While high blood pressure (hypertension) is a well-known risk factor for various health issues, including heart disease and stroke, chronic low blood pressure (hypotension) can also be a concern as it may indicate an underlying problem that requires medical attention.
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What Is Hypotension?
Blood pressure is the force exerted by the blood against the walls of the arteries as it is pumped by the heart throughout the body. It is typically measured in millimeters of mercury (mmHg) and is expressed as two numbers: systolic pressure over diastolic pressure. For example, a normal blood pressure reading for adults is considered to be less than 120/80 mmHg.
Hypotension, or low blood pressure, occurs when blood pressure falls below 90/60, potentially leading to inadequate blood flow to various organs and tissues. Hypotension is considered benign if the affected individual does not show signs of deoxygenation. These can include:
- Confusion
- Dizziness or lightheadedness
- Nausea
- Fainting
- Fatigue
- Neck or back pain
- Headache
- Blurred vision
- Heart palpitations
There are two main types of hypotension. Orthostatic (postural) hypotension occurs when a person experiences a systolic blood pressure decrease of at least 20 mmHg or a diastolic blood pressure decrease of at least 10 mmHg within three minutes of transitioning from a lying or sitting position to a standing position. While it is normal for blood pressure to drop briefly with a change of position, the body should be able to compensate and normalize blood pressure quickly under normal circumstances. Chronic (absolute) hypotension is a form of persistent, low resting blood pressure independent of postural changes.
What Are the Possible Causes of Hypotension?
Hypotension can have various causes, and it's important to determine the underlying reason to provide appropriate treatment.
The regulation of blood pressure in the human body involves a complex interplay of physiological mechanisms to maintain a stable and appropriate blood pressure level. These mechanisms, encompassing baroreceptors, hormone systems, and the autonomic nervous system (ANS), help ensure that blood flow to vital organs, particularly the brain and heart, remains adequate. The ANS is the division of the nervous system responsible for controlling "automatic" bodily functions, including heart rate, temperature control, and blood pressure. In individuals with autonomic dysfunction, the ANS fails to function correctly, disrupting the body's capacity to regulate blood pressure in response to positional changes effectively. Autonomic dysfunction can arise from various medical conditions, including multiple system atrophy, Parkinson's disease, and diabetic neuropathy. (3)
The adrenal glands also play a role in maintaining blood pressure through their secretion of cortisol, epinephrine, and aldosterone. Adrenal hyporesponsiveness occurs when there is dysregulation in the hypothalamic-pituitary-adrenal (HPA) axis, resulting in insufficient production of adrenal hormones. Orthostatic hypotension is one of the signs of adrenal hyporesponsiveness/dysfunction.
A number of medical conditions can cause orthostatic and chronic hypotension. Anemia, dehydration, and blood loss can cause low blood volume, reducing blood pressure. Drops in blood pressure are common in pregnancy, especially during the first 24 weeks. Chronic heart and lung conditions can lead to low blood pressure. Severe infection, called septic shock, occurs when bacteria enter the bloodstream; bacterial toxins negatively impact blood vessels, resulting in a life-threatening decline in blood pressure. Low blood pressure may also indicate certain endocrine disorders, including Addison's disease and hypothyroidism. (12, 14)
Finally, some medications can cause low blood pressure as a side effect. This list includes diuretics, alpha- and beta-blockers, drugs for Parkinson's disease, tricyclic antidepressants, and medications for erectile dysfunction.
Functional Medicine Labs to Test for Root Cause of Hypotension
Orthostatic hypotension can be diagnosed with a test of active standing or a tilt table test. For patients with persistent and symptomatic hypotension, diagnostic testing helps identify underlying causes.
Complete Blood Count
A complete blood count (CBC) is a panel that includes various markers and measurements of red blood cells, white blood cells, and platelets in circulation. Elevated or low white blood cell counts can indicate infection. Low red blood cell counts, hemoglobin, and hematocrit indicate anemia or blood loss. Low platelets may indicate sepsis. Abnormal results may indicate the need for additional follow-up tests. For example, anemias are commonly caused by nutrient deficiencies, so a micronutrient panel can be ordered to diagnose iron, vitamin B12, or folate deficiency.
