Blood pressure lying down

Ask the experts

To what extent do blood pressure measurements vary depending on position, i.e., sitting, standing, or lying down? Also, if the arm is allowed to hang down vertically instead of resting horizontally, what effect does this have on the blood pressure measurements? Finally, what effects do any of these variations have on the prescribed treatments for high blood pressure?

Doctor’s response

When the blood pressure (BP) is measured, the arm should be at the level of the heart. In other words, in the sitting and standing positions, the arm should be extended out straight and should be about 2-3 inches below the shoulder to approximate the level of the heart. If the arm is allowed to hang down straight, the BP may be falsely diminished by as much as 12 mm Hg. below its true value. This is not an issue when the person is lying down, as long as the arm is kept along side at the level of the body.

Normally, properly taken BP measurements show only minor variations with changes in position. Certain patients with an imbalance of the autonomic nervous system (ANS), however, may tend to have a fall in BP with the upright position. The ANS normally controls constriction (narrowing) and dilation (widening) of blood vessels and so helps regulate a person’s BP. Such a fall in BP with standing is called postural hypotension (low blood pressure), which, when significant, can cause weakness, lightheadedness, and even fainting. The treatment of high blood pressure (hypertension) with medications in these patients may actually lead to an excessive fall in BP with standing. The doctor might, therefore, prescribe more limited treatment of hypertension for these patients.

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Postural (orthostatic) hypotension is when your blood pressure drops when you go from lying down to sitting up, or from sitting to standing. When your blood pressure drops, less blood can go to your organs and muscles. This can make you more likely to fall, and falls can be dangerous.

Although many people with postural hypotension have no symptoms, others do. These symptoms can differ from person to person, and may include:

  • Dizziness or lightheadedness
  • Feeling about to faint, passing out, or falling
  • Headaches, blurry or tunnel vision
  • Feeling vague or muddled
  • Feeling pressure across the back of your shoulders or neck
  • Feeling nauseous, or hot and clammy
  • Weakness or fatigue

Postural hypotension can be caused by or linked to:

  • High blood pressure
  • Diabetes, heart failure, atherosclerosis, or hardening of the arteries
  • Taking some diuretics, antidepressants, or medicines to lower blood pressure
  • Neurological conditions like Parkinson’s disease and some types of dementia
  • Dehydration
  • Vitamin B12 deficiency or anemia
  • Alcoholism
  • Prolonged bed rest

How to manage postural hypotension

  • Tell your health care provider about any symptoms.
  • Ask if any of your medicines should be reduced or stopped.
  • Get out of bed slowly. First sit up, sit on the side of the bed, then stand up.
  • Take your time when changing position, such as when getting up from a chair.
  • Try to sit down when washing, showering, dressing, or working in the kitchen.
  • Exercise gently before getting up (move your feet up and down and clench and unclench your hands) or after standing (march in place).
  • Make sure you have something to hold on to when you stand up.
  • Don’t walk if you feel dizzy.
  • Drink 6-8 glasses of water or low-calorie drinks each day—unless you have been told to limit your fluid intake.
  • Avoid taking very hot baths or showers.
  • Try sleeping with extra pillows to raise your head.

If you have symptoms often, see your doctor for a check-up.

What Your Blood Pressure Says About You

Doctors have been measuring patients’ blood pressure, the force that blood exerts on the inside walls of your vessels — since the first sphygmomanometers (yes, that’s what blood pressure cuffs are called) were invented at the beginning of the 20th century.

Doctors are still finding new ways to glean information about your health from these numbers. British researchers recently found differences in blood pressure between the right and left arms might be a sign of vascular disease. Likewise, a difference in blood pressure when you’re lying down vs. standing up may indicate heart problems or blood vessel disease. Doctors can tell that from a painless test that takes only a few minutes.

The Basics: What Does Blood Pressure Mean

The most important thing to know about your blood pressure is whether or not it’s high. A blood pressure reading consists of two numbers, with acceptable ranges for each one. The first, or top, number is called the systolic number. That’s the pressure inside your arteries when your heart beats. The bottom, or diastolic, number is the pressure between beats. You want those numbers to be below 120 and 80, respectively.

“What high blood pressure means is too much resistance inside your arteries,” says Ivan V. Pacold, MD, a cardiology professor at Loyola University’s Stritch School of Medicine and director of cardiology at Gottlieb Memorial Hospital in Chicago. “Simply speaking, that causes arterial damage and increases your risk for stroke, heart attack, heart failure, and kidney failure.”

The Lowdown on Low Blood Pressure

“In a healthy person, low blood pressure is a sign of good health as long as the systolic pressure is above 80,” explains Dr. Pacold. “Very low blood pressure in a person with heart disease could be a sign of heart failure.”

