What is hypotension?

Hypotension is defined as a sustained low systemic blood pressure of 90mmhg (Systolic) over 60mmhg (diastolic) or less.  The gold standard for diagnosing hypotension is by 24hr ambulatory blood pressure monitoring, where an automatic digital blood pressure machine is fitted and worn by the person for 24hrs, during which time the machine measures blood pressure twice per hour during waking hours, and at least once per hour during the night.  The mean wake and sleep blood pressures, along with a number of other blood pressure values are calculated to determine hypotension.

There are 2 parts to a blood pressure reading.  The highest number or systolic blood pressure is the maximum pressure created when the heart contracts.  This can be felt as the pulse moving through an artery.  The lower number or diastolic pressure, is the minimum pressure in the arteries when the heart is at rest between beats.  In a normalised, healthy population of people we would expect the blood pressure to be around 120/80mmhg +/- ~20mmhg.  It is generally regarded that the lower the resting blood pressure the better, as long as it does not become too low as to become symptomatic which is known as hypotension.

Hypotension is not considered to be a component of cardiometabolic disease, however may be a symptom of other structural or functional changes to the heart and blood vessels and these factors, along with kidney function, neurological conditions, effects of medications, shock, or loss of blood volume should be investigated before reaching a diagnosis of benign hypotension or low blood pressure without known cause.

Sharma S, Hashmi MF, Bhattacharya PT. Hypotension. [Updated 2021 May 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499961/

The conventional approach

Hypotension is defined as low systemic blood pressure.  Whilst there are no universally accepted values for determining hypotension, it is most commonly accepted as being a systolic pressure of less than 90mmhg and a diastolic pressure of less than 60mmhg.  In many cases, hypotension is diagnosed if a patient presents with the signs of symptoms of low blood pressure without any other identifiable cause.

In asymptomatic hypotension no treatment is generally recommended.  In symptomatic patients, the usual approach will be to investigate for a number of potentially serious underlying causes such as:

Abnormalities in heart structure and function

Renal disorders

Effects from medications

Neurological disorders

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Signs and symptoms of hypotension

In most people hypotension will be asymptomatic and will be an incidental finding during a routine medical examination.

In a small number of people hypotension will be a symptom that develops as an effect of a more serious condition requiring medical attention.

A small number of people determined to have benign hypotension will experience some mild to moderate symptoms associated with hypotension which may include:

Dizziness, especially when moving from a lying to a standing position, or if bending over.

Fainting, especially following quick postural changes, or if exposed to high temperature environments

Some people may experience brain fog or lack of concentration, especially if sitting for extended periods of time.

What causes eczema?

There isn’t one single cause of eczema but a range of potential contributing factors that are unique to each person. These include:

Genetics

Research has found people with the ‘atopic triad’ have a defective barrier of the skin and upper and lower respiratory tracts.

These genetic alterations cause a loss of function of filaggrin (filament aggregating protein), which is a protein in the skin that normally breaks down to create natural moisturisation and protect the skin from penetration by pathogens and allergens.

Filaggrin mutations are found in approximately 30 percent of people with atopic dermatitis, and also predispose people to asthma, allergic rhinitis (hayfever), keratosis pilaris (dry rough patches and bumps on the skin), and ichthyosis vulgaris (a chronic condition which causes thick, dry, scaly skin.)If one parent carries this genetic alteration, there is a 50 percent chance their child will develop atopic symptoms. And that risk increases to 80 percent if both parents are affected. 

Food allergy and sensitivity

Food hypersensitivity has been found to cause or exacerbate atopic dermatitis in 10-30% of cases, and 90% of these are caused by eggs, milk, peanuts, soy and wheat.

Compromised gut health

The connection between the gut microbiome and skin health is complex, however, research has found the microbiota contributes to the development, persistence, and severity of atopic dermatitis through immunologic, metabolic and neuroendocrine pathways.

Nutritional deficiencies

Deficiency of Omega-6 essential fatty acids (EFA) has been linked with the increased incidence of atopic dermatitis, along with the inability for the body to efficiently metabolise EFA’s to gamma linoleic acids (GLA) and arachidonic acids (AA).

Weather and environment

Changing weather conditions can certainly aggravate eczema symptoms, but the triggers are subject to change among individuals.

Hormones

Hormones also play a role in the course of atopic dermatitis, including the stress hormone cortisol which triggers an inflammatory immune response affecting all organs of the body, including the skin.

Mould exposure

Mould exposure and susceptibility to mould can cause Chronic Inflammatory Response Syndrome (CIRS), of which dermatitis is a manifestation.

Root causes of hypotension

Excluding hypotension that is associated with significant medical concerns, benign hypotension has no specific know cause, and will usually be a symptomatic presentation of other systemic dysfunctions that are resulting in an effect on one of the key regulatory mechanisms for blood pressure.

The key regulatory mechanisms are:

The ability of the heart rate to increase and decrease responsively.

The ability of the heart muscle to contract more or less forcefully as required.

The ability of the blood vessels to expand and contract to control blood flow to the tissues and blood pressure.

The ability of the body to regulate blood volume, by control fluid balance in the body.

Sharma S, Hashmi MF, Bhattacharya PT. Hypotension. [Updated 2021 May 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499961/

Contributing factors

As benign hypotension has no specific know cause, conditions or dysfunctions that result in the following may need to be considered:

Chronic unintentional dehydration resulting from electrolyte or hormonal imbalances or poor hydration practices.

Systemic inflammatory conditions that affect blood vessel responsiveness to expand and contract, or lead to other more serious cardiovascular or cardiometabolic diseases.

Stress related disorders that result in syncope (fainting).

Functional testing considerations

There are no specific functional medicine tests for hypotension.  Tests that may be ordered would be dependent on the unique clinical presentation of each patient, this may include general pathology, functional pathology, or referral to specialist services if required.

Common misconceptions

The most common misconception about hypotension ss that it is healthy.  Whilst in most people, hypotension is asymptomatic and therefore does not present any clinically significant risk to the patient, symptomatic presentations need to be carefully investigated to identify any comorbid condition or systemic dysfunction that is resulting in the low blood reading.

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