Comprehensive Metabolic Panel
A comprehensive metabolic panel (CMP) includes 14 markers of metabolic health and function. A CMP can detect electrolyte imbalances, abnormal serum glucose, and kidney dysfunction. Abnormal CMP results may also appear in the context of chronic heart and pulmonary diseases. Similarly to the CBC, the CMP acts as a preliminary screening tool and helps make decisions regarding additional testing needed.
Cortisol
Cortisol is one of the primary hormones produced and secreted by the adrenal glands, so it is used to screen for adrenal pathologies. Serum morning cortisol is the diagnostic test of choice for adrenal insufficiency. Salivary cortisol tests are also available to identify more functional imbalances within the HPA axis, contributing to what is often called "adrenal fatigue."
Thyroid Panel
A thyroid panel includes markers of thyroid function, such as TSH, free T3, and free T4. Underproduction of thyroid hormones, called hypothyroidism, can be diagnosed by measuring elevated TSH and low levels of T3/T4.
Additional Labs to Test
Imaging studies may also be recommended for patients with persistent hypotension. Brain imaging, including CT and MRI, can detect possible neurological causes of low blood pressure. Electrocardiograms and echocardiograms may also be performed to detect heart failure or structural heart diseases as a cause of abnormal blood pressure readings. (12)
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Conventional Treatment for Hypotension
Treatment for hypotension depends on its underlying cause. In many cases, lifestyle modifications such as increasing fluid and salt intake, wearing compression stockings, and avoiding sudden changes in position can help manage orthostatic hypotension. Chronic hypotension is typically addressed by treating the underlying medical condition responsible for low blood pressure or modifying preexisting medications. Other treatments include infusing fluids into the blood to increase blood volume and medications to constrict blood vessels or help the kidneys retain salt and fluid. (12)
Integrative Medicine and Hypotension: A Comprehensive Guide
A functional medicine treatment protocol for addressing low blood pressure takes a whole-person, patient-centered approach to improve health and promote well-being, using various natural strategies to raise blood pressure naturally and encourage the healthy functioning of the physiologic pathways involved in maintaining healthy blood pressure.
Nutritional Strategies to Treat Hypotension
The foods you eat notably impact heart health and blood pressure. Certain dietary tips can help to raise and maintain blood pressure at a healthy level.
Foods with high salt content can elevate blood pressure; therefore, increasing salt intake is recommended as a first-line intervention in managing symptomatic orthostatic hypotension. Studies show that increasing salt intake improves or resolves symptoms of low blood pressure in over 60% of patients. Increasing salt in the diet is the preferred approach to increasing sodium intake (over supplements). Recommended daily amounts of sodium chloride vary from 6-10 grams. (4)
Eating foods rich in iron, vitamin B12, and folate is important in supporting the health of red blood cells and preventing anemia. Iron is found in plant and animal sources of foods, like red meat, seafood, liver, legumes, and molasses. Vitamin B12 is rich in animal-based foods, including eggs, chicken, fish, and dairy. Good dietary sources of folate include dark leafy green vegetables, legumes, and liver.
Postprandial hypotension primarily affects older adults, especially those with underlying medical conditions, and is characterized by a significant drop in blood pressure following a meal, particularly within the first two hours after eating. Foods high in carbohydrates that are very quickly digested have been shown to exacerbate this form of hypotension. Eating a low-carb diet and eating smaller meals throughout the day has been shown to help offset dips in blood pressure (13).
Fluids increase blood volume and prevent dehydration. General fluid recommendations suggest that individuals drink one-half to one ounce of water per pound body weight daily to prevent dehydration. Alcohol can also contribute to dehydration by acting as a diuretic. Therefore, it is recommended to limit or eliminate alcohol consumption.
Supplements for Raising Blood Pressure Naturally
A systematic review and meta-analysis revealed a connection between vitamin D deficiency and orthostatic hypotension, especially in older women. This link suggests that providing vitamin D supplementation to raise serum levels may be suitable for addressing this issue among this demographic. Moreover, research has demonstrated vitamin D's benefits for various health conditions linked to low blood pressure, including cardiovascular disease, dysglycemia, hypothyroidism, and Addison's disease.
