Low blood pressure

and Carola Felchner, science journalist

Dr. med.Julia Schwarz is a freelance writer in the medical department.

More about the experts

Carola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.

More about the experts All content is checked by medical journalists.

Low blood pressure (arterial hypotension) is common, especially in young, slim women. Low blood pressure is when the blood pressure is below 100/110 to 60 mmHg. Those affected usually suffer from dizziness, tiredness or a racing heart. Read more about the topic here: How does low blood pressure develop? What can you do about it? Why can low blood pressure be dangerous during pregnancy?

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. I95

Brief overview

Symptoms: sometimes none, but often symptoms such as palpitations, dizziness, headache, tiredness, shortness of breath
Causes: Low blood pressure is partly hereditary. However, it can also be caused by environmental influences, illnesses or medication, as well as certain postures or (rapid) changes in position.
Diagnostics: repeated blood pressure measurements, certain circulatory tests, possibly further examinations (such as ultrasound and blood tests). Limits: 110 to 60 mmHg for men, 100 to 60 mmHg for women
Treatment: Home remedies and general measures such as contrast showers, exercise, enough salted food, plenty of drinking; if none of that works: medication
Prognosis: generally harmless, precise observation only necessary in certain cases.

Low blood pressure: limit values table

The term blood pressure refers to the pressure in the large arteries. These are the vessels that lead away from the heart. How high or low the pressure inside it is depends on the one hand on the elasticity and resistance of the vessel walls. On the other hand, the blood pressure is influenced by the strength of the heart - i.e. how much blood volume is transported into the circulation per heartbeat. Heart rate also plays a role.

Low blood pressure is actually only a symptom and not a disease, although it is often viewed as such in Germany. That is why low blood pressure in (English-speaking) foreign countries is often referred to somewhat derisively as "German disease".

The blood pressure is given in "millimeters of mercury" (mmHg). The upper (systolic) value describes the blood pressure at the moment when the heart muscle contracts and ejects blood. The lower (diastolic) value refers to the relaxation phase of the heart (slackening) when it fills with blood again.

Low blood pressure: values

According to the World Health Organization (WHO), blood pressure should ideally be below 120 to 80 mmHg. If the systolic value is below 110 (men) or 100 (women) and the diastolic value is below 60, doctors speak of low blood pressure (arterial hypotension). The table shows how deviations from the optimum value are assessed upwards:

	Systolic (mmHg)	Diastolic (mmHg)
Low blood pressure (hypotension)	< 110/100*	< 60
Optimal blood pressure	< 120	< 80
Normal blood pressure	120 - 129	80 - 84
High normal blood pressure	130 - 139	85 - 89
High blood pressure (hypertension)	≥ 140	≥ 90

* For men, values below 110/60 are considered to be low blood pressure, for women values below 100/60.

Low blood pressure is rarely a threat. Only if the values drop too much can low blood pressure become dangerous - there is a risk of fainting. Occasionally, arterial hypotension is indicative of a potentially serious organ disease.

Low blood pressure: symptoms

Low blood pressure does not always cause symptoms. However, symptoms such as dizziness, palpitations and circulatory problems, headaches or tiredness can occur, especially with a rapid attack of blood pressure. Frequently affected are (inactive) adolescents, young, slim women, pregnant women and gaunt elderly people. In principle, the following applies: If low blood pressure causes symptoms such as the following and these occur frequently or very suddenly, the cause should be clarified by a doctor:

Palpitations: If the blood pressure is low, a rapid heartbeat (pulse) often occurs. This is because the body wants to counteract the reduced blood flow - and it does this by making the heart beat faster by activating the sympathetic nervous system.

Dizziness: Low blood pressure also means insufficient blood supply to the brain. This causes visual disturbances such as the famous “seeing asterisk” or “turning black before the eyes”, ringing in the ears and dizziness. In the worst case, those affected may faint. Often these symptoms are also noticeable when those affected change position, for example standing up (quickly) or bending down. The blood sinks into the legs and the body needs a moment to regulate the blood pressure again.

Such “dropouts” become dangerous when there is a risk of falling or when they occur while driving.

Headache: Often low blood pressure is accompanied by (sharp, pulsating) headaches. The reason: the blood circulation in the head is restricted. Then it can help to have a drink and thereby increase the volume of blood circulating. A walk is also good, as the fresh air improves the oxygen supply in the brain and stimulates the circulation.

Fatigue: fatigue, concentration problems, drowsiness, tiredness - low blood pressure makes you tired. Patients take longer in the morning to get going and generally feel listless. In addition, they are often shaky or sweat more due to the reduced blood flow.

