Quick answer
What Is Persistent Hypotension?
Persistent hypotension is blood pressure that stays low, generally below 90/60 mmHg across repeated measurements. In some people it is constitutional and harmless, while in others it is caused by a disease that needs to be identified.
SourcesSigns That Need Urgent Help
- Fainting, especially during activity or with palpitations
- Chest pain or shortness of breath
- Severe weakness with vomiting, abdominal pain, and difficulty drinking
- Confusion or being hard to wake
- Cold, pale, sweaty skin with rapid breathing
If these signs appear, go to the nearest emergency department right away or call Heart Attack Center 1500 258.
01 / Understanding the condition
About Persistent Hypotension
Persistent hypotension means your blood pressure is low not just occasionally but almost every time it is measured, over weeks to years. A commonly used cutoff is below 90/60 mmHg. The term sets it apart from drops in blood pressure that happen only in certain situations, such as when standing up, after eating, or just before fainting.
Inborn or Constitutional Hypotension
Many people have had low blood pressure since they were young without any disease. This is called constitutional hypotension and is found more often in slim young women and in physically trained people, such as athletes. Their heart and blood vessels work normally, and their organs still receive enough blood. Some feel nothing at all, while others tire easily, have cold hands and feet, or feel dizzy when standing up quickly. This type of hypotension does not need medication, and everyday habits are usually enough to ease the symptoms.
When There Is an Underlying Disease
Blood pressure that used to be normal and then becomes persistently low needs its cause investigated. Causes your doctor may consider include a lack of adrenal gland hormones (Addison's disease), a weakened heart pump in heart failure, severe narrowing of the aortic valve, autonomic nerve disorders, malnutrition or drastic weight loss, and the effects of medicines. Clues include weight loss, worsening weakness, darkening of the skin or gums, shortness of breath, or swelling in the legs. In people being treated for hypertension, blood pressure that stays low may mean their medicines need to be reviewed.
Pregnancy also naturally lowers blood pressure in the first and second trimesters. This is generally normal but is still monitored by an obstetrician or midwife.
What You Should Know
Low blood pressure in healthy people does not strain the heart and blood vessels the way high blood pressure does. For this reason, a low number on its own is not a reason to take medicine to raise blood pressure. What decides whether further tests are needed is your symptoms, any change from your usual blood pressure, and signs of other diseases. Persistent hypotension is one type of hypotension, covered on the Hypotension page. Drops that occur only when standing up are covered on the Orthostatic Hypotension page.
02 / Understanding the condition
Symptoms to Recognize.
Common Symptoms
Many people with persistent hypotension have no symptoms at all.
- Tiring easily and lacking energy
- Dizziness or light-headedness when standing up quickly
- Hands and feet that often feel cold
- Difficulty concentrating
- Brief blurred vision when getting up from sitting
- Easily feeling unwell or nauseous in hot places
03 / Understanding the condition
What Causes This Condition?
- Inborn or constitutional, with no underlying disease
- High physical fitness in athletes, which generally causes no symptoms
- A lack of adrenal gland hormones (Addison's disease) or pituitary gland hormones
- Heart failure, severe narrowing of the aortic valve, or heart muscle disease
- Autonomic nerve disorders, for example in long-standing diabetes or Parkinson's disease
- Malnutrition, very low body weight, or an eating disorder
- Long-term medicines that lower blood pressure
04 / Understanding the condition
Who Is at Higher Risk?
Age
Constitutional hypotension is found more often in teenagers and young adults, while hypotension caused by disease or medicines is more common in older age.
Medical
Heart failure, aortic valve disease, diabetes with nerve damage, Parkinson's disease, adrenal or pituitary hormone disorders, and chronic kidney disease.
Lifestyle
Very low fluid and salt intake, a poor diet, and very low body weight tend to keep blood pressure low.
Other
Being a slim young woman, the first and second trimesters of pregnancy, and long-term use of blood pressure medicines or diuretics.
Groups at Higher Risk
- Slim Young Women: Constitutional hypotension is often found in this group and is generally harmless if it does not come with fainting.
- Older Adults: More likely to have heart disease or autonomic nerve disorders, or to take many medicines that keep blood pressure low.
- People with Heart Failure: A weak heart pump and heart failure medicines can lower blood pressure; this is managed together with a cardiologist.
- People with Adrenal Hormone Disorders: A lack of the hormones cortisol and aldosterone makes the body lose salt and fluid, so blood pressure drops.
05 / Understanding the condition
How Is It Diagnosed?
Your doctor will first confirm that your blood pressure really is persistently low, for example with repeated measurements at the clinic, home measurements over several days, or 24-hour monitoring. You will be asked about your symptoms, weight changes, eating habits, medicines, and family history. The physical examination includes blood pressure while lying down and standing.
If there are no symptoms and the examination is normal, further tests are often not needed. If there are clues of a disease, your doctor may order blood tests to check for anemia, electrolytes, blood sugar, kidney function, and hormones, including cortisol. An ECG and echocardiography assess the heart's rhythm, pumping, and valves.
Home Blood Pressure Monitoring
Measuring your own blood pressure morning and evening for several days to confirm that it really is persistently low.
Ambulatory Blood Pressure Monitoring
Automatic measurements over 24 hours to see your blood pressure pattern during the day and night.
Physical Examination
Measuring blood pressure lying down and standing, body weight, and examining the heart and lungs.
Laboratory Tests
Blood tests for anemia, electrolytes, blood sugar, kidney function, and hormones, including cortisol if an adrenal gland disorder is suspected.
