Hypotension: Mumbai doctors highlight why you should take low blood pressure seriously

Last week, Indian industrialist Ratan Tata passed away at 86 on October 9 due to age-related issues. This was two days after he was admitted to Breach Candy Hospital on October 7. While the exact cause of his death isn't known, several media reports are speculating that it was due to low blood pressure, also known as hypotension, after he was admitted for dyspnea, which is shortness of breath. While the cause may not be known, it highlights the need to know more about low blood pressure.

Interestingly, there is a day dedicated to high blood pressure, more popularly called as World Hypertension Day that is observed on May 17 every year. Dr Aklesh Tandekar, head consultant, critical care, Wockhardt Hospitals in Mira Road, explains, "People tend to take low blood pressure levels lightly in comparison to high blood pressure levels. Low blood pressure can be dangerous if neglected. This is because the symptom of low blood pressure mostly includes dizziness and fainting which can make these people more prone to severe falls and accidents. This is why it's crucial to take low blood pressure seriously and take proactive steps to maintain it."

It is also why he says Individuals are advised to actively track their blood pressure levels. The need for older people to pay more attention is important among old people as blood vessels start to lose their flexibility as they age.

With the recent developments, mid-day.com spoke to Dr Koulsoum Houssein, General Medicine, Holy Family Hospital in Bandra, and Dr Hemalata Arora, senior consultant, Internal Medicine, Nanavati Max Super Speciality Hospital in Vile Parle West to raise awareness about low blood pressure. The city-based health experts not only highlight the causes and effects but also why people need to take it seriously by taking the necessary steps to deal with it in time.

What is considered low blood pressure and how is it caused?
Houssein: Low blood pressure, or hypotension, is a systolic pressure of fewer than 90 mmHg or a diastolic pressure of less than 60 mmHg. The causes include dehydration, loss of blood, medications, hormonal imbalances, and neurological disorders. Poor nutrition, deficiencies in vitamins, and some diseases, anaemia, and diabetes can also cause low blood pressure. In some cases, the reason behind this condition is not known.

Arora: However, it can be naturally low in some individuals without causing any issues. Common causes include dehydration, infections, hormonal imbalances (such as adrenal insufficiency), and certain medications like diuretics, beta-blockers, or antidepressants. It may also result from prolonged bed rest, nutritional deficiencies, or underlying medical conditions.

What are the symptoms of low blood pressure in the body?
Houssein: Some of these symptoms of low blood pressure include dizziness, fainting, fatigue and weakness, nausea, palpitations, breathlessness, pale and clammy skin, less urine output, or problems with mental function.

Arora: People with low blood pressure often experience chronic fainting, dizziness, blackouts, light-headedness, fatigue, and blurred vision, especially when standing up too quickly (a condition known as orthostatic hypotension). These symptoms occur due to reduced blood flow to the brain.

What are the effects of low blood pressure?
Houssein: Low blood pressure can severely affect the body, particularly in terms of inadequate blood flow to vital organs. This can easily lead to a reduction in oxygenation and a nutrient delivery rate, thus causing organ damage or eventual failure. Low blood pressure is the opposite of high blood pressure and may lead to decreased cardiac output and reduced peripheral resistance. This risks shock and cardiac arrest compared to increased cardiovascular risk with high blood pressure. Low blood pressure also leads to some damage to cognitive functions, and it increases the fall rate as well as injury rates. At the same time, the general quality of life is affected.

Arora: Low blood pressure can lead to symptoms like dizziness, fainting, and fatigue due to reduced blood flow to vital organs, potentially impacting daily functioning. On the contrary, high blood pressure (hypertension) exerts increased force against artery walls, which can lead to long-term complications such as headaches, neck strain, vision problems, cardiovascular disease, kidney damage, and stroke. Unlike hypotension, hypertension often has no symptoms until severe damage occurs.

Can friends and family help people dealing with low blood pressure?
Houssein: Low blood pressure patients also require support from their loved ones. Their close friends and family can call them anytime to get their blood pressure checked from time to time, remind them about keeping themselves hydrated and consuming nutritious food, and support them emotionally so that they don't get stressed. The friends can make much of the work lighter by helping them out with grocery purchases, cooking, reminding check-up dates, and also teach how to do some first aid during fainting or other emergencies. There should be coordination between individuals with a low blood pressure level so that they can control their condition and avoid complications.

Arora: All individuals with chronic low blood pressure should inform their family members, colleagues and friends about the condition and prescribed management protocol to ensure correct measures are taken during any emergency.

To manage low blood pressure, it's important to stay well-hydrated by drinking fluids rich in electrolytes, such as oral rehydration solutions, coconut water, or sports drinks. Compression stockings can help improve circulation and prevent blood from pooling in the legs. If someone feels faint, they should be helped to lie flat with their legs elevated above heart level to restore blood flow to the brain. Family members can encourage frequent small meals, and a balanced diet with adequate salt, and ensure they avoid sudden posture changes.

