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Medical Edge Newspaper Column from Mayo Clinic
A LOW-TECH TREATMENT FOR LOW BLOOD PRESSURE
DEAR MAYO CLINIC: I have orthostatic hypotension and have tried prescription drugs without success. Several weeks ago, with permission from my doctor, I tried salt tablets. There has been a significant improvement ever since in the way I feel — much less lightheadedness and hardly any headaches — but I’m concerned about side effects. Also, could the salt tablets adversely affect my health over the long term?
ANSWER: Most likely you need not be concerned about side effects or long-term problems from salt tablets; they are usually well tolerated. I have patients who have been taking them for years, and they are doing fine.
Salt tablets could cause complications if you also have a serious kidney or heart condition, but your doctor would certainly have withheld permission in such a case. Still, it’s a good idea to monitor your blood pressure regularly just to be sure you haven’t traded a low blood pressure problem for high blood pressure, although salt tablets rarely have this effect.
Orthostatic (postural) hypotension is a sudden decrease in blood pressure when standing up from a sitting or prone position. Ordinarily, blood tends to pool in the legs whenever a person stands, though the body compensates by increasing the heart rate and constricting blood vessels, thereby ensuring that enough blood is sent to the brain. But in people with postural hypotension, the compensating mechanism fails. Blood pressure drops, leading to the symptoms you mention as well as dizziness, blurred vision and even fainting.
Postural hypotension can result from medical problems such as diabetes, heart disease and certain neurological disorders. It can also be caused by some medications — diuretics, beta-blockers, calcium channel blockers and tricyclic antidepressants, among others — or by temporary conditions such as dehydration, excessive heat or fever. While it makes sense to preferentially treat the underlying problem rather than the low blood pressure, in many cases the postural hypotension is idiopathic (of unknown cause) or the result of an incurable condition. We then need to employ one of several options for alleviating the blood pressure drop.
First-line treatments are non-drug, simple and largely in the self-help category. Using salt tablets to increase one’s blood volume and therefore the intravascular pressure is a leading alternative. Compression stockings, which have a similar effect by forcing greater blood flow up from the legs, is another, as is resistance training for strengthening the calf and thigh muscles. Drinking more water (along with less alcohol) also enhances blood volume.
Similarly, a well-balanced diet and small, low-carbohydrate meals make relatively modest demands on the circulatory system — they do not divert significant quantities of blood to the gut (for digestion purposes), which would lower blood pressure. And it’s a good idea to take it easy when moving from a prone position to a standing position. Instead of leaping out of bed, for example, breathe deeply for a few minutes and then slowly sit up before getting on your feet.
If these options are insufficient, drugs such as midodrine are available to raise standing blood pressure levels. A problem with using these medications, however, is that they raise blood pressure all the time, possibly giving people high blood pressure when they sit down and at night (when blood pressure should decline). I should mention, though, that recent research has identified a “smart” drug — pyridostigmine — which appears to increase standing blood pressure without affecting supine (lying down) pressure.
Drug issues are moot in your case, however, and not only because they didn’t work for you. Even if they were effective, there would be no point in using them when something as easy and safe as salt tablets does work for you. Be happy and run with it.
— Paola Sandroni, M.D., Ph.D., Neurology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Orthostatic Hypotension
Appointment Information
More Information on Orthostatic Hypotension
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© 2006 TRIBUNE MEDIA SERVICES, INC.
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