Licorice is known to increase blood pressure. This effect is attributed to its active constituent, glycyrrhizin, which induces similar physiologic effects as aldosterone and cortisol to raise blood pressure.
Complementary Therapies for Hypotension
Compression stockings apply graduated pressure to the legs, with the highest pressure at the ankle and gradually decreasing pressure as they move up the leg. This compression helps improve blood flow in the veins, preventing blood from pooling in the lower extremities and reducing the risk of complications like swelling and blood clots. Studies have shown that compression stockings are effective in increasing systolic blood pressure and reducing the incidence of orthostatic hypotension (22, 28).
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Summary
Blood pressure is considered one of the most crucial vital signs in healthcare. Low blood pressure, called hypotension, is less common than hypertension, but it can affect up to 30% of elderly individuals, increasing the risk for falls and injury when it causes symptoms like fatigue and dizziness. If you experience symptoms of hypotension or consistently have low blood pressure readings, it is advisable to consult a healthcare professional for evaluation and guidance. Integrative practitioners can use functional medicine tests to determine the root cause of abnormal blood pressure readings and implement various natural interventions to support healthy blood volume, circulation, and pressure.
While high blood pressure (hypertension) is a well-known risk factor for various health issues, including heart disease and stroke, chronic low blood pressure (hypotension) can also be a concern as it may indicate an underlying problem that requires medical attention.
[signup]
What Is Hypotension?
Blood pressure is the force exerted by the blood against the walls of the arteries as it is pumped by the heart throughout the body. It is typically measured in millimeters of mercury (mmHg) and is expressed as two numbers: systolic pressure over diastolic pressure. For example, a normal blood pressure reading for adults is considered to be less than 120/80 mmHg.
Hypotension, or low blood pressure, occurs when blood pressure falls below 90/60, potentially leading to inadequate blood flow to various organs and tissues. Hypotension is considered benign if the affected individual does not show signs of deoxygenation. These can include:
- Confusion
- Dizziness or lightheadedness
- Nausea
- Fainting
- Fatigue
- Neck or back pain
- Headache
- Blurred vision
- Heart palpitations
There are two main types of hypotension. Orthostatic (postural) hypotension occurs when a person experiences a systolic blood pressure decrease of at least 20 mmHg or a diastolic blood pressure decrease of at least 10 mmHg within three minutes of transitioning from a lying or sitting position to a standing position. While it is normal for blood pressure to drop briefly with a change of position, the body should be able to compensate and normalize blood pressure quickly under normal circumstances. Chronic (absolute) hypotension is a form of persistent, low resting blood pressure independent of postural changes.
What Are the Possible Causes of Hypotension?
Hypotension can have various causes, and it's important to determine the underlying reason to provide appropriate treatment.
The regulation of blood pressure in the human body involves a complex interplay of physiological mechanisms to maintain a stable and appropriate blood pressure level. These mechanisms, encompassing baroreceptors, hormone systems, and the autonomic nervous system (ANS), help ensure that blood flow to vital organs, particularly the brain and heart, remains adequate. The ANS is the division of the nervous system responsible for controlling "automatic" bodily functions, including heart rate, temperature control, and blood pressure. In individuals with autonomic dysfunction, the ANS may not function correctly, disrupting the body's capacity to regulate blood pressure in response to positional changes effectively. Autonomic dysfunction can arise from various medical conditions, including multiple system atrophy, Parkinson's disease, and diabetic neuropathy. (3)
The adrenal glands also play a role in maintaining blood pressure through their secretion of cortisol, epinephrine, and aldosterone. Adrenal hyporesponsiveness occurs when there is dysregulation in the hypothalamic-pituitary-adrenal (HPA) axis, resulting in insufficient production of adrenal hormones. Orthostatic hypotension is one of the signs of adrenal hyporesponsiveness/dysfunction.
