9. Hypotension: The Pressure Drop in HRS
Hypotension, or low blood pressure, in hepatorenal syndrome, is an elusive symptom, often going unnoticed until it manifests as lightheadedness or fainting. It’s a result of the compromised circulatory regulation due to the liver’s reduced synthesis of angiotensinogen, a precursor to a hormone involved in blood pressure control. Additionally, the kidneys’ impaired function exacerbates the issue by failing to signal the release of hormones that constrict blood vessels and elevate pressure.
Patients may not even be aware of the symptom until it’s revealed during a blood pressure reading or when they experience its sudden effects, such as a dizzy spell upon standing. This symptom can be disarming, making everyday tasks risky due to the potential for falls and injuries.
For medical providers, hypotension is a vital sign that provides insights into the volume status and the overall circulatory state of the patient. In hepatorenal syndrome, the monitoring of blood pressure becomes a critical aspect of care, as the numbers can indicate whether the condition is stable or if there’s a sudden downturn.
Managing hypotension involves a nuanced approach to fluid balance and medication management. Patients with HRS often require a tailored plan to ensure that blood pressure is maintained at a safe level without exacerbating other symptoms like ascites or edema. (9)
