Low Blood Pressure

What is Low Blood Pressure?

Low blood pressure, or hypotension, is a blood pressure below normal values, usually taken as under 90/60 mm Hg. Many people with low readings have no symptoms and never need treatment, so the number alone matters less than whether the pressure is causing problems or has a treatable cause.^[1]

Common symptoms

Most people with hypotension have no symptoms. Symptoms appear when too little blood reaches the brain and other organs, and they often relate to lightheadedness and reduced blood flow to the brain.^{[1, 2]}

• Dizziness or lightheadedness, often on standing up
• Blurred vision or feeling faint
• Fatigue and trouble concentrating
• Nausea
• Fainting and falls in some people

Causes and risk factors

A common form is orthostatic (postural) hypotension, a drop in pressure within 3 minutes of standing, defined as a fall of at least 20 mm Hg in systolic or 10 mm Hg in diastolic pressure. It is typically caused by failure of the body's automatic reflexes, loss of body fluid, heart disease, nerve damage or medication effects.^[2] About 1 in 5 people aged 60 or older is affected.^[2]

Medicines are a frequent contributor. In a meta-analysis of 69 placebo-controlled trials, beta-blockers and tricyclic antidepressants were linked to the largest increase in the odds of orthostatic hypotension, and alpha-blockers, antipsychotics and SGLT-2 inhibitors to smaller ones.^[3] Low pressure after meals, called postprandial hypotension, is also common in older adults and in people with autonomic failure.^[2]

How it is diagnosed and treated conventionally

Diagnosis relies on a careful history, physical examination and blood pressure measured lying down and standing.^[4] When symptoms are present, the cause should be identified and addressed directly.^[1] A key question is whether the problem is neurogenic, meaning due to nerve or autonomic damage, as this affects management and outlook.^[4]

Treatment is stepwise and mainly non-drug: stopping or adjusting blood pressure-lowering drugs, counterpressure maneuvers and other lifestyle measures, with medicines added in selected cases.^{[4, 5]} Abdominal binders and compression stockings are commonly used. One review gave abdominal binders a strong recommendation for neurogenic orthostatic hypotension, while another rated the evidence for compression in older people as very low quality.^{[6, 7]} A review of 36 trials concluded that many commonly recommended treatments for orthostatic hypotension have a limited evidence base.^[8] Decisions about medicines belong to your physician.

Why Low Blood Pressure calls for a whole-person approach

Low blood pressure is a finding with many possible causes, not one disease, so more than one factor usually needs attention. Fluid balance, medicines, the nervous system and other health conditions can all contribute, and they may differ from person to person.^{[2, 4]}

Looking at these factors together is why a medical evaluation comes first. Complementary care, when used, is added around that evaluation and does not replace it.

Medicines and polypharmacy

Taking several medicines may add up. The meta-analysis of drug-induced orthostatic hypotension noted that drugs acting on several parts of the blood pressure reflex may carry cumulative risk, and that people on many medicines could benefit from checking blood pressure when standing.^[3] Any change to medicines must come from your prescriber.

The autonomic nervous system

Neurogenic orthostatic hypotension reflects impaired reflex constriction of blood vessels when a person stands, caused by damage or dysfunction in the nervous system pathway that controls it.^[5] It can be an early sign of Parkinson's disease and related conditions.^[4]

Falls and safety

Orthostatic hypotension is linked to falls in older adults. A meta-analysis of 50 studies found an odds ratio of 1.73 for falls in people with orthostatic hypotension.^[9] This is one reason low blood pressure with symptoms deserves a physician's attention.

Eating and fluids

Blood pressure can drop after meals in older adults and people with autonomic failure.^[2] Fluid loss is also a recognized cause of orthostatic hypotension.^[2] Dietary advice about fluids and salt should come from your physician, particularly if you have heart or kidney disease.

Acupuncture for Low Blood Pressure

What the research shows

The research is limited. We found no systematic reviews and no large sham-controlled trials of acupuncture for chronic low blood pressure or orthostatic hypotension in general. What exists are small trials in specific settings, mostly from single centers.

A 2024 trial of 60 older adults in China with orthostatic hypotension compared the drug midodrine alone with midodrine plus heat-sensitive moxibustion. The moxibustion group had higher blood pressure and a smaller drop on standing after 4 weeks, but there was no sham treatment, and the report is a short, single-center trial.^[10]

Another trial of 135 people with low blood pressure during hemodialysis used electrical stimulation at the Neiguan (P6) point, compared with an inactive device. Blood pressure was higher in the treated group, and fatigue and pain scores fell.^[11]

Two small trials looked at low blood pressure after spinal anesthesia for cesarean birth, a hospital setting unlike ordinary outpatient care. Stimulation at the PC-5 and PC-6 points reduced the severity of low blood pressure in a 36-patient trial, and high-frequency stimulation at PC6 reduced it in a 90-patient trial.^{[12, 13]} These results should not be extended to everyday low blood pressure.