A number of medical conditions can cause orthostatic and chronic hypotension. Anemia, dehydration, and blood loss can cause low blood volume, reducing blood pressure. Drops in blood pressure are common in pregnancy, especially during the first 24 weeks. Chronic heart and lung conditions can lead to low blood pressure. Severe infection, called septic shock, occurs when bacteria enter the bloodstream; bacterial toxins negatively impact blood vessels, resulting in a life-threatening decline in blood pressure. Low blood pressure may also indicate certain endocrine disorders, including Addison's disease and hypothyroidism. (12, 14)
Finally, some medications can cause low blood pressure as a side effect. This list includes diuretics, alpha- and beta-blockers, drugs for Parkinson's disease, tricyclic antidepressants, and medications for erectile dysfunction.
Functional Medicine Labs to Test for Root Cause of Hypotension
Orthostatic hypotension can be diagnosed with a test of active standing or a tilt table test. For patients with persistent and symptomatic hypotension, diagnostic testing helps identify underlying causes.
Complete Blood Count
A complete blood count (CBC) is a panel that includes various markers and measurements of red blood cells, white blood cells, and platelets in circulation. Elevated or low white blood cell counts can indicate infection. Low red blood cell counts, hemoglobin, and hematocrit indicate anemia or blood loss. Low platelets may indicate sepsis. Abnormal results may indicate the need for additional follow-up tests. For example, anemias are commonly caused by nutrient deficiencies, so a micronutrient panel can be ordered to diagnose iron, vitamin B12, or folate deficiency.
Comprehensive Metabolic Panel
A comprehensive metabolic panel (CMP) includes 14 markers of metabolic health and function. A CMP can detect electrolyte imbalances, abnormal serum glucose, and kidney dysfunction. Abnormal CMP results may also appear in the context of chronic heart and pulmonary diseases. Similarly to the CBC, the CMP acts as a preliminary screening tool and helps make decisions regarding additional testing needed.
Cortisol
Cortisol is one of the primary hormones produced and secreted by the adrenal glands, so it is used to screen for adrenal pathologies. Serum morning cortisol is the diagnostic test of choice for adrenal insufficiency. Salivary cortisol tests are also available to identify more functional imbalances within the HPA axis, contributing to what is often called "adrenal fatigue."
Thyroid Panel
A thyroid panel includes markers of thyroid function, such as TSH, free T3, and free T4. Underproduction of thyroid hormones, called hypothyroidism, can be diagnosed by measuring elevated TSH and low levels of T3/T4.
Additional Labs to Test
Imaging studies may also be recommended for patients with persistent hypotension. Brain imaging, including CT and MRI, can detect possible neurological causes of low blood pressure. Electrocardiograms and echocardiograms may also be performed to detect heart failure or structural heart diseases as a cause of abnormal blood pressure readings. (12)
[signup]
Conventional Treatment for Hypotension
Treatment for hypotension depends on its underlying cause. In many cases, lifestyle modifications such as increasing fluid and salt intake, wearing compression stockings, and avoiding sudden changes in position can help manage orthostatic hypotension. Chronic hypotension is typically addressed by treating the underlying medical condition responsible for low blood pressure or modifying preexisting medications. Other treatments include infusing fluids into the blood to increase blood volume and medications to constrict blood vessels or help the kidneys retain salt and fluid. (12)
Integrative Medicine and Hypotension: A Comprehensive Guide
A functional medicine treatment protocol for addressing low blood pressure takes a whole-person, patient-centered approach to improve health and promote well-being, using various natural strategies to support healthy blood pressure levels and encourage the healthy functioning of the physiologic pathways involved in maintaining healthy blood pressure.
Nutritional Strategies to Support Healthy Blood Pressure
The foods you eat notably impact heart health and blood pressure. Certain dietary tips can help to support and maintain blood pressure at a healthy level.
Foods with high salt content can elevate blood pressure; therefore, increasing salt intake may be considered as a first-line intervention in managing symptomatic orthostatic hypotension. Studies show that increasing salt intake may help improve or manage symptoms of low blood pressure in some patients. Increasing salt in the diet is the preferred approach to increasing sodium intake (over supplements). Recommended daily amounts of sodium chloride vary from 6-10 grams. (4)
Eating foods rich in iron, vitamin B12, and folate is important in supporting the health of red blood cells and maintaining healthy blood levels. Iron is found in plant and animal sources of foods, like red meat, seafood, liver, legumes, and molasses. Vitamin B12 is rich in animal-based foods, including eggs, chicken, fish, and dairy. Good dietary sources of folate include dark leafy green vegetables, legumes, and liver.
