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hypotension
Abnormally low blood pressure < 90/60 mm Hg.
Etiology:
1) pharmaceutical agents
a) antihypertensive agents
b) nitrates
c) PDE 5 inhibitors
d) alpha-blockers
e) tricyclic antidepressants
f) trazodone [2]
g) citrated blood
h) levodopa
i) morphine
j) nitroglycerin
k) phenothiazines
l) protamine
m) quinidine
n) Coenzyme Q10 (ubiquinone)
2) shock
3) orthostatic hypotension
Clinical manifestations:
- SBP* > 90 mm Hg: lightheadedness
- SBP* < 90 mm Hg: altered mental status
- MAP* < 65 mm Hg: diaphoresis
- a decrease in SBP* of > 40 mm Hg: oligouria
- prolonged capillary refill time may be associated with ischemia [[4]
* SBP = systolic blood pressure
* MAP = mean arterial pressure
Laboratory:
- increased serum creatinine when lack of blood pressure response to fluid bolus
Complications:
- intraoperative hypotension is associated with excess 30 day mortality
Management:
- see specific etiology
- a mean arterial pressure of 65 mm Hg is the theshold at which there is sufficient pressure for organ perfusion (most humans)
Related
blood pressure (BP)
Specific
hypotension during pregnancy
orthostatic hypotension; Bradbury-Eggleston Syndrome; postural orthostatic tachycardia syndrome (POTS)
postprandial hypotension
shock
General
cardiovascular disease (CVD)
hemodynamic instability (compromise)
sign/symptom
References
- Harrison's Principles of Internal Medicine, 13th ed.
Companion Handbook, Isselbacher et al (eds), McGraw-Hill
Inc. NY, 1995, pg 829-39
- Geriatric Review Syllabus, 7th edition
Parada JT et al (eds)
American Geriatrics Society, 2010
- Monk TG et al.
Association between intraoperative hypotension and
hypertension and 30-day postoperative mortality in
noncardiac surgery.
Anesthesiology 2015 Aug; 123:307.
PMID: 26083768
Mascha EJ et al.
Intraoperative mean arterial pressure variability and 30-day
mortality in patients having noncardiac surgery.
Anesthesiology 2015 Apr 30; 123:79.
PMID: 25929547
- Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19
American College of Physicians, Philadelphia 2015, 2018, 2022
- National Heart, Lung, and Blood Institute (NHLBI)
Low Blood Pressure: NIH Institute and Center Resources
https://www.nhlbi.nih.gov/health-topics/low-blood-pressure