How acupuncture may work

Laboratory research suggests acupuncture can change autonomic nervous system activity, and that the effect on blood pressure may depend on whether the starting pressure is high or low. This work comes largely from laboratory research, and it is a proposed explanation, not a proven mechanism in people with low blood pressure.^[14]

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the arms, legs, back or head, usually left in place for about 20 to 40 minutes. A course is typically several visits, with reassessment to see whether it is helping. Moxibustion, the warming of points with burning herb, is a related technique that was used in one of the trials above.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction, and half of the reactions were bleeding, pain or flare at the needle site; serious events occurred in about 1 in 10,000 patients.^[15] Because people with low blood pressure may feel faint, treatment is usually given lying down, and you should tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant or have a pacemaker.

Ayurvedic medicine for Low Blood Pressure

The Ayurvedic view

Ayurveda does not have an exact match for low blood pressure. Dizziness, weakness and fatigue may be described in traditional terms as a depletion or imbalance of Vata, or as weak digestive fire (agni) with low vitality (ojas). These are traditional frameworks that guide care, not biomedical diagnoses, and because low readings can have medical causes, the cause is checked first.^[1]

Therapies that may be used

Care is individualized and traditionally may combine:

• Regular, warm, nourishing meals and steady sleep hours
• Gentle warm oil massage
• Herbs chosen for the person by the practitioner, from tested sources, because about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic^[16]
• Calming practices such as breathing exercises

Panchakarma, the classical cleansing program, is not appropriate during pregnancy, acute illness or frailty, and its fluid shifts make it a poor fit for anyone with symptomatic low blood pressure or a tendency to faint.

What the research shows

We found no clinical trials of Ayurvedic treatment or Panchakarma for low blood pressure. The evidence is therefore none for the condition itself. Any benefit for related complaints such as stress or poor sleep has not been shown specifically for people with hypotension.

Herbal medicine for Low Blood Pressure

Herbs and formulas that have been studied

In Chinese medicine, low blood pressure with fatigue and dizziness is traditionally linked to qi and yang deficiency, and tonic herbs such as ginseng and astragalus are classically used for such patterns. In Ayurveda, tonic herbs such as ashwagandha are traditionally used for low vitality. Their use here is traditional, not evidence-based.

What the research shows

We found no clinical trials of Chinese herbal formulas or Ayurvedic herbs taken by mouth in people with chronic or orthostatic low blood pressure. One small randomized pilot study of 32 hemodialysis patients (27 completed it) tested an herbal preparation applied to acupoints for low blood pressure during dialysis. Episodes of low blood pressure were fewer than with sham treatment, and the authors called for larger studies.^[17] The clinic's transdermal medication therapy also uses herbal preparations applied to the skin, but that pilot tested one specific patch in dialysis patients, and it is not enough to say that any such product works for low blood pressure.

Safety and herb-drug interactions

Herbs can raise or lower blood pressure and can interact with medicines. Licorice is a particular concern. A meta-analysis of 18 studies found that regular licorice intake raised blood pressure and lowered potassium, so it should not be self-prescribed.^[18] People with heart disease, kidney disease or high blood pressure should not use it without medical advice.

Reviews describe herb-drug interactions affecting blood thinners, blood pressure and other medicines.^[19] Tell us about all prescribed medicines and supplements, and about pregnancy or breastfeeding, liver or kidney disease. In one study, about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic, so herbs should come from tested sources.^[16]

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. In Chinese medicine, the dizziness, tiredness and cold limbs that can accompany low blood pressure are often described as deficiency of qi, yang or blood. Researchers studying acupuncture look at related ideas such as autonomic nervous system activity and the control of blood vessel tone, mainly in laboratory work.^[14]

In Ayurveda, a weak or unsteady Vata or reduced ojas describes weakness and instability. No study has shown that these terms correspond to a specific measurable process such as baroreflex function.

How this care fits with your medical care

Complementary care for low blood pressure works alongside your physician and does not replace them. We do not diagnose the cause of low blood pressure or manage the underlying disease, and we do not prescribe or change prescription drugs. Do not stop or change prescribed medicines, including blood pressure and heart medicines, without your prescriber.

Please bring your diagnosis if you have one, your recent blood pressure readings including standing and lying measurements, a full list of medicines and supplements, and recent test results. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

When to seek urgent medical care

Low blood pressure can be a sign of a serious problem such as bleeding, infection or a heart problem, and it needs prompt assessment in these situations.^[1]

• Fainting or near-fainting, especially with a fall or head injury
• Chest pain, shortness of breath or a very fast or irregular heartbeat
• Confusion, or cold, clammy, pale skin with a weak, rapid pulse
• Black or bloody stools, vomiting blood, or other signs of bleeding
• Fever with dizziness or weakness, or severe dehydration from vomiting or diarrhea

If any of these occur, call 911 or go to the nearest emergency department.