Postprandial hypotension primarily affects older adults, especially those with underlying medical conditions, and is characterized by a significant drop in blood pressure following a meal, particularly within the first two hours after eating. Foods high in carbohydrates that are very quickly digested have been shown to exacerbate this form of hypotension. Eating a low-carb diet and eating smaller meals throughout the day has been shown to help offset dips in blood pressure (13).
Fluids increase blood volume and help maintain hydration. General fluid recommendations suggest that individuals drink one-half to one ounce of water per pound body weight daily to support hydration. Alcohol can also contribute to dehydration by acting as a diuretic. Therefore, it is recommended to limit or eliminate alcohol consumption.
Supplements for Supporting Blood Pressure
A systematic review and meta-analysis revealed a connection between vitamin D deficiency and orthostatic hypotension, especially in older women. This link suggests that providing vitamin D supplementation to raise serum levels may be suitable for addressing this issue among this demographic. Moreover, research has demonstrated vitamin D's benefits for various health conditions linked to low blood pressure, including cardiovascular health, blood sugar management, thyroid function, and adrenal health.
Licorice is known to influence blood pressure. This effect is attributed to its active constituent, glycyrrhizin, which may have similar physiologic effects as aldosterone and cortisol to support blood pressure.
Complementary Therapies for Hypotension
Compression stockings apply graduated pressure to the legs, with the highest pressure at the ankle and gradually decreasing pressure as they move up the leg. This compression helps improve blood flow in the veins, preventing blood from pooling in the lower extremities and reducing the risk of complications like swelling and blood clots. Studies have shown that compression stockings may be effective in supporting systolic blood pressure and reducing the incidence of orthostatic hypotension (22, 28).
[signup]
Summary
Blood pressure is considered one of the most crucial vital signs in healthcare. Low blood pressure, called hypotension, is less common than hypertension, but it can affect up to 30% of elderly individuals, increasing the risk for falls and injury when it causes symptoms like fatigue and dizziness. If you experience symptoms of hypotension or consistently have low blood pressure readings, it is advisable to consult a healthcare professional for evaluation and guidance. Integrative practitioners can use functional medicine tests to determine the root cause of abnormal blood pressure readings and implement various natural interventions to support healthy blood volume, circulation, and pressure.
1. Anderson, S. (2022, July 18). What Is Adrenal Fatigue? Is It A Real Condition? Rupa Health. https://www.rupahealth.com/post/wired-but-tired-this-isnt-a-normal-part-of-aging
2. Anderson, S. (2022, September 14). This is What Happens to Your Body When You are Dehydrated. Rupa Health. https://www.rupahealth.com/post/this-is-what-happens-to-your-body-when-you-are-dehydrated
3. Autonomic Dysfunction. (2022, July 25). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/23555-autonomic-dysfunction
4. Biaggioni, I. (2021). Blood pressure regulation in autonomic failure by dietary sodium, blood volume and posture. Autonomic Neuroscience, 236, 102891. https://doi.org/10.1016/j.autneu.2021.102891
5. Bradley, J. G., & Davis, K. A. (2003). Orthostatic Hypotension. American Family Physician, 68(12), 2393–2399. https://www.aafp.org/pubs/afp/issues/2003/1215/p2393.html
6. Cloyd, J. (2023, February 2). Top Lab Test to Run on Your Iron Deficiency Anemia Patients. Rupa Health. https://www.rupahealth.com/post/top-lab-test-to-run-on-your-iron-deficiency-anemia-patients
7. Deutch, M. R., Grimm, D., Wehland, M., et al. (2019). Bioactive Candy: Effects of Licorice on the Cardiovascular System. Foods, 8(10), 495. https://doi.org/10.3390/foods8100495
