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There are several types of hypotension. One type, chronic asymptomatic hypotension, happens in people who always have low blood pressure. They have no symptoms and need no treatment. Their low blood pressure is normal for them.
Other types of hypotension happen only sometimes, when blood pressure suddenly drops too low. The symptoms and effects on the body can be mild or severe. The three main types of this kind of hypotension are orthostatic hypotension, neurally mediated hypotension (NMH), and severe hypotension associated with shock.
Orthostatic hypotension is low blood pressure that occurs upon standing up from a sitting or lying down position. It can cause a person to feel dizzy, lightheaded or even to faint. It occurs when the body is not able to adjust blood pressure and blood flow fast enough for the change in position. Usually orthostatic hypotension lasts for only a few seconds or minutes after a person stands up. Sometimes a person will need to sit or lie down for a short time while the blood pressure returns to normal.
Orthostatic hypotension can occur in all age groups, but it is more common in older adults, especially those who are frail or in poor health. Orthostatic hypotension can be a symptom of other medical conditions, and treatment generally focuses on treating the underlying condition(s). Some people can have orthostatic hypotension but also have high blood pressure when lying down.
A form of orthostatic hypotension called postprandial hypotension is a sudden drop in blood pressure after a meal. Postprandial hypotension most commonly affects older adults. It also is more likely to affect those with high blood pressure or diseases such as Parkinson disease.
Neurally Mediated Hypotension
In this form of hypotension, blood pressure drops after a person has been standing for a long time. A person may feel dizzy, faint, or sick to the stomach as a result. NMH also can happen when a person faces an unpleasant, upsetting, or frightening situation.
NMH affects children and young adults more often than other age groups. Children often outgrow this form of hypotension.
Severe Hypotension Associated With Shock
Many times people will say a person has "gone into shock" as a result of an emotionally upsetting experience. But to doctors, the word "shock" has a different meaning. Shock is a life-threatening condition in which blood pressure drops so low that the brain, kidneys, and other vital organs can’t get enough blood to work properly. It is different from the other forms of hypotension because blood pressure drops much lower, and it is life threatening if not treated immediately. There are many causes of shock, including major loss of blood, certain severe types of infection, severe burns, severe allergic reactions, and poisoning.
Hypotension is diagnosed based on your medical history, a physical exam, and results from tests. Your doctor will want to know:
A primary care doctor or specialist may diagnose and treat hypotension. The type of specialist most commonly involved is a cardiologist (heart specialist).
Other specialists also may be involved, such as surgeons, nephrologists (kidney specialists), neurologists (brain and nerve specialists), or others.
When a person is in shock, someone should call 9–1–1 right away because emergency treatment is needed.
For other types of hypotension, your doctor may order tests to find out how your blood pressure responds in certain situations. The results will help your doctor understand why you’re fainting or having other symptoms.
During a blood test, a small amount of blood is taken from your body. It’s usually drawn from a vein in your arm using a thin needle. The procedure is quick and easy, although it may cause some short-term discomfort.
Blood tests can show whether anemia or low blood sugar is causing your hypotension.
An EKG is a simple test that detects and records the heart’s electrical activity. It shows how fast the heart is beating and the heart’s rhythm (steady or irregular). An EKG also shows the strength and timing of electrical signals as they pass through each part of the heart.
Holter and Event Monitors
Holter and event monitors are medical devices that record the heart's electrical activity. These monitors are similar to an EKG. However, a standard EKG only records the heartbeat for a few seconds. It won't detect heart rhythm problems that don't occur during the test.
Holter and event monitors are small, portable devices. You can wear one while you do your normal daily activities. This allows the monitor to record your heart longer than an EKG can.
Echocardiography is a test that uses sound waves to create a moving picture of your heart. The picture shows how well your heart is working and its size and shape.
There are several different types of echocardiography, including a stress echocardiogram, or “stress echo.” This test is done as part of a stress test (see below). A stress echo usually is done to find out whether you have decreased blood flow to your heart, a sign of coronary artery disease.
Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise (or are given medicine if you’re unable to exercise) to make your heart work hard and beat fast while heart tests are done.
These tests may include nuclear heart scanning, echocardiography, and magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning of the heart.
This is a simple test of the part of your nervous system that controls functions such as your heartbeat and the narrowing and widening of your blood vessels. If something goes wrong with this part of the nervous system, blood pressure problems may occur.
During this test you take a deep breath and then force the air out through your lips. You will do this several times. Your heart rate and blood pressure will be checked during the test.
Tilt Table Test
This test is used if you have fainting spells for no known reason. For the test, you lie on a table that moves from a lying down to an upright position. Your doctor checks your reaction to the change in position.
Doctors use a tilt table test to diagnose orthostatic hypotension and neurally mediated hypotension (NMH). People who have NMH usually faint during this test. The test can help your doctor find any underlying brain or nerve condition.