John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Low blood pressure in healthy subjects without symptoms
or organ damage needs no treatment. However, all patients with symptoms possibly due to
low blood pressure should be evaluated by a doctor. (Patients who have had a
major drop in blood pressure from their usual levels even without the
development of symptoms also should be evaluated.) The doctor needs to identify
the cause of the low blood pressure; remedies will depend on the cause.
For example, if a medication is
causing the low blood pressure, the dose of medication may have to be reduced or
the medication stopped, though only after consulting the doctor. Self-adjustment
of medication should not be done.
Dehydration is treated
with fluids and minerals (electrolytes). Mild dehydration without nausea and
vomiting can be treated with oral fluids and electrolytes. Moderate to severe
dehydration usually is treated in the hospital
or emergency room with intravenous fluids and electrolytes.
Blood loss can be treated with intravenous fluids and
blood transfusions. Continuous and severe bleeding needs to be treated immediately.
Septic shock is an emergency and is treated with intravenous fluids and antibiotics.
Blood pressure medications or diuretics are adjusted, changed, or stopped by
the doctor if they are causing low blood pressure symptoms.
Bradycardia may be due to
a medication. The doctor may reduce, change or stop
the medication. Bradycardia due to sick sinus syndrome or heart block is treated
with an implantable pacemaker.
Tachycardia is treated
depending on the nature of the tachycardia. Atrial
fibrillation can be treated with oral medications, electrical
a catheterization procedure called
isolation. Ventricular tachycardia can be controlled with medications or with
an implantable defibrillator.
Pulmonary embolism and deep vein thrombosis
is treated with blood thinners, intravenous initially with
heparin, and oral warfarin (Coumadin) later.
Pericardial fluid can be removed by a procedure called pericardiocentesis.
Postural hypotension can be treated with changes in diet
such as increasing water and salt intake*,
increasing intake of caffeinated beverages (because
constricts blood vessels), using compression stockings to compress the leg veins and reduce the pooling of blood in the leg veins, and in some patients, the use of a medication called
midodrine (ProAmatine). The problem with
ProAmatine is that while it increases blood pressure in the upright position, the supine blood pressure may become too high, thus increasing the risk of strokes. Mayo
Clinic researchers found that a medication used to treat muscle weakness in
myasthenia gravis called
pyridostigmine (Mestinon) increases upright blood pressure but not supine blood pressure. Mestinon, an anticholinesterase medication, works on the autonomic nervous system, especially when a person is standing up. Side effects include minor abdominal cramping or increased frequency of bowel movements.
*Note: Increasing salt intake can lead to heart failure in patients with existing heart disease and should not be undertaken without consulting a doctor.
Postprandial hypotension refers to low blood pressure occurring after meals.
indomethacin (Indocin) may be beneficial.