One type of low blood pressure that could predict future heart problems is called orthostatic hypotension. In this type of low blood pressure, “there is a drop of 10 to 20 points of blood pressure when a person moves from a sitting or supine (flat) position to a standing position,” Pacold says. “It causes a sudden sense of lightheadedness and can be due to a heart that is starting to have trouble compensating.”

A recent study on orthostatic hypotension published in the journal Hypertension followed more than 12,000 adults for about 17 years. None of them had heart failure at the start. People who had episodes of orthostatic hypotension during the study period, especially between the ages of 45 to 55, were more likely to develop heart failure by the end.

Blood Pressure Differences Between Arms

Has your doctor ever measured your blood pressure in both arms? “Not a bad idea,” says Pacold. “Finding blood pressure differences between one side of the body and the other can be a warning sign for atherosclerosis in the main blood vessel leaving the heart or elsewhere in the body. It is a signal that you need to look further.”

Research published in the British medical journal The Lancet found that a blood pressure difference of 10 to 15 points between arms increases the risk for dying from a stroke or from heart disease. Having a difference of 15 points or more was found to double the risk for peripheral artery disease (PAD), a condition that affects more than 12 million Americans. Researchers concluded this after reviewing 20 studies that recorded blood pressure differences between arms.

Getting Blood Pressure Help

You should get your blood pressure checked during your routine doctor visits, or at least once every two years, according to the American Heart Association. “Blood pressure is called the silent killer because there may be no symptoms until damage is already being done,” Pacold says. “You can prevent that damage by getting early diagnosis and treatment.” Here are some takeaway tips:

  • Blood pressure readings from 120 to 139 (systolic) or from 80 to 89 (diastolic) are considered to be pre-hypertension. You may need to have your blood pressure checked more frequently.
  • If your blood pressure readings stay at or above 140 and 90 over time, your doctor may start you on a treatment program.
  • Any time you have a blood pressure reading of over 180 systolic or over 110 diastolic, check it again. If it is still that high, you need to get emergency blood pressure help right away.

Your blood pressure readings can tell you and your doctor a lot about your current health and may even predict future problems. If you are concerned about PAD or if you have episodes of feeling dizzy when you stand up, talk to your doctor. Checking your blood pressure, both sitting and standing and in both arms, is a great way to learn more about what’s going on inside your arteries.

For the latest news and information on living a heart-healthy lifestyle, follow @HeartDiseases on Twitter from the editors of @EverydayHealth.

Embargoed until 3 p.m. CT / 4 p.m. ET Friday, Sept. 6, 2019

NEW ORLEANS, Sept. 6, 2019 — Applying a heating pad overnight may help people with supine hypertension, a condition that causes their blood pressure to increase when they lie down including during sleep, according to preliminary results presented at the American Heart Association’s Hypertension 2019 Scientific Sessions.

Supine hypertension is present in about half of people with autonomic failure, a chronic degenerative disease that affects the part of the nervous system that regulates involuntary functions such as blood pressure and heart rate. Overnight increases in blood pressure are associated with damage to the heart and kidneys. It can also increase urine production, which can worsen a condition where a person’s blood pressure rapidly drops upon standing, such as when first getting out of bed in the morning.

Researchers studied 10 patients with autonomic failure and supine hypertension. The average age of the study participants was 76 years, with a systolic (upper number) blood pressure of 168 mm Hg measured in the lying position. During the two-night study, participants received heat at 100 degrees Fahrenheit from a medical grade heating pad placed under their torso on one night, and an unheated pad on the other. Supine blood pressure was monitored every two hours from 8 p.m. to 8 a.m., and heat therapy was applied from 10 p.m. to 6 a.m.

The researchers found that heat therapy applied during sleep decreased systolic blood pressure, with a maximum reduction of 30 mm Hg after four hours of heat. Despite lowering overnight systolic blood pressure, heat therapy did not decrease nighttime urine production or improve the sudden drop in morning blood pressure.

“In many patients with autonomic failure, heat exposure decreases blood pressure by shifting blood to skin vessels,” said Luis E. Okamoto, M.D., study author and research assistant professor of medicine at Vanderbilt University Medical Center in Nashville, Tennessee. “The use of local, controlled heat therapy may be a novel and simple approach to treat supine hypertension in these patients without using medications; however, additional studies are needed to assess the long-term safety and efficacy of this approach.”

Among the study’s limitations are its small size and its focus on primary forms of autonomic failure, which is a rare condition. Although the study population was Caucasian, the researchers anticipate that the results may be applicable to other ethnic groups.

The National Institutes of Health funded this study.

Blood Pressure Information

What is blood pressure?

Blood pressure is the pressure of the blood in the arteries as the heart pumps it around the body.

How is blood pressure measured?