8. Diorio, B. (2023, January 17). Why Most Functional Medicine Practitioners Say No To Alcohol. Rupa Health. https://www.rupahealth.com/post/why-most-functional-medicine-practitioners-say-no-to-alcohol
9. How to Choose and Use Compression Stockings. (2015, June 30). WebMD; WebMD. https://www.webmd.com/dvt/choose-compression-stockings
10. Khakham, C. (2023, August 25). Top Labs To Run Bi-Annually On Your High Blood Pressure Patients. Rupa Health. https://www.rupahealth.com/post/top-labs-to-run-bi-annually-on-your-high-blood-pressure-patients
11. Loughlin, E. A., Judge, C. S., Gorey, S. E., et al. (2020). Increased Salt Intake for Orthostatic Intolerance Syndromes: A Systematic Review and Meta-Analysis. The American Journal of Medicine, 133(12), 1471-1478.e4. https://doi.org/10.1016/j.amjmed.2020.05.028
12. Low Blood Pressure. (2022, February 2). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21156-low-blood-pressure-hypotension
13. Low blood pressure (hypotension). (2022, May 14). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/low-blood-pressure/symptoms-causes/syc-20355465
14. Low Blood Pressure - When Blood Pressure Is Too Low. (2016). American Heart Association. https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/low-blood-pressure-when-blood-pressure-is-too-low
15. Low, P. A. (2008). Prevalence of orthostatic hypotension. Clinical Autonomic Research, 18(S1), 8–13. https://doi.org/10.1007/s10286-007-1001-3
16. Maholy, N. (2023, April 24). A Functional Medicine Protocol for Hypo-Responsiveness Adrenal Dysregulation. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-protocol-for-hypo-responsiveness-adrenal-dysregulation
17. Neibling, K. (2023, April 26). Complementary and Integrative Medicine Treatments for Hypertension and Cardiovascular Disease. Rupa Health. https://www.rupahealth.com/post/complementary-and-integrative-medicine-treatments-for-hypertension-and-cardiovascular-disease
18. Ometto, F., Stubbs, B., Annweiler, C., et al. (2016). Hypovitaminosis D and orthostatic hypotension. Journal of Hypertension, 34(6), 1036–1043. https://doi.org/10.1097/hjh.0000000000000907
19. Shahoud, J. S., Aeddula, N. R., & Sanvictores, T. (2019, February 11). Physiology, Arterial Pressure Regulation. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538509/
20. Sweetnich, J. (2023, April 26). Unlocking the Benefits of Vitamin B12: The Importance of Maintaining Optimal Levels. Rupa Health. https://www.rupahealth.com/post/vitamin-b12-101
21. Sweetnich, J. (2023, May 8). Understanding the Importance of Folate Testing and Proper Supplementation for Optimal Health. Rupa Health. https://www.rupahealth.com/post/understanding-the-importance-of-folate-testing-and-proper-supplementation-for-optimal-health
22. Tezuka, K., Sugishita, C., Kuwaki, T., et al. (1997). Effects of compression stockings on blood pressure and its orthostatic change in female subjects. Pathophysiology, 4(2), 81–86. https://doi.org/10.1016/s0928-4680(97)00161-2
23. Thompson, A. D., & Shea, M. J. (2022, September). Postprandial Hypotension. Merck Manuals Consumer Version. https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/symptoms-of-heart-and-blood-vessel-disorders/postprandial-hypotension
24. Tilt Table Test. (2023, March 1). Cleveland Clinic. https://my.clevelandclinic.org/health/diagnostics/17043-tilt-table-test
25. Vitamin D. (2020, May 21). Fullscript. https://fullscript.com/ingredient/vitamin-d
26. Vloet, L. C., Mehagnoul-Schipper, D. J., Hoefnagels, W. H., et al. (2001). The influence of low-, normal-, and high-carbohydrate meals on blood pressure in elderly patients with postprandial hypotension. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56(12), M744-748. https://doi.org/10.1093/gerona/56.12.m744
27. Waxenbaum, J. A., Varacallo, M., & Reddy, V. (2019). Anatomy, Autonomic Nervous System. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539845/
28. Woo, J. H., Kim, Y. J., Jeong, J., et al. (2018). Compression stockings reduce the incidence of hypotension but not that of cerebral desaturation events in the beach-chair position: a randomized controlled trial. Korean Journal of Anesthesiology, 71(2), 127–134. https://doi.org/10.4097/kjae.2018.71.2.127
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