Low Blood Pressure (Hypotension) In Teens: Causes, Symptoms, And Treatment

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Lightheadedness and black spots in the vision can be symptoms of low pressure in teens. Periodic drop in blood pressure or low blood pressure in otherwise healthy teens is not a cause of concern. Some may get hypotension while changing body positions, such as standing or sitting from a lying position. However, it is recommended that frequent hypotension in teens be evaluated since it can be due to underlying conditions (1). Read on to know the causes, symptoms, treatment, and preventive measures for hypotension in teens and when to seek medical care for fainting spells.

What Is Low Blood Pressure In Teens?

Low blood pressure happens when the blood pressure (BP) levels are less than normal. The normal blood pressure for a teenager is around 110/70mmHg (2). (BP is measured in millimeters of mercury denoted as mmHg and features two numbers: one that indicates the upper value (systolic) followed by the lower (diastolic) value.

In children aged ten years or less, blood pressure lower than 90/50mmHg is defined as low blood pressure or hypotension (3).

Low blood pressure can be categorized into the following types, the symptoms of which can range from mild to severe.

• Neurally mediated hypotension (NMH): It occurs when the child stands for a long time or encounters an upsetting or scary situation. It causes dizziness. However, children usually outgrow NMH (4).

• Orthostatic hypotension: (Also known as postural hypotension): It occurs while standing up suddenly from a sitting or lying position. It happens when the body is unable to adjust to the sudden change in the blood flow. However, the blood pressure will be back to normal after a few seconds (5). There could be many reasons for this occurrence, including autonomic nervous system dysfunction. According to the data from the American Academy of Pediatrics (AAP), about 40% of people faint at some point in their lives, and half of these cases occur during adolescence, mostly at the age of 15 (5).
• Severe hypotension: It can develop due to severe infections, allergic reactions, severe blood loss due to an injury, or a circulatory shock. Severe hypotension can cause complications by preventing the blood from reaching the brain, thus making it a life-threatening condition. In such cases, immediate medical attention is necessary (6).

If left untreated, low blood pressure can lead to serious complications such as fainting, injuries from falls, and in severe cases, shock, which can be life-threatening.

What Are The Symptoms Of Low Blood Pressure In Teenagers?

Most symptoms of hypotension may be recurrent but don’t usually last for a long time. Watch out for the following symptoms, and consult a doctor if they persist (6):

• Blurred vision or black out
• Light-headedness
• Confusion
• Dizziness
• Fainting
• Feeling weak
• Nausea or vomiting
• Sleepiness

There could be various reasons for low blood pressure in teens.

Sharing her sudden fainting episode, Lucy, a 15-year-old high school freshman says, “I was recently diagnosed with postural hypotension, which is a fancy term for low blood pressure. Basically I have an unusually low blood pressure and when I stand still for extended periods of time, it drops significantly. I am prone to fainting and lightheadedness. So that’s how I got a concussion. Fainting. In the shower. While shaving my legs. I was told to spend a week recuperating. No screens, no sports, no reading. In short, anything that required concentration or gave me headaches or made me dizzy (i).”

What Causes Low Blood Pressure In Teens?

A drop in the blood pressure level could be due to several factors (7) (8) (9) (10). Underlying health issues or the lifestyle can be a reason common causes include :

• Low intake of salts and fluids
• Emotional stress
• Standing in an upright posture for a long time and in a warm environment like a hot bath
• Severe iron deficiency anemia
• Drinking alcohol (teenagers)
• Prolonged bed rest (orthostatic hypotension)

Dr. Madalina Petrescu, a cardiologist from Seattle, Washington, says, “Stress can play a significant role in the teenage years. Therefore, teens should engage in relaxing and de-stressing techniques, such as exercise, going out in nature, journaling, coloring, and meditation. If the emotional stress is significant, I recommend seeing a therapist to share and express feelings. Not expressing or talking out emotions can increase the overall risk of more stress.”

If your child’s doctor diagnoses hypotension due to the factors mentioned above, then it may be addressed with certain lifestyle changes.

However, there are a few uncommon causes for hypotension in children, which might indicate an underlying medical condition. These may include (11):

• Hypovolemia (low blood volume in the body) due to excess use of diureticsⁱAlso known as water pills, they help remove salt and water from the body , vasodilatorsⁱDrugs that allow blood arteries to expand, impacting the muscles that line the arteries and veins limiting tightness of the walls )
• Addison’s disease (a condition where adrenal glands do not produce enough hormones)
• Diabetes
• Sudden loss of blood
• Severe infection
• Allergies in children (anaphylaxis)
• Septic shockⁱA life-threatening condition occurring due to severe bacterial infection, causing dangerously low blood pressure.
• Heart diseases, such as heart failure, bradycardia, and changes in heart rhythm

Low Blood Pressure In A Teenage Girl

Sometimes, teenage girls tend to have hypotension and episodes of unconsciousness during menstruation. This could be triggered due to pain or heavy bleeding during menstruation, or due to vasovagal syncope.

Vasovagal syncope (VVS) is a reflex disorder that leads to transient loss of consciousness. This is characterized by symptoms, such as acute visual disturbance, auditory disturbance, cognitive slowing, followed by hypotension with lightheadedness and loss of consciousness. However, studies found that the severity of lightheadedness changes during the menstrual cycle and was found to be similar in both VVS patients and healthy individuals.