Electrocardiogram (ECG)
A recording of the heart rhythm to look for a heart rate that is too slow or signs of heart disease.
Echocardiography
Heart ultrasound to assess pumping strength and the valves if there is shortness of breath, swelling, or a heart murmur.
06 / Understanding the condition
Treatment Options.
Treatment is decided by a doctor after an assessment. The categories below can help you follow the conversation with your doctor.
Monitoring Without Medication
Constitutional hypotension without severe symptoms only needs monitoring. Low blood pressure in healthy people does not need to be raised with medicines.
Everyday Habits
Drinking enough fluids, eating regular balanced meals, getting up gradually, exercising regularly, and avoiding standing for long periods in hot places.
Treating the Underlying Disease
Hormone therapy for Addison's disease, treatment of heart failure or heart valve disease, and improved nutrition, depending on the cause found.
Medication Review
If low blood pressure is related to medicines, your doctor may change the type, dose, or timing. Do not stop your medicines on your own.
Salt and Medicines to Raise Blood Pressure
For persistent, bothersome symptoms, your doctor may recommend extra salt or a fluid-retaining medicine, after assessing your heart and kidneys.
07 / Understanding the condition
Complications to Watch For.
Fainting and Falls
Blood pressure that is already low can drop further more easily when standing up, overheating, or not drinking enough, which can lead to fainting and injury.
Reduced Quality of Life
Persistent tiredness and difficulty concentrating can interfere with school, work, and daily activities.
Adrenal Crisis
In Addison's disease that has not yet been recognized, an infection or severe stress can trigger a severe drop in blood pressure that requires emergency care.
Reduced Blood Flow to Organs
When the cause is heart disease, persistently low blood pressure can reduce blood flow to the kidneys and other organs.
08 / Understanding the condition
What Can You Do?
- Drink enough water throughout the day, and more in hot weather or when exercising.
- Eat regular, balanced meals and maintain a healthy body weight.
- Get up gradually from lying down and from sitting.
- Exercise regularly to train the leg muscles that help blood return to the heart.
- Have your blood pressure checked regularly, especially if you take heart or blood pressure medicines.
09 / Understanding the condition
When Should You See a Doctor?
If your blood pressure has always been low and you feel healthy, checking it regularly is enough. See a doctor if any of the following symptoms or changes appear.
- Blood pressure that used to be normal is now consistently low
- Worsening tiredness, unexplained weight loss, or loss of appetite
- Skin, palm creases, or gums that look darker
- Frequent dizziness, nearly fainting, or having fainted
- Shortness of breath, swelling in the legs, or palpitations
- Go to the emergency room right away if you have severe weakness with vomiting, abdominal pain, or confusion
Don't Wait in an Emergency.
If symptoms are severe or come on suddenly, go to the nearest emergency department right away or call Heart Attack Center 1500 258, rather than waiting for an appointment.
10 / Common questions
Questions You May Have.
Frequently asked questions about persistently low blood pressure.
Is it dangerous to have had low blood pressure since I was young?
Generally not. Many healthy people have a blood pressure of around 90/60 mmHg throughout their lives without problems, and this does not strain the heart and blood vessels the way high blood pressure does. What matters are symptoms such as fainting, or blood pressure that used to be normal and then becomes low, because these need to be checked by a doctor.
How do you tell inborn hypotension apart from hypotension caused by disease?
The first clue is your history. Inborn hypotension has usually been present since youth, is stable, and does not come with worsening symptoms. Hypotension caused by disease tends to be new and comes with worsening weakness, weight loss, shortness of breath, swelling, or darkening skin. A physical examination, blood tests, and heart tests help your doctor confirm the cause.
Do I need medicine to raise my blood pressure?
The majority of people with persistent hypotension do not need medication. Habits such as drinking enough, eating regularly, and getting up gradually usually help. Your doctor considers medication only if symptoms persist and are bothersome, or if there is a disease that needs specific treatment, such as a lack of adrenal hormones. Do not use medicines or supplements to raise blood pressure without your doctor's advice.
Can I exercise if my blood pressure is low?
Yes, and regular exercise can actually help, because trained leg muscles help blood return to the heart. Drink enough before and after exercise, warm up and cool down, and avoid stopping suddenly and then standing still. If you have ever fainted during exercise, see a doctor before continuing.
Can certain foods raise blood pressure?
No specific food has been proven to raise blood pressure in a lasting way. What helps is getting enough fluids, eating regular balanced meals, and for some people, extra salt as advised by a doctor. Eating a large meal all at once can actually make blood pressure drop after eating. Avoid alcohol, because it widens blood vessels and makes the body lose fluid.
Is low blood pressure during pregnancy normal?
In the first and second trimesters, blood pressure does tend to fall because blood vessels widen due to hormonal changes. This is generally normal, and blood pressure rises again toward delivery. However, severe dizziness, fainting, or bleeding needs to be checked right away. Tell your obstetrician or midwife about any symptoms at your checkups.
Sources and Medical Review
Translated from the Indonesian edition medically reviewed by dr. Debby C. Soemitha, Sp.PD.
Sources as cited in the Indonesian edition.
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- Wessely S, Nickson J, Cox B. Symptoms of low blood pressure: a population study. BMJ. 1990;301(6748):362-365.
- Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874-2071.
- Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD, et al. Diagnosis and treatment of primary adrenal insufficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(2):364-389.
- McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-3726.
- Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21):1883-1948.
Doctors Who Treat This Condition
dr. Debby C. Soemitha, Sp.PD
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