Management of Hypotension

Initial Assessment and Treatment

The European Society of Cardiology recommends that the treatment of hypotension depends critically on whether the patient is symptomatic and the underlying cause, with asymptomatic low blood pressure requiring no acute intervention, while symptomatic hypotension demands immediate assessment of organ perfusion and targeted therapy based on the specific etiology 1, 2
The American Heart Association suggests that critical threshold requiring intervention is systolic BP <80 mmHg or symptomatic hypotension with significant symptoms (dizziness, syncope, fatigue) 1, 3

The European Journal of Heart Failure recommends that midodrine is FDA-approved for symptomatic orthostatic hypotension and should be used when lives are considerably impaired despite standard clinical care 6, 7
The American Diabetes Association suggests that droxidopa is FDA-approved for orthostatic hypotension 6, 7

The European Society of Cardiology recommends that asymptomatic or mildly symptomatic low BP should NOT prevent initiation or continuation of guideline-directed medical therapy (GDMT) in HFrEF patients 1, 3
The American College of Cardiology suggests that start with SGLT2 inhibitors and mineralocorticoid receptor antagonists (MRAs) - these have minimal BP effects and may actually increase BP in low BP groups 1, 3, 5

The British Journal of Anaesthesia recommends that perform passive leg raise (PLR) test to determine if preload augmentation will help 8
The British Journal of Anaesthesia suggests that only ~50% of postoperative hypotensive patients respond to fluid bolus 8

The European Journal of Heart Failure recommends that goal is to improve postural symptoms, standing time, and function—NOT to achieve upright normotension 6, 7
The British Journal of Anaesthesia suggests that target BP approximately 10% above baseline preoperative values in postoperative setting 8