Low Blood Pressure in Psychiatric Care: A Comprehensive Narrative Review

Low blood pressure (hypotension) is a frequently overlooked concern in psychiatric care, despite its significant clinical implications. This narrative review synthesizes findings from 26 studies published between 1998 and 2024, examining the relationship between hypotension and psychiatric disorders, psychotropic medications, medical comorbidities, substance use, and cognitive decline. Evidence suggests that hypotension can contribute to symptoms such as fatigue, impaired concentration, emotional blunting, and confusion, which are often misattributed to primary psychiatric illness. Medications, particularly antipsychotics, antidepressants, and mood stabilizers, frequently induce hypotension, especially in older adults and patients with complex physical conditions. Additional risk arises from polypharmacy and substance use, including alcohol, opioids, and stimulants. In geriatric and forensic psychiatric populations, unrecognized hypotension is associated with increased falls, delirium, and delayed recovery. The review highlights the importance of regular blood pressure monitoring, medication reconciliation, interdisciplinary collaboration, and environmental safety strategies. Recognizing hypotension as a modifiable factor in psychiatric outcomes can support more accurate diagnosis, safer treatment planning, and improved quality of care for vulnerable patients.