Dizziness and Low Blood Pressure During Physical Activity

Dizziness, low blood pressure?

While hiking (approximately at the level of a small hill like Bagua Mountain), I suddenly experienced tinnitus, dizziness, nausea, blurred vision, and chills (the symptoms appeared in the order mentioned).
I felt better when I sat or lay down.
Since my menstrual period had just ended a few days prior, I initially thought it might be anemia.
However, when I visited a general practitioner, they couldn't measure my blood pressure with the device after two attempts.
Later, the doctor used a manual sphygmomanometer and said my blood pressure was normal, so I had blood tests done, which also showed no anemia (Hb around 12.5).
However, the next evening, I measured my blood pressure at 73/61 with a home monitor, and my heart rate was 70.
My usual diastolic pressure is typically in the 60s, and the last time I measured my systolic pressure with a machine was about six months ago, around the low 90s.
I usually do not have any discomfort, but I experience the aforementioned symptoms during mild exercise.
When my blood pressure was 73/61, I did not feel particularly unwell, but I find that number a bit alarming.
I would like to ask the doctor if I should seek medical attention, or if I should just monitor my blood pressure myself? (Note: I do not have any systemic diseases, nor have I experienced significant weight changes, but I have lost about 3 kg in the past month due to increased stress, which I hope can be considered as a reference.) Thank you, doctor.

Winnie, 20~29 year old female. Ask Date: 2023/08/02

Dr. He Dongjin reply Cardiology

Hello, young women often experience low blood pressure.
It is advisable to eat more and include some cooling supplements to restore your energy.
It would be best to monitor your condition.
Changhua Hospital cares about you.

Reply Date: 2023/08/02

More Info

Dizziness and low blood pressure during physical activity can be concerning symptoms, especially when they manifest in a specific sequence, as you described. The symptoms of tinnitus (ear ringing), dizziness, nausea, blurred vision, and chills can indicate a variety of underlying issues, particularly when they occur during exertion, such as hiking.

Firstly, it's important to understand what low blood pressure (hypotension) is. Blood pressure is measured in millimeters of mercury (mmHg) and is expressed as two numbers: systolic (the pressure when your heart beats) over diastolic (the pressure when your heart is at rest). Normal blood pressure is typically around 120/80 mmHg. When your readings are significantly lower, such as 73/61 mmHg, it can lead to symptoms like dizziness and fainting, particularly during physical activity.

Your experience of feeling better when sitting or lying down suggests that your symptoms may be related to orthostatic hypotension, which occurs when blood pressure drops significantly upon standing or during physical exertion. This can happen due to several reasons, including dehydration, prolonged standing, or even certain medications. Given that you mentioned increased stress and a recent weight loss of about 3 kg, these factors could contribute to your symptoms as well.

The fact that your blood pressure was measured as normal by the physician using a traditional sphygmomanometer is reassuring, but the subsequent reading of 73/61 mmHg at home is concerning. This discrepancy could be due to various factors, including anxiety, which can cause fluctuations in blood pressure. Stress and anxiety can lead to changes in heart rate and blood pressure, sometimes causing them to drop unexpectedly.

Additionally, your recent menstrual cycle could also play a role in your symptoms. Hormonal changes can affect blood volume and blood pressure, and if you experienced heavy bleeding, it could lead to transient low blood pressure or even mild anemia, although your hemoglobin level of 12.5 g/dL suggests that you are not anemic.

Given your symptoms and the low blood pressure reading, it would be prudent to monitor your blood pressure regularly, especially during and after physical activity. If you continue to experience dizziness, nausea, or any other concerning symptoms, it is advisable to seek medical attention. A healthcare provider may recommend further evaluation, including tests to assess your cardiovascular health, hydration status, and possibly a referral to a specialist if necessary.

In the meantime, consider the following recommendations:
1. Stay Hydrated: Ensure you are drinking enough fluids, especially before and during physical activity. Dehydration can exacerbate low blood pressure.

2. Gradual Movements: When transitioning from sitting or lying down to standing, do so slowly to allow your body to adjust.

3. Balanced Diet: Eating a well-balanced diet can help maintain your energy levels and overall health. Include foods rich in iron if you are concerned about potential anemia.

4. Monitor Symptoms: Keep a log of your blood pressure readings and any symptoms you experience. This information can be valuable for your healthcare provider.

5. Limit Stress: Since you mentioned increased stress levels, consider stress-reduction techniques such as mindfulness, meditation, or gentle exercise like yoga.

6. Follow-Up: If symptoms persist or worsen, or if you have any new symptoms, do not hesitate to seek medical advice. It’s better to err on the side of caution when it comes to your health.

In summary, while your symptoms could be related to low blood pressure, they may also be influenced by other factors such as stress and hydration. Regular monitoring and a proactive approach to your health will help you manage your symptoms effectively.

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