Blood pressure is usually measured by wrapping an inflatable pressure bag around the upper arm. The bag is connected to a mercury ( aneroid ) or digital pressure-measuring device. The entire instrument is called a sphygmomanometer (sfig-mo-mah-nom-eh-ter).

Blood pressure is recorded as two numbers, for example 120 over 80 (120/80). The higher number indicates the pressure in the arteries as the heart squeezes blood out during each beat. It is called the systolic blood pressure. The lower number indicates the pressure as the heart relaxes before the next beat. It is called the diastolic blood pressure. Blood pressure is measured in millimetres of mercury (mmHg).

It is best to measure blood pressure when you are relaxed and sitting or lying down.

Blood pressure varies

Blood pressure does not stay the same all the time. It is always changing to meet your body’s needs.

If a reading is high, your doctor will probably measure your blood pressure again on several occasions to confirm the level. Your doctor may also recommend that you measure your blood pressure at home or have a 24-hour recording with a portable monitoring device, particularly if he or she suspects that coming to the clinic makes your blood pressure rise.

You can read more about measuring your own blood pressure in our information sheet Self-measurement of blood pressure

What is high blood pressure?

There is no firm rule about what defines high blood pressure. Your risk of heart, stroke and blood vessel disease increases as your blood pressure increases, and for most people, the lower the blood pressure the better. However, the following figures are a useful guide.

Normal blood pressure:
Generally less than 120/80 mmHg (i.e. systolic blood pressure less than 120 and diastolic blood pressure less than 80 mmHg). This is a guide only.

Normal to high blood pressure:
Between 120/80 and 140/90 mmHg. High blood pressure: 140/90 mmHg or higher. If your blood pressure is 180/110 mmHg or higher, you have very high blood pressure.

Note: The word hypertension is the medical term for high blood pressure. Hypertension does not mean nervous tension.

Why does blood pressure matter?

If your blood pressure remains high, it can lead to serious problems such as a heart attack, a stroke, heart failure or kidney disease. High blood pressure usually does not give warning signs. You can have high blood pressure and feel perfectly well. The only way to find out if your blood pressure is high is by having it checked regularly by your doctor.

The following factors increase the risks of serious problems associated with high blood pressure:

  • Smoking
  • Having high blood cholesterol
  • Being overweight

What can I do if I have high blood pressure?

Your doctor is likely to measure your blood pressure several times on several occasions to confirm the diagnosis of high blood pressure. He or she may recommend that you do a test that measures your blood pressure over a 24-hour period, or that you measure your own blood pressure at home.

Your lifestyle is very important in helping you to control high blood pressure and its associated risks. Your doctor will probably advise you to:

  • Be smoke-free (for information on quitting smoking, call the Quitline on 13 QUIT)
  • Reduce your salt intake
  • Achieve and maintain a healthy body weight
  • Limit your alcohol intake to no more than two drinks per day (for men), or one drink per day (for women)
  • Undertake regular physical activity.

Note: some specific types of exercises should be avoided by people with high blood pressure. These include body presses and lifting heavy weights.

Many people with high blood pressure will need to take medicines for the long-term that help to lower it. It is important that you take any blood pressure medicine exactly as it is prescribed. Don t stop taking it or change the dose without talking to your doctor first.

Normal blood pressure (less than 120/80 mmHg)

There are several ways that you can help to keep your blood pressure under control and reduce the risk of heart disease.

Have your blood pressure checked regularly, as part of an assessment of your overall risk of heart, stroke and blood vessel disease. The higher your risk, the more often that you should have these checks.

  • Be smoke-free.
  • Limit your alcohol intake.
  • Achieve and maintain a healthy body weight.
  • Be active every day accumulate 30 minutes or more of moderate physical activity on all or most days of the week. Try walking, cycling or any physical activity that you enjoy.
  • Enjoy healthy eating. Choose mainly plant-based foods, such as vegetables, fruits and legumes (dried peas, dried beans and lentils), and grain-based foods (preferably wholegrain), such as bread, pasta, noodles and rice. Consume moderate amounts of lean meats, poultry, fish and reduced fat dairy products, and moderate amounts of polyunsaturated or monounsaturated fat.

© 2008 National Heart Foundation of Australia ABN 98 008 419 761

Self-measurement of blood pressure

Advantages of measuring your blood pressure at home
Blood pressure changes from moment to moment. Some of the things that can affect blood pressure are body position, emotional state, physical activity and sleep. If you have high blood pressure, altering your lifestyle may be all that is required to lower it. In other cases, you may also need to take one or more medicines.

Measuring your blood pressure at home and/or at work, with your own equipment, gives your doctor a guide to what your blood pressure is outside the clinic during your usual activities. It will also help your doctor to know whether any prescribed treatment is working.

Taking your blood pressure at home will give you a better understanding of your condition and will help you to be more actively involved in your own management.

