Low blood pressure, also known as hypotension, is usually considered a sign of good health and low risk for cardiovascular disease. However, there are times when persistently low blood pressure or a sudden drop can be a sign of an underlying health issue that needs medical attention. Knowing when low blood pressure becomes a problem can help ensure timely intervention and proper care.

Blood pressure readings consist of two numbers:

Systolic pressure (the top number) indicates the pressure in your arteries when your heart pumps blood. Diastolic pressure (the bottom number) reflects the pressure in your arteries while your heart is resting between beats.

The normal reading is usually 120/80 mmHg or less. Hypotension is clinically defined as having blood pressure readings less than 90/60 mmHg. In some patients, low blood pressure will have no adverse health consequences and therefore does not need to be treated. In extreme cases, however, it can limit the flow of oxygen and nutrients to vital organs, resulting in potentially life-threatening complications, such as shock.

Causes of Low Blood Pressure

Hypotension can result from many factors. Some of the factors that cause hypotension are as follows:

• Insufficient fluid intake or excessive fluid loss can lead to decreased blood volume and hence hypotension.
• An injury or internal bleeding may result in hypotension. This happens because blood pressure becomes significantly reduced.
• Some hormonal changes along with the increased blood requirement during pregnancy also causes hypotension.
• Issues like heart failure or arrhythmias can impair blood circulation and result in low blood pressure.
• Certain drugs, including diuretics, antidepressants, and blood-pressure-lowering medications, can induce hypotension.

Symptoms of Hypotension

While low blood pressure may not always cause symptoms, it can sometimes be associated with:

- Dizziness or fainting

- Fatigue and weakness

- Blurred vision

- Nausea

- Confusion or difficulty concentrating

- Shallow breathing

- Palpitations

If the person experiences these symptoms, with the recorded blood pressure reading, the medical services have to be consulted.

Types of Low Blood Pressure

1. Orthostatic Hypotension: This is a kind of hypotension that appears as a result of decreased blood pressure when a person is standing up from lying down or sitting position and primarily affects elderly people.

2. Postprandial Hypotension: This is a drop in blood pressure after eating, more common in older people.

3. Neurally Mediated Hypotension: It is triggered by standing for long periods. This type can affect younger people and is associated with miscommunication between the brain and heart.

When Is Low Blood Pressure Dangerous?

There is no such thing as a universal threshold for very low blood pressure, but a blood pressure reading below 90/60 mmHg can be dangerous and require prompt medical assessment if accompanied by symptoms of fainting, confusion, or shortness of breath. Sudden falls in blood pressure may point to potentially serious underlying causes, which can include:

• Internal bleeding
• Sepsis (severe infection)
• Allergic reactions

Management and Treatment

Treatment of hypotension depends on its cause:

• Hydration Drinking more water can help against dehydration-related hypotension.
• Compression Stockings: These can improve circulation and reduce blood pooling in the lower limbs.
• Dietary Changes: Increasing salt intake under supervision can help increase blood pressure
• Medication Changes: The physician may need to reduce dosages of some medications or replace prescriptions.

For more severe cases, physicians might also administer fludrocortisone or midodrine to increase blood pressure. Shock from hypotension should be treated promptly to ensure proper function of organs.

Can Hypotension Cause Fatigue?

Chronic fatigue syndrome has also been associated with low blood pressure. Prolonged tiredness, despite adequate rest, may require reassessment of blood pressure levels. Fatigue secondary to hypotension will impact functionality and thus requires assessment and treatment of the cause.

When to Seek Medical Care

If your blood pressure readings are low consistently and without symptoms, you probably have nothing to worry about. If you do have symptoms like dizziness, fainting, or confusion, you need to go to the doctor. Blood pressure checks are usually conducted regularly. Once you are aware of your own normal baseline, you will know right away when there is something wrong.

Lifestyle Tips That Support Normal Blood Pressure

1. Other than directly treating hypotension, a healthy lifestyle overall would promote balanced blood pressure levels.
2. Exercise regularly; it promotes cardiovascular health and can help regulate blood pressure.
3. Focus on nutrient-dense foods rich in iron, B vitamins, and electrolytes to support circulatory health.
4. Excessive alcohol consumption dehydrates the body and lowers blood pressure.
5. Practices like yoga and meditation can help maintain a healthy blood pressure range.

Often, we underestimate the way our brain works and daydreaming has long been seen as a major sign of creativity. Many artists have used their imagination to bring their work to life. However, science offers a different perspective.

Coined in 2002 Dr. Eliezer Somer, those who experience “maladaptive daydreaming” often fantasize about celebrities, historical figures or idealized versions of themselves. Their imaginations are more elaborate, diverse, and complex as compared to other daydreamers.

