Diagnosis and Prevention of Hypotension

Diagnosis

· First, a detailed medical history is taken about what discomfort brought the patient to the hospital, when the symptoms started, how severe they are, and whether the patient has any risk factors that could cause low blood pressure. In particular, it is necessary to ask about any medications the patient is currently taking, so rather than bringing the medicine itself, it is better to bring the most recent prescription, and if prescriptions have been received from multiple hospitals or departments, all of them should be brought.

· Blood pressure and pulse are measured, along with body temperature and respiratory rate; these are called vital signs and are the most important physical examination. They are recorded for all patients, and as the name suggests, they are the most important indicators for assessing the patient's condition. Based on them, the pace of testing and treatment is determined.

· A general physical examination is performed, including inspection, palpation, percussion, and auscultation. Depending on the need, neurological examination and a digital rectal examination may also be performed to check for gastrointestinal bleeding.

· Blood tests are performed to check hemoglobin and hematocrit for signs of bleeding, and blood glucose is also measured. Depending on the results of the medical history and physical examination, tests for suspected causes are carried out.

· An electrocardiogram is recorded to identify arrhythmias or heart diseases that can lower blood pressure. If a likely heart disease suggested by the medical history or past history is not diagnosed by the ECG, a 24-hour Holter test is also considered for a more detailed evaluation.

· Echocardiography helps identify whether there is a cardiac cause of low blood pressure. For example, it can detect myocardial infarction, pericardial disease, obstructive hypertrophic cardiomyopathy, or blood pressure reduction due to valve obstruction.

· If a patient taking medications that can lower blood pressure occasionally feels dizzy or has fainted, the relationship between these symptoms and blood pressure must be confirmed. For this purpose, there is 24-hour ambulatory blood pressure monitoring, in which a small device is worn while the patient goes home and returns the next day. It automatically measures blood pressure at set intervals, allowing assessment of the relationship between the blood pressure recorded by the device and the symptoms recorded in diary form.

· An exercise stress ECG test is used to examine the correlation between exercise and hypotension, as well as organic causes that may trigger hypotension.

· As mentioned above, in the case of vasovagal syncope, a tilt table test is performed. The patient is 반드시 laid on a table tilted at about 70–80 degrees, causing blood to pool in the lower body and reducing the blood returning to the heart, thereby inducing activation of the sympathetic nervous system. If sympathetic activation does not appear sufficiently, the test may be performed while administering a medication that increases the pulse rate. If syncope occurs, blood pressure and pulse are recorded to determine the relationship with fainting, and if either one decreases, vasovagal syncope is diagnosed.

Prevention

It is important to gradually avoid the factors that can be corrected among the causes, to always pay attention to medications and consult with the primary doctor, and to know how to prevent symptoms, as in orthostatic hypotension caused by diabetes, as well as how to respond appropriately when hypotension occurs.

· Drink alcohol in moderation and consume an appropriate amount of fluids to avoid dehydration. Even if dehydration does occur, be careful not to let it lead to hypotension. If you are a patient receiving medical care, you need to consult with your primary doctor about drinking water and how much is appropriate.

· Eat a balanced diet in moderate amounts and at regular intervals. In the case of postprandial hypotension, it is better to eat smaller meals more often, and a low-carbohydrate diet is good. An appropriate amount of salt should also be consumed, but this too requires consultation with your primary doctor.

· When standing up from lying down or sitting, rise slowly, and once you stand, move only after the dizziness has subsided. If symptoms occur, crossing your legs and tensing the leg muscles, or placing one foot on a chair and leaning your upper body forward, can help.

· Exercise regularly to improve cardiovascular reserve.

So far, we have explained the diagnosis and prevention of hypotension.

In the next article, we will look at dizziness.

Source: Korea Centers for Disease Control and Prevention, National Health Information Portal