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General: Treatment is rarely needed if hypotension (low blood pressure) does not cause any signs or symptoms. If symptoms are present, treatment depends on the underlying cause. If it is unclear what is causing symptoms of hypotension, treatment focuses on raising blood pressure. Blood pressure may be increased with diet and lifestyle changes, as well as medications. Epinephrine: If a severe allergic reaction, called anaphylaxis, is causing hypotension, a medication called epinephrine is injected into the patient. Epinephrine helps open the breathing tubes. It also constricts the blood vessels, which increases blood pressure. Patients who experience anaphylaxis may also be admitted to the hospital to have their blood pressure monitored and to receive breathing support. Some patients may need to have a breathing tube placed through the nose or mouth. In severe cases, emergency surgery that involves placing a tube directly into the trachea may be necessary. Blood transfusion: If blood loss causes low blood pressure, a blood transfusion can help increase blood pressure. Intravenous antibiotics and fluids: If sepsis is causing hypotension, patients typically receive intravenous antibiotics and fluids immediately. This treatment kills the bacteria and helps increase blood pressure. If blood pressure is still low after these treatments are given, patients may then receive vasopressor medications, such as ephedrine (Ephedrine Sulfate®). Drink plenty of fluids: Drinking more water may help raise blood pressure because fluids increase blood volume. Drinking adequate amounts of water also helps prevent dehydration, a common cause of hypotension. Increase salt intake: Salt has been shown to increase blood pressure. Therefore, increasing salt intake may be a beneficial treatment for patients with hypotension with no known underlying cause. However, because salt may lead to heart failure, particularly in older adults, patients should talk to their doctors before increasing their salt intake. Doctors can also help individuals identify foods that have high amounts of sodium. Eat small portions: If hypotension occurs after eating, patients may help reduce their symptoms by eating smaller meals several times a day. Reducing the amount of carbohydrates (such as rice, pasta, and bread), may also help prevent blood pressure from dropping suddenly after meals. Studies have shown that low-carbohydrate meals induce significantly smaller systolic blood pressure declines than high-carbohydrate meals. However, patients should talk to their doctors before changing their diets. Caffeine: Caffeine has been shown to increase blood pressure. Therefore, patients may benefit from drinking caffeinated beverages, such as coffee or tea. However, since caffeine may cause health problems, patients should talk to their doctors before increasing their caffeine intake. Avoid consuming alcohol: Alcohol is dehydrating, and it may lower blood pressure. These effects may occur even if a person drinks in moderation. Therefore, patients with hypotension are encouraged to avoid consuming alcohol. Stand up slowly: If hypotension occurs when a person stands up after sitting or lying down, it may help to take several deep breathes before getting up. Sleeping with the head slightly elevated may also reduce symptoms. If a person develops symptoms of hypotension after standing for a long period of time, it may help to cross the thighs. This puts pressure on the blood vessels and may improve blood pressure. As a result, blood flow from the legs to the heart may increase. Compression stockings: Compression stockings, which are often used to relieve pain and swelling of varicose veins, may help prevent blood from pooling in the legs. As a result, symptoms of hypotension may be reduced. Medications: When there is no known cause of hypotension, medications may be prescribed to increase a person's blood pressure. For instance, a medication called fludrocortisone is often used to treat postural hypotension, which occurs when a patient stands up after sitting or lying down. This drug, which is classified as a mineralcorticoid, increases extracellular fluid and plasma volume and sensitizes blood vessels to the vasoconstrictive effect of norepinephrine. Other drugs, such as midodrine (Orvaten® or ProAmatine®), pyridostigmine (Mestinon®, Mestinon Timespans®, Mytelase Caplets®, Prostigmin®, or Regonol®), erythropoietin, and nonsteroidal anti-inflammatory drugs (NSAIDs), are sometimes prescribed either alone or in combination with other drugs to increase blood pressure.
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