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Nitroglycerin is a vasodilator commonly used to relieve chest pain associated with angina or to manage heart failure. However, its use is contraindicated in patients with severe hypotension because it can further lower blood pressure. Nitroglycerin works by dilating blood vessels, which decreases vascular resistance and lowers blood pressure. In a patient with severe hypotension, this can lead to dangerously low blood pressure levels, potentially resulting in inadequate blood flow to vital organs.

Severe anemia, glaucoma, and hyperlipidemia do not have the same immediate and severe impact on the patient's safety as severe hypotension does when nitroglycerin is administered. Severe anemia can affect oxygen transport, glaucoma can be adversely affected by systemic vasodilation, and hyperlipidemia is related to cholesterol levels which doesn’t directly conflict with nitroglycerin use. However, the risk of exacerbating already low blood pressure makes nitroglycerin particularly risky for patients with severe hypotension.