A 2012 Consciousness and Cognition study found that maladaptive daydreamers spend, on average, 57 percent of their waking hours daydreaming far more than their counterparts.

Dr Somer explains: "The greatest difference is the maladaptive daydreamers reported that the activity interfered with their daily life. They also reported higher rates of attention-deficit and obsessive compulsive symptoms, and more than 80% used kinesthetic activity or movement when daydreaming, such as rocking, pacing or spinning"

He further noted that while everyone experiences moments of mind-wandering, it usually does not interfere with daily life. But maladaptive daydreaming does interfere in regular life. The condition has not been classified as a mental illness and there is no treatment for it yet.

What Do People Say?

Many Reddit users have shared their experiences with maladaptive daydreaming, often asking questions such as: “Is it normal to daydream for such long hours?”

While some responses described daydreaming as a form of dissociation when bored, others relied on music or movies to fuel fantasies of being a “better version” of themselves, often struggling to return to reality.

Common Symptoms Of Maladaptive Daydreaming

Here are some early signs of maladaptive daydreaming to keep an eye out for:

• Compulsive need to daydream
• Avoiding social interaction and activities
• An inability to perform work or other daily tasks
• Extreme feelings of shame or guilt
• Feeling a compulsive need to daydream that you can't control
• Making a conscious effort to stop or lessen daydreaming episodes.
• Intense and extremely vivid daydreams
• Complex and elaborate daydreams, often with many people involved
• Daydreams accompanied by repetitive movements such as pacing
• Prolonged daydreams that may last hours at a time
• A feeling of disconnect or dissociation from people and reality during the episode.

What Does Science Say?

Rachel Bennett, a member of Dr. Somer’s online community, shared she usually dreams up new episodes of her favorite Japanese animé characters and TV shows. She’s also created four families of fictional characters which have grown with her over the years.

“I’d much rather stay home and daydream than go out,” she said.

What Causes Maladaptive Daydreaming?

Dr. Somer noted that about one-quarter of maladaptive daydreamers are trauma survivors who use daydreaming as an escape. Many report family members with similar tendencies, as well as being shy or socially isolated.

Meanwhile, a Harvard Medical study found that 80 percent of maladaptive daydreamers have ADHD, followed by anxiety disorders, depression, and OCD. Researchers believe daydreaming often acts as a coping mechanism for pent-up emotions that cannot be expressed in real life, so they are released through imagination instead.

How Do You Cope With Maladaptive Daydreaming?

Experts emphasize that maladaptive daydreaming is not an extreme condition requiring formal diagnosis, but many people have shared strategies that help:

• Exercise: One forum user reported swimming daily, gradually reaching 2,000 meters, which acted as meditation and grounded them in reality.
• Remove triggers: Avoid activities that spark daydreaming episodes.
• Practice mindfulness: Stay present and aware of thoughts.
• Limit music use: Music is a common trigger.
• Scheduled daydreaming: Set aside specific times with a timer, then consciously exit the session.
• Seek professional help: Therapies such as CBT, DBT, and mindfulness-based stress reduction have shown benefits.
• Stay busy: Engage in tasks to prevent wandering thoughts.
• Improve sleep quality.
• Make daydreams less appealing: Reduce instant gratification.
• Self-development and creativity: Channel imagination into productive outlets.
• Journaling: Record thoughts daily or weekly.
• Practice self-acceptance.
• Find group support.

A new review published in The Lancet highlights how close this shift may be. The study underscores a hard truth: despite having effective medicines for years, global blood pressure control remains disappointingly poor. The real challenge, experts say, is not the absence of drugs—but problems with adherence, health systems, and long-term patient engagement.

The Unrelenting Burden of a Silent Killer

Hypertension continues to be the leading cause of heart attacks, strokes and premature deaths worldwide. The World Health Organization (WHO) defines high blood pressure as readings at or above 140 mm Hg systolic and/or 90 mm Hg diastolic. A normal reading is below 120/80 mm Hg.

The numbers are staggering. Between 2024 and 2025, an estimated 1.4 billion adults aged 30 to 79—roughly one in three people in this age group—are living with hypertension globally. Nearly 44 percent do not even know they have it. Among those diagnosed, fewer than one in four have their blood pressure adequately controlled.

India reflects this alarming trend. The ICMR-INDIAB study (2023) estimated that about 315 million Indians—35.5 percent of the population—have hypertension. Data from NFHS-5 further showed that nearly half of hypertensive men and more than a third of hypertensive women in India do not have their condition under control.

