Fluctuating Blood Pressure In The Elderly Treatments And Prevention
To achieve a better understanding of your fluctuating blood pressure, a doctor will likely have your pressure monitored. The best way to accomplish this is by prescribing a 24 hour home ambulatory blood pressure monitor.
Its a device that has a traditional arm cuff attached to a monitor you keep with you all day and night. These monitors can be adjusted to take your pressure at different intervals throughout the day. Typically, it will be set to measure your blood pressure three times an hour during the day and once an hour while sleeping.
Depending on the severity of your blood pressure readings and fluctuations, medication might be prescribed. In all cases lifestyle changes will be recommended like the following:
When Is Abpm Used
While high blood pressure readings taken in a healthcare provider’s office may truly indicate hypertension is present, sometimes that is just not the case. ABPM is helpful in assessing people with white coat hypertension.
Some people have wide fluctuations in blood pressure and ABPM can help with a difficult diagnosis. It’s also useful to investigate whether existing anti-hypertensive medications are working, or why they’re not effective.
ABPM can help in the diagnosis and treatment of some forms of dysautonomia, an autonomic nervous system disorder that can lead to intermittent and unpredictable episodes of very low blood pressure.
When To See A Doctor
Since labile hypertension can go undetected, it is important to get your blood pressure measured by your healthcare provider if you are experiencing any of the following symptoms:
- Fatigue
- Vision problems
- Confusion
If your doctor has prescribed medication to treat your blood pressure fluctuations and it is not improving, you should visit your doctor to discuss alternative treatment plans.
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Errors And Mistakes Taking Blood Pressure
There are many errors people make while measuring their blood pressure that can cause your readings to fluctuate . The different readings can occur between your morning and evening measurements, or even minutes apart from each other. The following are the most common:
- Crossed legs can elevate blood pressure.
- Failure to sit upright can raise your blood pressure.
- Sitting with your back unsupported can increase your measurements.
- Arm position, which changes the height of the cuff, can raise or lower your BP. Even when arm position is perfect, making one mistake can raise BP by 10%. Read about that mistake in my blog post, Effect Of Arm Position On Blood Pressure.
- Failure to have 5 minutes of quiet time prior to measuring.
- Distractions while measuring like talking, texting, watching Tv, browsing social media and similar common activities.
- As mentioned earlier, measuring BP with a full bladder.
- Making your cuff too tight or loose can cause inconsistent readings.
- Wrapping the cuff around clothing and not on your bare arm.
- Failure to take 2 to 3 readings and average them together.
- Using an inaccurate home monitor. To determine if your home monitor is accurate, read how in my blog post, right here.
- Smoking, drinking caffeine or exercising within 30 minutes of taking your measurement.
- Failure to take your blood pressure the same times every day.
- Taking a hot or cold bath within 20 minutes of measuring your BP.
Conditions That Are Easily Controllable
We’ve broken them up into easily digestible sections because there are various risk factors and causes for variations in blood pressure readings. This section will discuss the potential causes that are mostly within your control. These will be the easiest to rule out as possible reasons for fluctuations by making lifestyle modifications.
Eating foods with sodium
Sodium intake is known to affect blood pressure¹ levels. Those with hypertension should avoid consuming too much sodium, as it raises blood pressure. If you generally don’t eat a lot of sodium, and your blood pressure spikes coincide with an increased intake of sodium, try removing it from your diet and see if your readings normalize.
Caffeine or alcohol consumption
Aside from medication, caffeine² and alcohol³ are two of the most widely consumed substances that can raise your blood pressure. Because most people aren’t under the effects of either drug all day, every day, the spikes caused by them and the subsequent return to normal could be the cause of your blood pressure fluctuations.
Consumption of other drugs and medications
Other drugs that may be less commonly used but can still cause changes in your blood pressure include common over-the-counter drugs such as certain nasal decongestants and illegal drugs like cocaine and methamphetamine.
Using tobacco products
Exercise
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So Whats The Best Time To Measure Blood Pressure
Theres no one best time to measure blood pressure. The best practice would be to have it monitored several times a day. A common approach is to measure it twice daily: one time in the morning, before eating or taking medications , and the second time in the evening. If youre having your blood pressure measured at a medical facility, the doctor or nurse can advise you.
Another important tidbit is that loss of the normal fall in blood pressure at night is associated with a greater future risk of cardiovascular disease. There is some evidence that nighttime blood pressure is a stronger predictor than daytime blood pressure, but this is unclear. Blood pressure also varies over longer time periods and this variability is useful in predicting adverse outcomes.