Also, VVS patients were not found to have any greater risk of gynecological abnormalities and pregnancy complications when compared to otherwise healthy individuals (12).

A few changes in lifestyle, such as taking adequate fluids and salts plus moderate exercise, can help manage this condition. However, if your teenager is having frequent episodes of lightheadedness during her periods, then it is best to schedule an appointment with a gynecologist.

Observe the symptoms to know if everything is alright with the child. The next section talks about diagnostic methods for low blood pressure in children.

When To See A Doctor

You may consult a healthcare provider if your teen experiences low blood pressure leading to the following (13) (14):

• Frequent episodes of passing out, disrupting their daily routine
• Fever above 101°F
• Presence of black or maroon stools
• Unconsciousness or fainting spells resulting in injuries
• Chest pain, shortness of breath, or irregular heartbeat
• Symptoms of shock, such as profuse sweating or cold spells
• Blue tint around the lips and fingernails

These signs may indicate significant distress and require prompt medical attention.

How Is It Diagnosed?

The doctor will begin the diagnosis by checking the teen’s medical and family health history. This is followed by a physical examination and a few tests, including cardiac examinations.

• Auscultation method: It is the preferred method for checking blood pressure, wherein the sound from the heart is heard using a stethoscope. It requires a cuff that fits the child’s upper arm (15).
• Blood tests: If anemia is suspected to be the reason for low blood pressure in the child, then a blood test like hemoglobin is done. Low blood sugar could also cause hypotension, which can be evaluated through the blood test.
• Electrocardiography: It is a standard health screening tool used for evaluating the cardiovascular health of children and adolescents. The high or low pulse rate (or heart rate) and the rhythm are evaluated through this diagnostic approach, which is typically used in the diagnosis of syncope that benign NMH can cause (16).
• Tilt table test: If a child complains of dizziness for unknown reasons, then this test is done. During the test, the child has to lie on a table that tilts from a horizontal to a vertical or upright position. The doctor checks the child’s reaction when the table is tilted, to diagnose orthostatic hypotension (17) (18).

Based on the diagnosis, your doctor will suggest the appropriate treatment for hypotension.

Treatment For Low Blood Pressure

Low blood pressure is associated with mild symptoms and rarely requires any treatment. If hypotension is due to the medication that your child has been taking for any other health problem, then the doctor may change the medication, lower its dosage, or advise to stop using it.

If your child is diagnosed with NMH, then the doctor suggests changes to their lifestyle and advises you to provide adequate fluids, salt, and nutritional foods. If that doesn’t work, then medication is recommended. Pediatric patients with NMH rarely might be given drugs like beta-blockersⁱDrugs that lower blood pressure, also known as beta-adrenergic blocking compounds and fludrocortisoneⁱA type of steroid used to regulate the quantity of salt and water in the body . However, these both have shown mixed results in pediatric patients, hence caution is needed (16).

How To Prevent Low Blood Pressure In Teenagers?

If your teen often has low blood pressure, lifestyle changes and dietary changes are the best ways to manage the condition. If the child has mild symptoms of low blood pressure, then minor changes in the lifestyle might be enough to prevent any problems. Here are a few measures you may consider (6) (14) (19):

• Avoid dehydration – encourage them to take a lot of fluids, i.e. 2-3 liters per day.
• Have them drink water before getting out of bed.
• Do gentle exercises, preferably seated or horizontal exercises.
• Encourage them to maintain their optimal wealth- not too much or underweight.
• Use adequate salt in the diet.
• Make them eat a balanced diet to provide all the essential nutrients to the body.

• Tell them to avoid standing up suddenly from a sitting position.
• Ask them to avoid standing too long as well.
• Let them eat smaller meals at regular intervals and cut down on the intake of carbohydrates.
• Ask them to wear compression stockings or socksⁱSpecialized stockings and socks that put light pressure on the legs and feet to improve blood pressure and not let the blood collected in the legs. .
• If they have light-headedness or dizziness, let them lie down for a few minutes, with both feet at a higher level than the body.
• Sitting down and putting the head between the knees will help get the blood pressure back to normal.
• Ask your teen to take their medication continually if prescribed by the doctor. 
• Some medications may also cause low pressure in teens. Speak to a doctor for dose adjustment or alternatives.
• Make sure your teen observes good habits, such as staying away from alcohol and tobacco.

A proper diet, along with the above tips, can help manage low blood pressure better.

Diet For Low Blood Pressure In Teens

Sometimes, blood pressure drops due to the poor supply of essential nutrients in the body. A balanced diet can help replenish these nutrients and elevate the blood pressure level. These dietary changes can also help manage your teen’s low blood pressure (14).

• Include vitamin B12-rich foods such as eggs and fortified cereals as they help prevent anemia. Eat egg in boiled or scrambled form.

• Include vitamin B12-rich foods such as eggs and fortified cereals as they help prevent anemia (11). Eat egg in boiled or scrambled form.
• Foods such as asparagus and broccoli, which are rich in folic acid, also help keep anemia at bay (20).
• Teenage girls should take iron-rich foods like green leafy vegetables, beans, and lentils to compensate for the blood loss during menstruation.

Illustration: Low Blood Pressure In Teens: Symptoms Treatment And Diet Plan

Learn how to raise low blood pressure quickly and naturally! Discover simple tips to help you increase your blood pressure and feel better fast.

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