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Excessive use of alcohol, while tending to promote hypertension by the disturbances that it causes, may give, by causing a weak heart muscle, a permanent low blood pressure. A single large dose of alcohol always lowers the blood pressure.

Arteriosclerosis frequently reaches a stage when the blood pressure is low, and with atheroma of the arteries of the arms a true blood pressure is difficult to obtain. Addison's disease, or any other organic lesion of the suprarenals, will lower the pressure, while stimulation of the suprarenals increases the pressure. Any great drain on the system, whether from diabetes without nephritis, or from profuse diarrhea of any type, will cause hypotension. Occasionally a girl with chlorosis who is not menstruating may have an increased blood pressure. Many of the hemorrhagic or purpuric conditions will show a hypotension.

Meningitis in various forms may show a hypertension from cerebral and nervous irritation. Neurasthenic patients quite generally have hypotension, although occasionally with suprarenal disturbance they may have an increased tension.

In the hypotension of surgical shock and in shock during anesthesia, Henderson's findings that hyperoxygenation and insufficient carbon dioxid may be partially responsible for the condition should be remembered, and it has long been known that carbon dioxid congestion, as caused by laughing gas anesthesia, for instance, increases the blood pressure.

A systolic pressure of 110 mm. or lower in an adult should be considered hypotension, anything below 105 mm. calls for treatment, and a systolic pressure of 100 or lower in an adult calls for rest from all active duties.

These patients are weary, they have mental and physical tire, may get short breathed, may have palpitation of the heart, and often have headaches and dizziness from imperfect circulation in the head. There may be edemas of the legs and ankles toward night. If such patients have the systolic blood pressure raised even a small amount, or if the diastolic pressure, which is very low, is raised even a small amount, they immediately feel better.

If the kidneys are normal, they should have meat as part of their diet. If they are not nervous and irritable, coffee and tea should be allowed, except at the evening meal. While sleep may tend to lower pressure somewhat, these patients' hearts require a long bed rest; in other words, they should go to bed at an early hour. They should rise early, however, in the morning, and, as recommended by Goodman, they should perform mild calisthenic exercises before dressing.

The increased muscle tone thus caused raises the blood pressure somewhat, and the great depression before breakfast is not experienced. These patients rely oil their morning coffee for bracing. If they have much indigestion at night which keeps them awake so that they do not get good comfortable rest, their largest meals should be the morning and noon meals, and the evening meal should be very light.

Pendent abdomens or ptosed abdominal organs should be held up by proper abdominal bandages or corsets.

If the bowels are constipated, only the vegetable laxatives should be used, if it drug is needed at all. Salines should not be allowed, or other cathartics which cause profuse watery discharges. If a brisk purge is required, castor oil is the best.

Plenty of fresh air, and mild exercises in the open air all tend to increase the pressure. Graded walking, climbing, or other more interesting exercises are advisable, as all tending to raise the pressure, provided that at no time are they carried to the point of exhaustion.

Forced feeding may be useful. Cool sponging in the morning, if there is proper reaction, is often of benefit. Iron may be indicated; bitter tonics may be indicated. Digitalis and strychnin are often of advantage. Caffein may be used as a drug as well as given in coffee and tea. Atropin may be of value in some forms of hypotension.

At times with a low systolic pressure, but a relatively high diastolic pressure, nitroglycerin is valuable.

More or less actite hypotension may occur in hot weather or with overheating, often termed heat exhaustion. Such patients should, if possible, go to a cooler region, whether to the seashore or to the mountains is unimportant. The treatment of dangerous sudden low blood pressure, as shock, will be discussed elsewhere.

Tags: Heart Disease