Breathlessness: Chest tightness or stitches in the heart area can also be signs of low blood pressure. Some people have difficulty breathing, and the skin may feel cool and pale. This is because in arterial hypotension the blood vessels are constricted in order to direct the blood volume to the vital organs such as the heart or brain.

Ringing in the ears, loss of appetite, irritability, sensitivity to the weather and depressive moods can also indicate low blood pressure.

Typical symptoms of low blood pressure

Low blood pressure is rarely dangerous, but people often suffer from unpleasant symptoms.

Low blood pressure: causes and risk factors

The body itself has its own system that regulates blood pressure - small pressure measuring bodies in the carotid arteries that can feel the blood pressure in the blood vessel. They transmit signals to the circulatory center in the brain stem. In the case of high blood pressure, this gives the command to dilate the blood vessels and, in the case of low blood pressure, the command to narrow the blood vessels. The kidneys also become active when the blood pressure in the supply vessel drops too low: it then releases the hormone renin. It triggers an increase in blood pressure via intermediate steps.

The mechanisms of blood pressure regulation may not function adequately or may be disturbed for a wide variety of reasons. This then results in low blood pressure. Doctors differentiate between different forms of hypotension: primary (essential) hypotension, secondary hypotension and orthostatic hypotension.

Primary hypotension

Primary or essential low blood pressure is the most common type of hypotension. It occurs for no apparent cause. The tendency to do so can, however, be inherited. Because it is particularly common for young, slim people (especially women) to have congenital low blood pressure, this is also referred to as constitutional hypotension (constitution = physique, general physical condition).

Secondary hypotension

Secondary low blood pressure is a consequence or a symptom of an underlying disease. These include, for example:

Underactive thyroid (hypothyroidism)
Underactive adrenal cortex (Addison's disease)
Underactive pituitary gland (anterior pituitary insufficiency)
Heart diseases (heart failure, cardiac arrhythmias, pericarditis)
Lack of salt (hyponatremia)
Weak veins (varicose veins)

A lack of fluids (in extreme heat, through profuse sweating, severe diarrhea and vomiting, etc.) can also lower blood pressure: The large loss of fluid reduces the amount of circulating blood, which in turn reduces the pressure in the vessels.

Also, as a side effect of some medications, blood pressure can drop excessively. Such drug hypotension can be triggered by:

Psychotropic drugs (drugs for depression, anxiety, insomnia)
Antiarrhythmics (anti-arrhythmias)
Antihypertensive drugs (anti-high blood pressure drugs)
Diuretics (water tablets)
Coronary medication (for angina pectoris: nitro sprays)
Vasodilators (vasodilators)

Orthostatic hypotension

The upright posture is called orthostasis. Correspondingly, orthostatic low blood pressure occurs when you get up quickly from a lying position and the blood sinks in your legs. So there is a volume shift to which the body cannot react sufficiently (quickly). The orthostatic hypotension is therefore also called orthostatic dysregulation.

Possible reasons for orthostatic hypotension are:

secondary low blood pressure
Disorders of the autonomic nervous system (for example due to diabetes mellitus)
Damage to nerve cells in the brain (e.g. from Parkinson's disease, alcohol abuse)
Varicose veins (varicosis)
Condition after deep vein thrombosis (post-thrombotic syndrome)

Doctors differentiate between two forms of orthostatic hypotension:

Sympathetic orthostatic hypotension: after standing up, the systolic blood pressure drops while the pulse rate increases at the same time.
Asympathetic orthostatic hypotension: Systolic and diastolic blood pressure drop when standing up, while the pulse rate remains unchanged or also drops.

Low blood pressure during pregnancy

Low blood pressure is normal in the first six months of pregnancy. But sometimes it stays too low even in late pregnancy. The reason for this can be the vena cava syndrome: The unborn child presses on the large vena cava of the mother. This large blood vessel carries blood from the body back to the heart. The pressure of the child on the large vena cava affects the blood flow back to the heart. As a result, the blood supply to the brain and other parts of the body is reduced - resulting in lower blood pressure.

Low blood pressure: exams and diagnosis

In order to be able to diagnose “low blood pressure”, the doctor has to measure the blood pressure repeatedly. It is usually important that the measurements are taken on different days and at different times.

The tilt table examination is particularly carried out on patients who have fainted as a result of circulatory problems. During the test, the patient is tied to a tilting table with two straps. Heart rate and blood pressure are monitored. After a ten-minute rest period in a lying position, the tilting table is quickly raised to a tilting angle of 60 to 80 degrees. The quick way to get up from lying down is simulated to see whether this causes blood pressure and pulse to drop and the patient to pass out. If this is the case, one speaks of so-called vasovagal syncope (fainting due to an excessive reaction of the vagus nerve, which is part of the autonomic nervous system).