How often should I measure my blood pressure?

This depends on your condition and treatment, and on what your doctor thinks is most relevant for you.

Typically, over the course of a week, you may be asked to measure your blood pressure first thing in the morning, two to four hours after taking your blood pressure medicine, and just before going to bed.

Once your doctor is happy with your blood pressure levels, you should take regular readings about two to three times a week. This will help you to keep up your skills in taking accurate readings. Your doctor may also ask that you take your blood pressure while lying down and/or standing.

Your blood pressure chart should be taken to your doctor at each visit. For some people who have high blood pressure readings at the clinic, your doctor may need your own recordings to help guide treatment decisions.

High Blood Pressure Questions Answered by Cardiologists

30-year-old Male with BP 164/106 and Overweight

Question: Do you have any recommendations for a program for an overweight 30-year-old male with blood pressure 164/106?

Answer: In addition to lifestyle measures such as regular physical activity and weight control, a large body of very solid medical evidence suggests that medications help to control blood pressure and lower the risk of complications, especially stroke. I cannot ascertain your particular target level of blood pressure without knowing more about your specific medical condition; however, if your systolic blood pressure (the upper number) exceeds 140, or 130 if you have kidney disease or diabetes, you should be on medication. For a summary of the current U.S. guidelines for blood pressure treatment, click here.

For a specific program, there are no quick fixes. In general, making physical activity a part of your daily routine, and changing your eating habits in sustainable and incremental ways that lead to gradual weight loss until you achieve your target weight, and then allow you to maintain that target weight, is more desirable than a “crash” diet program. Set yourself up for success by having realistic goals. Often a weight loss of only 5 or 10% of one’s body weight can make enormous inroads against cardiovascular risk factors such as high blood pressure. You should have a medical evaluation before embarking on a vigorous exercise program, but you don’t need a stress test before making walking part of your life. Every day presents opportunities for making healthy choices: Take the stairs rather than the elevator if you are only going up a few flights. Don’t fight for the parking space near the mall entrance; instead, walk from a more distant spot. Try a piece of fruit instead of ice cream or cake for dessert. And cut out sugary beverages — such drinks represent “empty calories” without nutritional value. You can easily learn to live without them, and eliminating them is an easy way to lose weight.

Blood Pressure Is Higher At Night Than Originally Thought

Blood pressure measured near the heart is significantly higher during sleep than originally thought, according to a new technology developed by scientists at UCL.
Blood pressure at night is an important predictor of both stroke and heart disease, with previous research suggesting that blood pressure calculated via the arm decreases at night during sleep. But the current study reveals that night-time reduction in blood pressure may be less significant than originally thought.
The findings, published in the journal Hypertension, reveal important implications for the assessment of future therapies, because drugs used to treat high blood pressure can have widely different effects on pressure near the heart, compared to the historic method of the arm.
The researchers worked with a Singaporean technology company to develop a portable wrist watch-based device that has a sensor in the strap that finds the pulse wave at the wrist, instead of calculating the pressure directly.
By modeling the pulse wave mathematically, the team was able to correctly calculate pressure at the aortic root (near the heart) for a full 24 hours without bothering the people who were being monitored.
Lead author Professor Bryan Williams, who is also Director of the NIHR University College London Hospitals Biomedical Research Centre, says:
“High blood pressure is a major risk factor in the development of cardiovascular disease (heart attack, stroke). It affects over 12 million people in the UK and is the single most important preventable cause of premature death.
This study provides the first ever description of the natural variation in blood pressure throughout the day and night in which measurements have been taken close to the heart. What we have shown is that pressures by the heart do not dip as much during sleep as we previously thought based upon conventional pressure measurements taken from the arm.”
The authors hope their results emphasize the importance of decreasing blood pressure at night, possibly changing approaches to treating and measuring high blood pressure.
Previous research suggests that insufficient sleep is associated with high blood pressure. The risk for unhealthy blood pressure levels rise when sleep patterns are irregular.
Prof. Williams and team found that by simultaneously calculating the trends of brachial blood pressure (in the arm) and central aortic pressures (where blood exits the heart), there was a significantly decreased night-time drop in central aortic pressure relative to the corresponding night-time drop in brachial pressure, despite similarities in the circadian rhythms.
The outcomes suggest that night-time aortic pressures are disproportionately higher than brachial pressures during sleep. This could be important information for clinicians examining the negative impact high blood pressure can have on the heart and brain.
Dr Peter Lacy (UCL Institute of Cardiovascular Science), a co-author on the paper, concluded:
“The fact that the watch can be worn continuously means that we can programme the device to sample the pulse wave day and night and obtain measurements of the aortic pressure over a 24 hour period. This allows us to accurately measure aortic pressure in a non-invasive way.”
Written by Kelly Fitzgerald

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