Why Daily Pills Are Falling Short

For decades, hypertension treatment has relied on daily oral medications—often combinations of two or more drugs. These may include ACE inhibitors, angiotensin receptor blockers paired with calcium channel blockers, and thiazide diuretics.

On paper, these regimens are effective. In reality, adherence is the weak link.

Many patients with hypertension also manage diabetes, obesity or high cholesterol. The result is polypharmacy—multiple pills, multiple times a day. Over time, missed doses, side effects and simple “treatment fatigue” erode consistency. Therapeutic inertia—where doctors do not intensify treatment despite poor control—further worsens outcomes.

The Rise of Long-Acting Injectables

This is where long-acting injectable therapies come in. According to Dr Mohit Gupta, cardiologist at G B Pant Hospital and UCMS, the field is now moving toward therapies that may be administered just twice a year.

Unlike traditional medicines that work downstream to reduce blood pressure numbers, these new drugs target upstream molecular pathways that drive hypertension.

One promising approach involves small interfering RNA (siRNA) therapies that inhibit angiotensinogen production in the liver. By silencing this protein, they dampen the renin–angiotensin system—central to blood pressure regulation. Zilebesiran, developed by Roche and Alnylam, is currently in global phase 3 trials.

Another candidate, ziltivekimab by Novo Nordisk, targets inflammatory pathways increasingly linked to cardiovascular risk. There are also newer strategies aimed at selectively modulating aldosterone, a hormone that increases blood volume and pressure.

The appeal is simple: durability. A twice-yearly injection could eliminate the daily burden of pill-taking, improve adherence and provide more stable blood pressure control over time.

Promise, But With Caution

However, excitement is tempered by concern. Cost remains a major question. The recent introduction of inclisiran, an injectable cholesterol-lowering therapy priced between Rs 1.8 and 2.4 lakh annually in India, highlights affordability challenges.

Long-term safety is another critical issue. Hypertension is lifelong. Patients may require these treatments for decades. Experts stress the need for robust long-term data across diverse populations before widespread adoption.

The promise is undeniable. A twice-yearly injection that reliably controls blood pressure could transform preventive cardiology. But its true impact will depend not only on scientific success—but on accessibility, affordability and sustained safety.

A new Lancet study titled Burden of MASLD and liver fibrosis: evidence from the Phenome India cohort published in The Lancet Regional Health - South Asia found that nearly four in 10 Indian adults have fatty liver or what scientifically is known as the metabolic dysfunction-associated steatotic liver disease (MASLD), formerly non as NAFLD or non-alcoholic fatty liver disease.

The study also highlights a more worrying condition that a sizeable proportion of the Indian population already show signs of liver fibrosis. This is an early scarring process that could lead to cirrhosis or liver cancer if left unchecked.

Lancet Study: How Was It Conducted?

The study analyzed data from more than 7,700 adults across 27 cities in India. The study found that 38.9 per cent of participants had MASLD. The authors also noted that this figure is similar to the global estimates, however, is deeply concerning for India's population and size of the country, including the ever-rising burden of diabetes and obesity.

The study also found that 6.3 per cent of people who live with MASLD had significant liver fibrosis, as compared to 1.7 per cent of those without fatty liver.

Read: Indians Are At Most Risk Of Having Fatty Liver Disease, According To Doctor

The study also found that 2.4 per cent of the entire population analyzed showed evidence of significant fibrosis. Why is this concerning? Fibrosis is a strong predicator of future complications. With the advancement of scarring, liver failure, cirrhosis, and liver caser risk also rises.

Lancet Study: Who Are At Risk?

The study found that people with obesity, diabetes, and central or abdominal fat were more likely to have MASLD. Obesity also was seen as the strongest risk factor, with likelihood rising steeply from overweight to severe obesity.

Another factor was also age. Liver fibrosis was seen in adults over the age of 60 years and in people with diabetes, among whom nearly one in ten showed fibrotic changes.

The study also showed that there was a presence of "Lean MASLD", which means it could also happen in people who are not overweight and have a normal body mass index. This is often linked to insulin resistance and visceral fat, which is the fat around internal organs. This tend to accumulate abdominal fat even at lower body weights.

Lancet Study: Can MASLD And Other Liver Diseases Be Prevented?

As per the authors of the study, MASLD is highly modifiable, especially at early stages. There are evidence that show that weight loss reduces liver fat and inflammation. Regular physical activity also improves insulin sensitivity, along with balanced diet. The diet must be consumed without or with very low sugar and ultra-processed food, which helps in control of diabetes and cholesterol and slows down disease progression.

Authors also noted that people should get their fatty liver disease scanned regularly. Especially because MASLD is common among people with obesity and diabetes. There are many non-aggressive tools that could also detect fibrosis early.