Diabetes Self-Management Blog

Talk around blood pressure typically centers on what to do if blood pressure is too high. We know that high blood pressure is more common in people with diabetes than people without diabetes. We also know that uncontrolled high blood pressure is a risk factor for stroke, heart disease, and kidney disease. The American Diabetes Association recommends a blood pressure goal of less than 140/80 for most people with diabetes. But what if your blood pressure is too low? Is it cause for concern? And what do you do about it?

Low blood pressure defined
Low blood pressure is also known as “hypotension.” You might be thinking that low blood pressure is a good thing, especially if yours tends to run on the high side. But the reality is that low blood pressure can be a serious condition for some people.

For people without diabetes, the American Heart Association recommends a blood pressure of less than 120 over 80 (written as 120/80). Low blood pressure is generally defined as a blood pressure of less than 90/60. If your blood pressure tends to hover in that area without any symptoms, then there’s likely no cause for concern. But if symptoms occur, that’s a signal that something is amiss.

Symptoms of low blood pressure
Low blood pressure may be a sign that there’s an underlying medical condition, especially if your blood pressure drops suddenly or if you have the following symptoms:

• Dizziness or lightheadedness
• Fainting
• Fast or irregular heartbeat
• Feeling weak
• Feeling confused
• Lack of concentration
• Blurred vision
• Cold, clammy skin
• Nausea
• Rapid, shallow breathing
• Depression
• Dehydration

That’s quite a list. Some of the above symptoms can occur if you have, say, the flu, a stomach bug, or have been outside for a long time in hot weather. You might occasionally get dizzy if you sit in a hot tub for a while, for example. These are generally not signs of a serious medical problem. But if these symptoms do occur, especially on a frequent basis, it’s important to seek medical help.

Blood pressure that drops upon standing is called orthostatic or postural hypotension. This type of low blood pressure is common in older adults. Blood pressure that drops after eating is called postprandial hypotension, and this type is also more common in older adults, as well as in people who have high blood pressure or Parkinson disease.

Causes of low blood pressure
A “low” blood pressure for one person may be different for someone else. In other words, some people naturally have low blood pressure and are perfectly healthy. However, certain medical conditions can cause low blood pressure, including:

Pregnancy. A woman’s circulatory system expands during pregnancy, which can lead to low blood pressure.

Prolonged bed rest. This can trigger orthostatic hypotension.

Heart problems. Heart failure, heart valve problems, and heart attack can lower blood pressure.

Dehydration. Dehydration reduces blood volume, thus lowering blood pressure.

Blood loss. Blood volume and, therefore, blood pressure, drops as a result of internal bleeding or some kind of major trauma (like being in a car accident, for example).

Endocrine problems. Thyroid disease, Addison disease, low blood glucose, and nerve damage from diabetes may lower blood pressure.

Severe infection. If an infection enters the bloodstream, this can lead to a life-threatening drop in blood pressure called septic shock.

Severe allergic reaction. An allergic reaction to medicine, foods, or, say, a bee sting can cause a drop in blood pressure, along with difficulty breathing, hives, and itching. This is called anaphylactic shock.

Medicines. Some medicines can cause blood pressure to drop too low. These include diuretics (water pills), beta blockers (like atenolol [brand name Tenormin] and propranolol [Inderal, Innopran XL, and more]), some Parkinson disease drugs, some antidepressants, and sildenafil (Viagra) and tadalafil (Cialis).

Vitamin B12 and folic acid deficiency. A lack of either of these B vitamins can cause anemia, which, in turn, can lead to low blood pressure.

Treating low blood pressure
Sometimes low blood pressure does not need to be treated, especially if there are no symptoms or if the symptoms are very mild, such as a brief spell of dizziness when you stand up. If you have any of the above-mentioned conditions that may be causing low blood pressure, your doctor needs to address and treat the underlying cause, such as heart failure or diabetes, or possibly change the type of medicine that you take. Other treatments for low blood pressure include:

• Drinking more fluids
• Adding more salt to your diet
• Avoiding or limiting alcohol
• Wearing compression stockings
• Taking certain medicines, such as fludrocortisone or midodrine (Orvaten)
• Going very slowly from a sitting to a standing position

It’s also a good idea to purchase a home blood pressure monitor so that you can check your blood pressure regularly, and especially if and when you get symptoms. Again, let your doctor know if you have symptoms of dizziness or fainting. Just like high blood pressure, low blood pressure is treatable.

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