Low Blood Pressure When Lying Down

Causes Of Orthostatic Hypotension

• Fever
• Some medications, such as some diuretics or antihypertensive medications
• Dehydration due to vomiting, diarrhoea or both, as in gastroenteritis
• Certain conditions, such as anaemia, diabetes, varicose veins or adrenal insufficiency
• Nervous system disease, such as Parkinsons disease or neuropathy
• Heart problems, including irregular heart beat , congestive heart failure, aortic stenosis or heart attack
• Spinal cord conditions such as syringomyelia
• Shy Drager syndrome, a degenerative disorder of the brain and spinal cord that affects functioning of the autonomic nervous system
• Significant blood loss.

Can Dehydration Cause Trouble Breathing

Yes, without proper fluids, the body is unable to provide cells with enough energy. Water moistens the bodys bronchial tubes, lungs, and nasal passages. It also thins mucus and prevents coughing episodes. Drink at least 3.7 liters of water if youre a male and 2.7 liters of water if youre a female every day to stay properly hydrated.

What Is The Conventional Treatment

If youre healthy, lifelong low blood pressure that doesnt cause symptoms requires no treatment. However, if you develop low blood pressure suddenly your physician will want to identify and treat any underlying condition that might be responsible, if one can be found. Hypotension can be dangerous, especially if a person falls because of dizziness or fainting. Shock, a severe form of hypotension that can follow trauma and blood loss, is a life-threatening condition that is often fatal if not treated immediately.

If you have acute symptoms of low blood pressure, lie down and raise your feet above the level of your heart. Symptoms that do not go away very quickly upon sitting or lying down may indicate a medical emergency requiring immediate medical attention.

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Condition Causes Significant Drop In Blood Pressure Upon Standing

Dear Mayo Clinic:

My mother is 62 and has had very low blood pressure for two years. She was hospitalized with blood pressure that dropped from 200/78 in bed to 60/40 sitting up. What could be causing this and what can be done to treat her?

Answer:

Your mother has a condition called orthostatic hypotension. It happens when blood pressure falls significantly as a person stands up. Orthostatic hypotension can cause a variety of symptoms the most common are feelings of dizziness and faintness.

Blood pressure is a measure of the pressure in a person’s arteries during the active and resting phases of each heartbeat. When you stand, gravity causes your blood pressure to fall slightly as blood pools in your legs, lowering the amount of blood circulating back to your heart to pump. Normally, the drop in blood pressure is limited, though, because when you stand your nervous system triggers your blood vessels to narrow and your heart to beat faster. Sometimes, however, those nervous system responses do not happen the way they should, resulting in large swings in blood pressure from lying down to standing.

Symptoms of orthostatic hypotension usually get worse in hot weather or when you are dehydrated. Some medications can also increase symptoms of orthostatic hypotension, including blood pressure medications, medications used to treat Parkinson’s disease, antidepressants and bronchodilators, as well as caffeine, alcohol and appetite suppressants.

How Can I Prevent Orthostatic Hypotension

If youre prone to orthostatic hypotension, these steps can reduce symptoms:

• Keep your temperature moderate: Dont take very hot baths or showers.
• Stay hydrated: Drink plenty of water, limit alcohol and avoid heavy, high-carbohydrate meals.
• Dont sleep flat: Elevate your head at night by using more pillows or tilting the mattress.
• Prepare before standing: Give yourself more time to move into a standing position after sitting or lying down. Have something sturdy nearby to hold onto when you stand up.
• Move your muscles: March your feet if you must stand for prolonged periods. Do isometric exercises to raise blood pressure before standing.
• Support blood pressure: Wear compression stockings or an abdominal binder to improve blood circulation and pressure.

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Q What Should You Eat When Experiencing Low Blood Pressure

Along with constantly monitoring your symptoms, and managing your blood pressure, here are some useful diet tips that will help you raise your blood pressure:

• Drinking plenty of fluids- hydration is key, and dehydration can severely affect blood volume.
• Drink plenty of water through the day, especially after a workout session.
• Vitamin B12- lack of vitamin B12 can lead to anemia. So, you have to consume foods like eggs, cereals, and beef to avoid a dip in your blood pressure.
• Folate- folate helps keep blood pressure levels at a steady level, and foods like asparagus, liver, and garbanzo beans are rich in folate.
• Salt: Salty foods are known to increase blood pressure, and you can eat food like smoked fish, cottage cheese, canned soup, and olives.
• Caffeine: Caffeinated tea and coffee can spike your blood pressure by stimulating the cardiovascular system and giving your rate a boost.

Blood Pressure Differences When Lying Down Standing Up And Sitting

Written byDr. Victor MarchionePublished onMay 6, 2016

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.

