Do you have low blood pressure and wonder if it’s related to lupus? While it’s common for people with systemic lupus erythematosus (SLE), the most common type of lupus, to have hypertension (high blood pressure), you could also experience the opposite. Hypotension (low blood pressure) occurs when blood flows through your blood vessels with less pressure than normal. Low blood pressure has a variety of causes, and some may be related to lupus.

You might not realize that you have low blood pressure if it weren’t for the number a health care provider reads from a blood pressure cuff. However, some signs and symptoms of low blood pressure may indicate it’s time to talk to your doctor or rheumatologist. Learn five key details about low blood pressure, including possible causes and treatment.

1. Normal Blood Pressure or Lower Is Linked With Reduced Risk of Cardiovascular Problems

In 2018, the American Heart Association and American College of Cardiology changed the definition of high blood pressure from 140/90 millimeters of mercury (mm Hg) or higher to 130/80 mm Hg or higher for the general population.

Taking into account the new guidelines, one study of people diagnosed with lupus found that having high blood pressure increased the risk of an atherosclerotic vascular event compared with having a blood pressure under 130 mm Hg. Atherosclerotic vascular events occur when blood vessels harden and narrow due to deposits of fats and other substances. These events include:

• Heart attack
• Angina (chest pain)
• Heart failure
• Peripheral vascular disease (a circulation disorder)
• Stroke

Specifically, the researchers found that more than 10 percent of people with an average blood pressure of 130-139/80-89 mm Hg experienced an atherosclerotic vascular event compared with fewer than 5 percent of those with a lower average blood pressure. These findings suggest that blood pressure below 130 mm Hg is an appropriate target to help minimize risk factors of cardiovascular problems in people with lupus.

2. Your Blood Pressure Isn’t Too Low Unless You Notice Symptoms

If you have low blood pressure, you may wonder if there’s such a thing as too low. According to the American Heart Association, no specific blood pressure number is considered too low, so long as you don’t feel certain symptoms. In other words, if you feel normal but your blood pressure reading is low, you don’t need to worry. However, signs and symptoms of low blood pressure becoming troublesome include:

• Feeling nauseated
• Fainting or feeling dizzy or light-headed
• Being thirstier than usual or thinking you’re dehydrated
• Having blurry vision
• Feeling confused
• Seeming unusually tired

One MyLupusTeam member described their symptoms of low blood pressure: “Speaking from experience, I was light-headed and dizzy with low blood pressure. I went to the ER and came back with a diagnosis of hyponatremia [low sodium levels].”

If you have any of the above symptoms, be sure to check in with your doctor so that they can determine if your low blood pressure needs treatment. Try to note if the symptoms occur during certain activities, which can help pinpoint what might be making you feel worse.

3. Some Lupus Comorbidities Can Lead To Low Blood Pressure

People with lupus may also have comorbidities (coexisting conditions) that can lead to low blood pressure. Some of these conditions may be related to how lupus affects different parts of the body.

For example, some people with lupus also have endocrine disease like thyroid problems or diabetes. One study found that about 5 percent of people with lupus also had hypothyroidism (underactive thyroid). Another study found that people with SLE had a 22 percent higher risk of developing type 2 diabetes. Some endocrine problems, such as hypothyroidism, Addison’s disease, and occasionally diabetes, can cause low blood pressure.

In addition, certain heart problems, including heart valve problems and heart failure, can cause low blood pressure and make blood flow throughout the body more difficult. Because lupus can cause heart problems like leaky valves and cardiovascular disease, it’s important to know when low blood pressure may be a sign of heart disease.

Although certain comorbidities can be a cause of low blood pressure, many other causes of low blood pressure may not be related to lupus, such as pregnancy or a nutritional deficiency. Talk with your doctor if you are concerned about low blood pressure so that they can help you get to the bottom of its cause and determine any treatments that may be needed.

4. Some Medications Can Cause Low Blood Pressure

Low blood pressure can be a side effect of several medications, some of which may be part of your lupus treatment plan. These drugs include diuretics and treatments for hypertension, which is common among people with lupus, especially those who also have kidney disease and reduced kidney function, known as lupus nephritis. Some people with lupus may take diuretics to manage fluid retention from corticosteroids like prednisone. Thus, if you’re taking medications to manage hypertension or other symptoms of lupus, like rituximab (Rituxan) to suppress the immune system, your blood pressure is likely lower than normal.

In addition, taking some prescription or over-the-counter drugs along with hypertension treatments can cause low blood pressure. Talk with your doctor to see if any of the medications you’re using to manage heart issues with lupus may be at the root of your low blood pressure.

Some medications for treating depression may also cause low blood pressure. If you’re taking antidepressants, ask your doctor if that may be the underlying cause of your low blood pressure.

5. Lifestyle or Drug Changes May Help Manage Low Blood Pressure

Low blood pressure may not need to be treated if it doesn’t cause you troublesome symptoms like light-headedness, nausea, or dizziness or otherwise affect your quality of life. However, if you do notice symptoms, your doctor may recommend treatment options such as:

• Medications to increase your blood pressure
• Adjustments to drugs that lead to low blood pressure
• Increased fluid intake
• Changes to your diet

Some MyLupusTeam members report that eating more salt or electrolytes, per their doctor’s recommendations, helps their low blood pressure. One member wrote, “I drink Propel-flavored water. It’s really good — has electrolytes to up your salt! Chicken soup has high sodium.” Discussing their partner’s experience with low blood pressure, one member shared, “We’ve also heard she needs to keep her salt levels up and fluid intake high as well.”

Be sure to seek medical advice from health care professionals before making any significant changes to your diet, such as consuming more sodium. Watching your salt intake is an important part of ensuring healthy blood pressure and heart health. If you have any concerns about having lupus and low blood pressure, it’s best to talk to your doctor to learn your best course of action.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 223,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Do you have lupus and low blood pressure? What does low blood pressure feel like for you? Share your experience in the comments below, or start a conversation by posting on your Activities page.