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The Rollin' RN's

Who Has Low Blood Pressure?

Low blood pressure, also known as hypotension, is a phenomenon many of us have added to the list of yet, just another “thing” to deal with when living with a spinal cord injury (SCI). This is especially true for those with higher injuries (T6 and higher).

With that in mind, we wanted to write an article that might help explain the circumstances that can lead to these bouts of low blood pressure as well as some tips for dealing with or avoiding it all together. We will cover two types of low blood pressure known as orthostatic and postprandial hypotension but first, we need to give you a little background on blood pressure. Blood pressure is the force that moves blood through our circulatory system distributing oxygen and nutrients to our tissues and organs throughout the body. But how does having an SCI contribute to low blood pressure? An SCI can disrupt the reflexes that make blood vessels constrict and relax. When blood vessels relax too much, there isn’t enough force to keep blood flowing efficiently, as it did before, causing a decrease in blood pressure. As a result, blood will start to pool in your arms and legs, reducing the total amount of blood circulating back to your heart and in turn your brain, setting you up for the nasty dizziness to occur.

The optimal blood pressure for a healthy able-bodied person is considered to be 130/80 for systolic and diastolic blood pressure measurements, respectively. (The systolic is the upper number-130 and diastolic is the lower number-80). According to the Christopher & Dana Reeve Foundation, an adult with a T6 or higher SCI has a normal systolic blood pressure between 90-110. That’s quite a bit lower than 130.

So, the first type of low blood pressure we will discuss is orthostatic hypotension. It is a condition characterized by low blood pressure after sitting up or standing up too quickly. It occurs when blood pools in the lower body, specifically the legs and abdomen, and can lead to a variety of debilitating symptoms, including:

  • Bouts of dizziness

  • Lightheadedness

  • Impaired vision

  • Nausea

  • Fainting

  • Muscle weakness

  • Shortness of breath

These symptoms are all characteristic of reduced blood flow to the brain. And although anyone can get orthostatic hypotension, it is significantly more prevalent amongst people with an SCI. And it’s more common in the first couple of weeks following an SCI, but it can become a chronic issue for some.

The best ways to manage orthostatic hypotension and increase your blood pressure with an SCI include:

  • Taking your time getting up - If you get up and suddenly start to feel disoriented, sit or lay down again until the dizziness goes away. You likely sat or stood up too fast.

  • Staying hydrated - Another effective way to prevent drops in blood pressure is to drink enough water. Dehydration can lower fluid volume in the body and result in unstable blood pressure.

  • Exercising regularly - Regular exercise is essential for promoting efficient blood flow. Due to paralysis, many spinal cord injury patients tend to not move enough to counteract blood pooling in the arms and legs. Exercise doesn’t have to be intense to be effective. Any sort of movement will help improve circulation, so try to perform some movement every couple of hours.

  • Wear an abdominal binder and compression stockings – these may help to prevent blood pooling and increase circulation throughout the body.

  • Increasing sodium intake - Increasing your sodium intake will help elevate blood pressure. However, consuming too much sodium can be harmful (even for those with low blood pressure) so check first with your doctor to try to find a good balance.

  • Taking medications - Doctors may prescribe medications called vasopressors that cause your blood vessels to constrict and promote circulation.

Generally, orthostatic hypotension after spinal cord injury can be effectively managed through a few simple lifestyle adjustments like getting up slowly and staying hydrated. But if it continues to be a problem follow up with your health care provider.

Postprandial hypotension is a condition when your blood pressure drops after you eat a meal. (Postprandial is a medical term that refers to the period of time following a meal). Typically, as you digest a meal, your intestine requires additional blood flow to work properly. But with an SCI, the loss of nervous system control, coupled with the intestine’s extra demand for blood during digestion can lead to a decrease in blood flow to other parts of the body resulting in a sudden, but temporary drop in blood pressure.

The main symptoms of postprandial hypotension are:

  • Dizziness

  • Lightheadedness

  • Fainting after a meal.

The best ways to manage postprandial hypotension and increase your blood pressure with an SCI include:

  • Track what you eat and make adjustments - Some health experts believe that the body’s response to eating high-carbohydrate meals may interfere with the autonomic nervous system in some people, leading to hypotension. If you’ve been experiencing postprandial hypotension, track what you’re eating. If you regularly notice symptoms after high-carbohydrate meals, consider reducing your carbohydrate intake. Eating more frequent, but smaller, low-carb meals throughout the day may also help.

  • Get moving after eating a meal - Movement can raise your blood pressure and increase circulation. However, be aware that your blood pressure may drop once you stop moving around.

  • Have a cup of coffee or another source of caffeine before a meal - Caffeine makes blood vessels constrict which can improve blood circulation. Don’t have caffeine in the evening though, because it can interfere with sleep, potentially causing other health problems.

  • Drinking water before a meal – Drinking about 16 oz. of water before eating may promote higher fluid volumes resulting in more stable blood pressure.

  • Adjusting blood pressure-lowering medications - If you take blood pressure-lowering medications, your doctor may advise you to adjust the timing of your dose. By avoiding blood pressure-lowering medications before eating, you may reduce your risk for a post-meal drop in blood pressure.

Postprandial hypotension can be a serious condition, but it’s often treatable with lifestyle changes. If you’re having symptoms after eating, talk with your health care provider.

Regardless of the type, if you feel the symptoms of low blood pressure coming on, do not ignore or attempt to fight the dizziness. It is not a matter of willpower. If you ignore the early signs you might faint. It’s important to get in a reclined position and get your legs raised higher than your heart if possible. This will get the blood flowing back towards your head. Once the dizziness passes, slowly sit up again.

Everyone has a unique spinal cord injury blood pressure and blood flow; it’s a matter of getting it to the optimal point that minimizes potential harm.

It’s all good, so keep on rollin’.

Roberta, RN and Patty, BSN, RNC

The Rollin’ RNs ™



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