Which age group is most affected by low blood pressure and why?
Houssein: Low blood pressure is more prevalent in aged persons or more than 65 years. The causes of these elevations include declining states of blood pressure regulation with age, undesirable side effects of the given drugs, and some chronic disorders such as diabetes and heart disease. Less chance of physical activity, poor diet, and dehydration are other causes. For that reason, aged patients should be monitored regularly and their blood pressure managed to prevent complications.

Arora: Low blood pressure is more common in women aged 15-50 years due to hormonal fluctuations, pregnancy, and menstruation-related blood loss. Older adults (aged 75 and above) are also at higher risk, partly due to age-related physiological changes and the use of multiple medications, which can lead to postural hypotension.

Does low blood pressure occur in one particular gender more than the other?
Houssein: Low blood pressure can be experienced by both genders, though some are at higher risk than others. Pregnant women are among them, because of the hormonal changes in their system. Another condition causing the same risk is menstrual disorder. This is when a woman experiences excessive bleeding in her menstrual cycle. Women are at a higher risk for another term of hypotension: orthostatic hypotension or postural hypotension. In this condition, the blood pressure drops once a person is upright.

Who is most vulnerable to low blood pressure and why?
Houssein: More individuals with pre-existing medical conditions, including diabetes and heart disease, are predisposed to the condition, because of low blood pressure. Certain medications, too, such as diuretics and beta-blockers also have a risk-increasing effect. Some of the other vulnerable populations include older adults, poor nutrition and hydration, and neurological disorders, such as autonomic nervous system dysfunction.

Arora: Women between the ages of 15-50 and older adults (75+) are particularly vulnerable to low blood pressure. Contributing factors include hormonal changes, pregnancy, dehydration, and certain chronic medical conditions. Older adults are prone to age-related changes in the autonomic nervous system, impaired thirst sensation, and the increased use of medications that affect blood pressure.

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How can people avoid getting low blood pressure?
Houssein: Preventive measures for low blood pressure include hydration and copious fluid intake, a balanced nutritional diet with all the required nutrients in it, and regular physical exercises. Management of stress through adequate relaxation, monitoring of blood pressure, and abstinence from excessive alcoholic beverages will help to maintain healthy blood pressure levels as well. Getting proper sleep, therefore, is also one of the precepts for keeping an individual's blood pressure healthy. Least consumption of sodium also plays a role in maintaining healthy blood pressure.

Arora: Preventing low blood pressure involves maintaining proper hydration by drinking water and electrolyte-rich fluids, especially in hot weather or during physical activity. Standing up slowly, especially from sitting or lying positions, can prevent postural hypotension. Regular light exercise, such as walking or stretching, helps improve circulation. Including a balanced diet with adequate salt intake (in moderation and as advised by a healthcare provider) can also help maintain stable blood pressure levels.

What makes low blood pressure dangerous for people and do people take it for granted? Houssein: Untreated low blood pressure can lead to serious consequences, including damage or failure of organs, a higher risk of falling and associated injuries, and decreased quality of life. People also underestimate the severity of this disease, which makes them forget their symptoms, further worsening the outcome. It is thus essential that the symptoms be presented in a hospital in case they persist or aggravate. Low blood pressure is also dangerous because it can lead to giddiness and falls which is one of the leading causes of fractures, especially in old people.

Arora: Low blood pressure can be dangerous because it may cause sudden fainting, even without exertion, which can lead to falls and serious injuries, particularly in older adults. Severe hypotension can result in shock, a life-threatening condition that requires immediate medical attention. Despite these risks, many people tend to take low blood pressure lightly, especially if they're asymptomatic, ignoring the potential for dangerous situations like falls or reduced blood flow to essential organs.

Can food help in maintaining blood pressure?
Houssein: Yes, a healthy diet can maintain blood pressure. It is important to eat vegetables like spinach and kale, which are rich in potassium; berries like blueberries and strawberries, which are rich in antioxidants; fatty fish, salmon, and tuna, which are rich in omega-3 fatty acids; nuts and seeds like almonds and pumpkin seeds, which are rich in magnesium; grains like brown rice and quinoa, which are rich in fibre; meats like chicken and turkey, which are rich in vitamin B12; foods rich in B vitamins: like eggs and dairy; some foods rich in omega-3 like flaxseeds and walnuts.

It is also important to limit sodium consumption and avoid excessive intake of coffee.

Arora: Yes, certain foods can help maintain blood pressure. A diet rich in fresh fruits and vegetables (such as bananas and leafy greens) provides necessary vitamins and minerals. Foods high in sodium, such as olives or pickles, may help raise blood pressure, though should be consumed in moderation. High-protein foods like eggs, fish, and lean meats, as well as complex carbohydrates like whole grains, are also beneficial. Drinking adequate water and consuming electrolyte-rich drinks help maintain blood volume, thus stabilising blood pressure.