Factors That Can Exaggerate Blood Pressure Readings
When you go to the doctors office, blood pressure measurement is one of the ways doctors can check up on your heart health. The only way to diagnose high blood pressure, known as hypertension, is by a blood pressure test. Blood pressure readings are typically taken at the start of your doctors appointment.
A healthy blood pressure reading is anywhere between 90/60 and 120/80. To understand your blood pressure reading, you need to know the difference between diastolic and systolic blood pressure. The first number is the systolic blood pressure which measures how much pressure your blood is exerting against the artery walls when your heart is beating. The second number is the diastolic blood pressure which indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats.
Anything 140/90 or above is considered a high blood pressure reading, which could be a diagnosis of hypertension. Hypertension is one of the leading causes of heart disease that can lead to heart attacks, kidney failure, stroke, and even dementia. If your blood pressure measures below 90/60, that could be an indicator of hypotension, or low blood pressure, which can result in dizziness, fainting, and long-term damage to the heart and brain.
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Medical Issues Or Conditions
Many different diseases and conditions can cause fluctuating blood pressure. The following can affect it higher or lower:
Pregnancy
In the beginning stages of pregnancy, a womans circulatory system expands quickly . This can cause blood pressure to drop during the day. The following pregnancy related issues can also cause it to fluctuate:
- Dehydration
- Malnutrition
Diabetes
Diabetes can raise or lower your blood pressure and cause inconsistent readings. If you have nerve damage on internal organs as a result of diabetes, your pressure can change. Swings in blood sugar levels can cause low blood pressure and then reverse back to normal.
Cardiovascular disease
If you have cardiovascular disease, you may be on medication. As youll see in the medication section below, different medications, dosages and the time you take it, can cause your blood pressure to fluctuate.
A person with cardiovascular disease may not see the dip in blood pressure while sleeping. Someone with high blood pressure may experience a bigger spike while exercising than someone who doesnt.
A person who has a clogged artery on one side of their body will likely get different blood pressure readings in each arm. For this reason, measuring it in the correct arm is very important . I dedicated a whole blog post on this topic. In it I tell a story of how a woman was misdiagnosed, hospitalized and given medication because of a nurses mistake. You can read about it by clicking here.
- Valve problems
- Low heart rate
What Can Cause Blood Pressure To Fluctuate
If you notice your blood pressure fluctuating, it can be helpful to understand the possible causes. This will give you some clues as to whether or not your actions are causing the fluctuations, so you can take steps to rule them out as a reason for the fluctuations. If you have drastic changes in your blood pressure that can’t be explained, you should consult a medical professional to look deeper into what could be causing it.
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How Is Fluctuating Blood Pressure Treated
First, a doctor will determine the underlying cause. They will ask about a persons history and discuss their lifestyle and current medications. The doctor may also order or conduct tests.
Medications can lower blood pressure and prevent dangerous fluctuations. A person may also be able to achieve this goal by making changes to their lifestyle.
Medical Causes Of A Fluctuating Heart Rate
Medical issues ââ¬â many of them easily treated ââ¬â can also cause a fluctuating pulse, including:
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Blood Pressure Fluctuates Throughout The Day
This graph shows blood pressure changes in a 73-year-old woman over a 24-hour period. They were recorded using an ambulatory blood pressure monitor, a technology clinicians use to investigate possible cardiovascular problems. A spike in the woman’s blood pressure at her clinician’s office in the morning suggests she may have white-coat hypertension. Her average blood pressure was 141/77.
In adults, hypertension is defined as a systolic pressure of 140 or greater or a diastolic pressure of 90 or greater . Another 60 million American adults have prehypertension . Home blood pressure monitoring could help clarify their situation and establish the need for treatment, according to the new advisory statement.
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Blood pressure category |
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100 |
There’s no cure for hypertension, but it can be managed with lifestyle changes and often with medications. Blood pressure is a key consideration in making such treatment decisions. Defining the goal as blood pressure below 135/85 or below 130/80 for people with diabetes or kidney disease the AHA/ASH/PCNA made the following recommendations:
Technique Of Ambulatory Blood Pressure Monitoringits History And Current Achievements
The occurrence of pronounced BP fluctuations over time was first observed by Stephen Hales in 1733, when performing his famous experiments on the arterial pulse by inserting a glass pipe into the crural artery of mares . In the following years, additional information on the occurrence of BP variations with time was obtained in humans, although only through indirect methods aimed at quantifying the arterial pulse, in most cases at the level of the radial artery . Further insights into the variations of BP in humans under the effects of exercise, stress, and emotions were later made possible by the introduction of the sphygmomanometric technique by Riva-Rocci1 and Korotkoff.