On the other hand, low blood pressure as a result of inadequate orthostatic regulation (orthostatic hypotension) can be detected using the Schellong test. In this circulatory test, the patient must first lie down for ten minutes and then get up quickly and stand for ten minutes. In orthostatic hypotension, the rapid change in position causes a drop in blood pressure and possibly other symptoms (such as dizziness).

If the doctor suspects that low blood pressure is caused by a certain underlying disease (secondary hypotension), further examinations can clarify the situation. For example, to clarify hypothyroidism, the thyroid values are measured in the blood and the thyroid is examined using ultrasound. Electrocardiography (EKG) can provide evidence of heart disease (such as arrhythmias).

Low blood pressure: treatment

The good news: As troublesome as the symptoms of low blood pressure can be, home remedies and a few simple measures can usually noticeably alleviate the symptoms. Drug therapy is only necessary if low blood pressure causes serious symptoms or a health hazard.

Low blood pressure: home remedies

So what exactly can you do with low blood pressure? First of all, move. Because physical activity gets the circulation going and reduces symptoms such as dizziness and fatigue. Endurance sports such as jogging, swimming or cycling are particularly suitable.

Movement begins even before you get up: It often helps to alternately stretch and bend your feet while lying in bed to stimulate blood flow, or to cycle with your feet in the air. Only then slowly raise up - if necessary with a break from sitting on the edge of the bed.

Fluctuations in blood pressure when getting up in the morning can often be prevented by sleeping with the upper body elevated at night (tilting the head at around 20 degrees).

Other home remedies for low blood pressure are compression / support stockings. They can stimulate blood circulation in the legs.

A shower instead of a full bath is also a good tip for people with low blood pressure. If you do not want to do without a full bath, you should make sure that the bath water is not too warm and that you only get out of the tub very slowly at the end. Due to the warmth, the vessels are wide open, which is why the blood can easily sink into the legs when you stand up.

Alternating showers are very useful when the blood pressure is low: The rapid change between warm and cold water causes the blood vessels to alternately expand and contract again. This trains the vessel walls and stimulates the circulation.

Those who shy away from showering the entire body with cold water can at least give the lower half of the body a cold shower - from the feet up to the buttocks. A blood circulation-promoting brush or a massage sponge increase the stimulating effect.

Speaking of the stimulating effect: a cup of coffee in the morning also has that. Green or black tea also has a stimulating effect on the circulation. In general, you should drink a lot if your blood pressure is too low (water, herbal or fruit tea, etc.). This increases the blood volume and thus the blood pressure.

Table salt also increases blood volume and blood pressure by binding fluids in the body. People with low blood pressure should therefore salt their food sufficiently (a maximum of five grams per day). It is also advisable to have several small meals a day instead of a few large ones.

If you have low blood pressure, you should also limit your alcohol consumption. Alcohol dilates the blood vessels and thus lowers blood pressure, at least for a short time.

Saponins are also said to have a positive effect on low blood pressure. These plant substances can be found in liquorice, oats and legumes, for example. They can increase the body's production of cortisol, thereby raising blood pressure.

Some medicinal plants can also stimulate the circulation. These include, for example, ginseng, hawthorn and rosemary. Some medicinal plants can be used to make tea, others are available as herbal preparations. Ask your doctor or pharmacist for advice on this.

Low blood pressure: medication

If home remedies and general measures (lots of exercise, etc.) do not adequately relieve symptoms of low blood pressure, you should talk to your doctor about drug treatment. However, he will only prescribe such medication for you if it is absolutely necessary. Because all active ingredients used can also have side effects.

The following active ingredients are available for the treatment of low blood pressure:

Sympathomimetics: These active substances (e.g. etilefrine, caffeine) constrict the blood vessels and increase the heart rate, which causes the blood pressure to rise. Possible side effects: cardiac arrhythmia.
Fludrocortisone: This active ingredient increases blood pressure by increasing the amount of fluid in the blood vessels. Possible side effects: fluid retention in the tissue (edema), weight gain and potassium deficiency.

In the past, so-called dihydroergotamines were also given for low blood pressure. However, due to pronounced side effects, they may no longer be prescribed for orthostatic hypotension since 2014.

Low blood pressure: course and prognosis

As a rule, low blood pressure is harmless and does not cause permanent damage. In severe cases, however, it can lead to severe dizziness and fainting.

Low blood pressure during pregnancy can also be dangerous: it can happen that the uterus does not have sufficient blood supply. Then the care of the unborn child is no longer guaranteed. Such a permanent undersupply of the child can lead to developmental disorders and increase the risk of complications during childbirth. Therefore, low blood pressure during pregnancy should be carefully monitored and monitored by a doctor.

Tags: parasites Menstruation hospital