemic and obstructive vasodilation. Systemic vasodilation occurs in septic, anaphylactic, neurogenic, autonomic dysfunction and drug-induced conditions. While obstructive found in pulmonary embolism disease.
# Causes of Hypotension
Some conditions that trigger hypotension include heart problems, endocrine problems, blood loss, severe infections, severe allergic reactions, pregnancy, nutritional deficiencies, and certain conditions. Heart problems that cause hypotension, such as bradycardia, heart valve disorders, heart attacks, and heart failure.
Endocrine problems include hypothyroidism, hyperthyroidism, adrenal insufficiency (Addison’s disease), hypoglycemia (low blood sugar), and some cases of diabetes. Blood loss that triggers hypotension can be caused by accidents and internal bleeding. A severe allergic reaction or anaphylaxis can be triggered by food, certain medications, insect venom, and latex.
Hypotension in pregnant women mainly occurs at the age of 24 weeks of gestation with the condition that the systolic pressure decreases between 5-10 mmHg and the diastolic pressure decreases between 10-15 mmHg. Dito explained, blood pressure will return to normal after giving birth. Nutritional deficiency leading to hypotension due to deficiency of vitamin B12 and folate. While some special conditions that cause hypotension, such as dehydration, fever, vomiting, severe and recurrent diarrhea, and strenuous exercise.
Hypotension can also be caused by certain medications or drugs. For example, alpha blockers (prazosin), beta blockers (atenolol, propranolol), diuretics (furosemide, hydrochlorothiazide), tricyclic antidepressants (doxepin, imipramine), medications for Parkinson’s disease (pramipexole or drugs containing levodopa). Sildenafil drugs (especially when combined with nitroglycerine), treatment for erectile dysfunction (sildenafil, tadalafil, especially when prescribed with heart medications such as nitroglycerin), calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors.
# Hypotension Solution
There are two approaches that can and are usually taken by the medical team to treat hypotension. First, the pharmacological method by giving drugs; second, non-pharmacological methods by changing lifestyle.
For the pharmacological approach, Dito Anurogo said, the doctor will give medicine according to the patient’s condition, including orthostatic hypotension of the hypoadrenergic (neurogenic) type or the hyperadrenergic type. The main goals of this therapy are to improve quality of life, prevent further injury, reduce episodes of orthostatic hypotension, reduce organ damage, and prevent uncontrolled hypertension.
The treatment of choice for patients with orthostatic hypotension is a vasopressor class or agent to increase blood pressure. Drugs that may be given by a doctor, including fludrocortisone, midodrine, or pyridostigmine. If hypotension persists, the doctor will ensure that the patient is not hypoglycemic, hypothermic, or anemic/hypoproteinemic and that there is no electrolyte imbalance.
For non-pharmacological approaches, there are several ways to reduce episodes of orthostatic hypotension, namely:
- Prevent exposure to hot environments
- Avoid consuming hot food or drinks
- Avoid bathing with warm water during the day
- Cut down on caffeinated drinks
- Increase salt intake by about 10-20 grams per day
- Limiting activity in the early morning and after eating
- Do not wear tight stockings and/or abdominal binders, such as stagens or belts throughout the day or during activities.
- Don’t push too hard while urinating
- Avoid elevating the head position while sleeping
- Don’t drink in a hurry before standing up
- Don’t wear damp or wet clothes in hot weather
- Drink (at least one glass) grape juice before bed for a vasodilator effect
Moderate hypotension can cause dizziness, weakness, fainting, and risk of injury from falls. Very low levels of hypotension can deprive your body of oxygen, causing damage to your heart and brain. “Hypotension needs to be treated by a doctor immediately before it continues to become a complication,” said Dito Anurogo, who is currently pursuing a doctorate at the International PhD Program for Cell Therapy and Regeneration Medicine (IPCTRM), College of Medicine, Taipei Medical University (TMU), Taiwan.