Techniques for continuous BP monitoring have provided us with a large amount of interesting data on the physiologic mechanisms regulating the cardiovascular system and on their derangement in pathologic conditions.13 This has been obtained through computer analysis of spontaneous BP and heart rate variations. This approach has yielded new information not only on the magnitude but also on the rapidity of spontaneous BP fluctuations, the latter found to be steeper in hypertensive than in normotensive persons.14 In spite of their great potential, techniques for continuous BP monitoring have been largely confined to a research setting, mainly because of their high cost and complexity.
Donald J. Krapohl, Pamela K. Shaw, in, 2015
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What Is Normal Blood Pressure
Experts agree that a healthy adult should have a blood pressure of less than 120 mmHg for their systolic pressure and under 80 mmHg for diastolic pressure. While people’s blood pressure can change minute by minute, you need to chart the blood pressure over a period of time if you want to get an accurate evaluation of your blood and heart health.
Blood Pressure Lying Down Vs Standing
Without blood pressure, our body would not receive the oxygen and nutrients it needs to function properly. The heart has two motions contracting and relaxing, so blood pressure is, therefore, recorded as two numbers over each other. Systolic is the actual beat of the heart and diastolic is when the heart relaxes. Systolic pressure is listed over diastolic, such as 120 over 80, which is normal blood pressure.
All sorts of conditions can have an impact on your blood pressure reading. Disease, stress, weight, and even posture can impact your blood pressure level. Blood pressure lying down verses standing has the same variations as lying down vs. sitting. Moving from a standing to a supine position could result in different readings.
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What Causes Fluctuations In Blood Pressure
Your heart works to ensure that your five or so liters of blood continue to pump throughout your body. Blood pressure is the force that your blood exerts onto the walls of blood vessels, and doctors measure it to determine how healthy your blood vessels and heart are. It is normal to experience some variation in your blood pressure throughout the day, but extreme changes may indicate another issue that should be checked out. Most people won’t notice any symptoms with their fluctuating blood pressure, making it challenging to detect them. Here the article will help you find out if your blood pressure is swinging and what you can do.
Blood Pressure Monitor Vs Blood Pressure Cuff
Blood pressure monitor and blood pressure cuff are two phrases often used to describe the same blood pressure measurement tool. The blood pressure cuff is the element that wraps around either the upper arm, wrist or finger to measure blood pressure. The blood pressure monitor is the element in charge of inflating and deflating the cuff, as well as providing your blood pressure reading on an easy-to-read display.
Most experts recommend using a blood pressure monitor with an upper arm blood pressure cuff for at-home readings because they tend to be more accurate than wrist cuffs and finger cuffs.
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Blood Pressure Differences When Lying Down Standing Up And Sitting
Accurate blood pressure measurements, including blood pressure differences when lying down versus standing up and sitting can be very helpful when healthcare providers are trying to monitor the condition. However, its important to understand the impact that each position has on blood pressure levels.
There are three common positions that healthcare workers use when taking someones blood pressure. Taking blood pressure lying down is the obvious method used when a patient is hospitalized, but in a doctors office a patient is usually sitting in a chair. Some nurses also measure blood pressure while a person is standing.
Records show that diastolic pressure is about 55mm/Hg lower when taking blood pressure lying down vs. sitting. Systolic pressure is approximately 88 mm/Hg in the lying down position versus the sitting position, but only when the person taking the measurement positions the patients arm so that it is at the same level as the right atrium of the heart.
People should also be conscious of the fact thatblood pressure readings are different if you are in a sitting position with your legs crossed. It actually increases systolic pressure by as much as 8mm/Hg.
Orthostatic hypotension is a type of low blood pressure that can occur when you stand up after lying or sitting down. It often causes dizziness and even fainting. Some doctors refer to it as postural hypotension. Older people are more at risk for postural hypotension, and so are people with heart conditions.
Reasons Your Blood Pressure Fluctuates
If you are seeing regular fluctuations in your blood pressure readings, youre not alone. Some variation in your blood pressure throughout the day is normal. In fact, there are a number of reasons for this including small changes in daily life, such as stress, exercise or even how well you slept the night before.
According to the American Heart Association , there are more than 116 million adults in the U.S. with high blood pressure. Recently, the U.S. Surgeon General, VADM Jerome Adams, released a for hypertension control to make it a national public health priority. Experts have called for monitoring your blood pressure at home because it is a great way to gain a better understanding of your numbers.
Knowing and regularly measuring your can help you see irregularities that you want to call to your doctors attention. Keeping track of your numbers may help your doctor determine a course of action or treatment. If variances in your blood pressure readings exist, it is important to know that there are some factors you can controlbut some you cant. Lets look at some of the reasons that may cause your blood pressure to fluctuate.
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