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Influence Of Arm Position On Supine Bp Readings

In all, 25 subjects years, BMI 26.1±4.9 kg/m2, arm circumference right 29.5±0.7 cm and left 29.3±1.2 cm) participated in the study. Pregnant women, patients with BP differences between the two arms larger than 10mmHg and patients with arm circumferences larger than 35cm were excluded. The BP measurements were performed using two automatic oscillometric devices . All BP readings were taken simultaneously at both arms, with the subject comfortably supine on an examination bed with one small cushion under the head. To test for BP differences between the two arms, one BP reading was first performed with the patients in the described supine position and both arms placed on the bed, with the palms upwards. One arm was then supported with a specially designed pillow with the cubital fossa and upper arm at half-distance between the bed and the sternum , whereas the other arm remained on the bed . After 5min of rest, three BP and HR were measured, 1min apart. The arm position was switched thereafter, with the arm first supported on the pillow now being placed on the bed and vice versa. Again after 5min of rest, the three BP and HR readings were repeated.

Figure 1

Computerised tomography illustrating the difference between the arm levels used in the present study . R: right arm L: left arm RA: right atrium.

Whos At Risk For Labile Hypertension

Labile hypertension tends to be situational. This means the spikes occur in response to stressful events a fender bender, intensive physical exertion or thinking about financial woes, for example. This helps distinguish labile hypertension from true hypertension, in which blood pressure is high all the time.

Although hypertension can develop at any time, it raises a red flag when it occurs in young people or after age 60.

People who develop hypertension in their 40s particularly if they have a family history of hypertension are more likely to have essential hypertension than labile hypertension. They tend to be overweight or have underlying dietary issues, such as excessive sodium intake or heavy alcohol consumption.

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Proposed Classification Of Shoh

There is no accepted taxonomy of the SHOH syndrome but such classification may be useful for purposes of study and evaluation of treatment options. Classification of SHOH may be attempted according to symptomatology, chronicity of course, pathophysiology, patterns on tilt test, or results of autonomic and haemodynamic tests . The following are our proposed classifications:

Causes And Risk Factors

Although postural hypotension can occur in healthy elderly people, it is more common in those with extra risk factors, particularly prolonged bedrest and an age of over 74. It can complicate many conditions, including hypovolaemia and diabetes, and can be caused by a number of medications, such as diuretics and antihypertensives.

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Cuff And Arm Position

The procedure is very similar to measuring your blood pressure sitting down, except youre lying down. The major mistake people make is resting their arm directly on the bed. The American Heart Association specifically states if the arm is resting on the bed, it will be below heart level 1.

The AHA also states when measurements are taken in a lying down position the arm can be supported by a pillow so it can raise up to the same level as the right atrium. Just like in the sitting position, if the cuff is below heart level, your blood pressure reading will be unaccurate.

In a study published in the Journal of Human Hypertension, 25 people had their blood pressure measured while lying down. First, their measurements were performed with their right arms at the right atrium height. The second measurement was performed with the arm resting on the bed. The results showed both systolic and diastolic pressure were higher, 4.6 mmHg and 3.9 mmHg respectively, when the arm was resting on the bed 2.

This backs up other research findings when the BP cuff is below heart level, while sitting. The readings are higher than when at the correct heart level. You can read about it here in my blog post, Effect of Arm Position On Blood Pressure.

Additional Tips For Measuring Blood Pressure Lying Down

• Dont eat or drink caffeine 30 minutes prior to your blood pressure measurement. Caffeine and coffee can cause a temporary spike. I wrote a whole blog post on how coffee affects your BP, short and long-term. You may be surprised about the long-term effect, you can read about it right here, Does Coffee Raise Blood Pressure.
• Dont measure your blood pressure with a full bladder. It can raise your systolic pressure by 10 to 15 mmHg 3.
• Always measure your blood pressure prior to taking any medication. In addition, most medical experts recommend measuring in the morning after relaxing and before eating.
• Dont smoke 30 minutes prior to measuring your blood pressure.
• Avoid any exercise within 30 minutes because it can affect your readings 4.
• Dont take any cold or warm showers before measuring your pressure.
• Use the correct size BP cuff.
• Make sure the cuff is positioned properly on the arm. This can be as critical as using an incorrect cuff size. Read more about how to do it correctly in my blog post, Blood Pressure Cuff Placement.
• Dont text, talk on the phone or watch television while relaxing or measuring your pressure.
• Take two to three measurements and keep a log of your results. Most newer home monitors store the information on the machine or a phone app. In addition, you can send the results to your physician through the app. If youre looking to upgrade your home monitor, you can check out the one I use here in my blog post, Home Blood Pressure Monitors.

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How Can You Prevent Low Blood Pressure Symptoms

If you have orthostatic hypotension, your doctor may suggest that you try some simple ways to prevent symptoms like dizziness. For example, you can:

• Stand up slowly.
• Drink little or no alcohol.
• Limit or avoid caffeine.
• Wear compression stockings.

If you feel dizzy or light-headed, sit down or lie down for a few minutes. Or you can sit down and put your head between your knees. This will help your blood pressure go back to normal and help your symptoms go away.

Blood Pressure Measurement Part : Lying And Standing Blood Pressure

15 July, 2007

VOL: 103, ISSUE: 20, PAGE NO: 24

Phil Jevon, PGCE, BSc, RN, is resuscitation officer/clinical skills lead, Manor Hospital, Walsall, and honorary clinical lecturer, University of Birmingham Medical School

John Holmes, MA, Cert Ed, DPNS, RMN, RN, is senior lecturer, pre-registration adult nursing, University of Wolverhampton

In healthy patients there is normally little difference between lying and standing blood pressure.

However, a significant fall can occur in older people, patients with diabetes and those with symptoms suggesting postural hypotension . It is advisable to measure both lying and standing blood pressure routinely in these patients.

Blood pressure measurement in the presence of atrial fibrillation, particularly when the ventricular rhythm is extremely irregular, is unreliable and may be improved with repeated measurements. Some automated devices may provide unreliable readings in the presence of atrial fibrillation . Auscultation using a mercury device may provide a more accurate reading.

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Blood Pressure When Laying Down

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Are Orthostatic Hypotension And Postural Tachycardia Syndrome The Same Condition

Postural tachycardia syndrome, or POTS, causes symptoms similar to orthostatic hypotension. Both cause dizziness or fainting upon standing. Along with a drop in blood pressure, POTS causes a heart rate increase of 30 to 40 beats per minute within 10 minutes of standing. POTS is less common than orthostatic hypotension.

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When You Should Take Blood Pressure Lying Down

As mentioned earlier, BP should be taken sitting down unless conditions exist which doesnt make it feasible. Under this situation youll have to ask, should I take blood pressure lying down?

Blood pressure should be taken lying down for the following reasons:

When diagnosing or treating postural hypotension.

When diagnosing or treating orthostatic hypertension.

When diagnosing or treating supine hypertension.

The patient is hospitalized.

The person is confined to a bed at home.

Postural Hypotension: This occurs when blood pressure is abnormally low when a person stands up from a lying down or sitting position. The decrease may recover closer back to the persons normal pressure or remain lower. Its also known as orthostatic hypotension 4.

To help diagnose and treat the condition, blood pressure will be measured while lying down and standing up. Orthostatic Hypotension can be caused by the following:

• Old age
• People who dont experience a drop in BP when sleeping.
• Supine hypertension

Orthostatic Hypertension: This is the opposite of postural hypotension. This condition is when a persons blood pressure increases while standing up 5.

This can occur for the following reasons:

• Elderly people
• Fluctuations in blood pressure and heart rate.
• An increase in the heart rate and change in blood pressure when standing up.
• When an artery in the back gets compressed.
• Conditions that cause the autonomic nervous system not to work properly.

What Therapies Does Dr Weil Recommend For It

If you experience dizziness or lightheadedness, see your physician to rule out any underlying medical problems and to check your medications. Getting the appropriate amount of salt in your diet and making sure that you drink plenty of water may help normalize your blood pressure. In addition, tonic supplements such as ginseng can help increase energy and normalize blood pressure. Whole licorice can also help raise low blood pressure.

If you are in good health and have no symptoms related to low blood pressure, consider it an advantage that will minimize your risk of the common forms of cardiovascular disease.

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Q What Can Cause Low Blood Pressure

Your blood pressure can vary throughout the day. It depends on your body position, breathing patterns, stress levels, physical activities, medications, what you eat or drink, and the time. Some of the main medical conditions that can cause low blood pressure are:

• Pregnancy
• Nutrition deficiency in the diet
• Certain antidepressants

Changing The Diameter Of Arterioles And Veins

Muscle tissue within the walls of arterioles allow these blood vessels to widen or narrow . The more constricted arterioles are, the greater their resistance to blood flow and the higher the blood pressure. Constriction of arterioles increases blood pressure because more pressure is needed to force blood through the narrower space. Conversely, dilation of arterioles reduces resistance to blood flow, thus reducing blood pressure. The degree to which arterioles are constricted or dilated is affected by

• Nerves that contract smooth muscle in the arterioles, thus reducing their diameter

• Hormones that are primarily made by the kidneys

• Certain drugs

Veins also play a role in the control of blood pressure, although their effect on blood pressure is much less than that of arterioles. Veins dilate and constrict to change how much blood they can hold . When veins constrict, their capacity to hold blood is reduced, allowing more blood to return to the heart from which it is pumped into the arteries. As a result, blood pressure increases. Conversely, when veins dilate, their capacity to hold blood is increased, allowing less blood to return to the heart. As a result, blood pressure decreases.

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