Normal Stress Blood Pressure

[Barb]

I am a IDDM, female, 42 years old who has been battling high blood pressure for about 4 years.  I now take an ACE Inhibiter, Beta Blocker and a Calcuim Blocker.  I have started to try to fit in exercise but only manage to get in 30 min 3X per week.  My blood pressure now has periods of low to normal when I am at home, relaxing quietly (100 - 130/65-85).  When I am at a doctors appointment or check my pressure at the grocery store, it is high (130-170/90-95).  These tend to be stressful times for me.  What are the pressure readings of a person who typically has normal blood pressure readings when they are under stress?    

Thanks!

[Cleveland Clinic, MD]

Your question reveals a very common misconception concerning blood pressure - that is if my blood pressure is high only during stress it does not need treated (or if already on treatment treated more aggressively).  The problem with this is that people do not live completely stress free lives. The reason we treat high blood pressure is to decrease the risk of stroke and heart attack.  The more time that one spends with elevated blood pressure the higher the risk.  Granted, if the BP is low during rest this is better than being high but the time spent in the high range (>85 diastolic and >130 systolic) increases this risk.  This is a rather long answer but I hope it addressed your question.

[Stan]

My blood pressure is almost always in the 150/90 range when taken in a doctor's office.  I am on Cozaar and a beta blocker for high bp, but it still was 150/90 at a recent checkup.  I was just put on a 24 hour bp monitor to see what my pressure is during a normal day's activity...results were 128/76 daytime, and 117/74 at night for averages.  As a result I was diagnosed as having "white coat stress syndrome", but I am still on the bp meds.  I do not get particularly nervous or stressed at my doctor's office, so this appears to be an involuntary reaction to having someone take your blood pressure.  I really don't know if the meds can help control this or not.

[Cleveland Clinic, MD]

With adequate medication this can (and I believe should) be controlled.

[John]

Approximately how higher or lower (in mmHg) is    the blood pressure when measured in lying(bed)    and standing position instead of sitting          position in average normal males?Thank you.John

[Barb]

Thanks for the information.  So, if anyone has a blood pressure reading above 130/85 under any stress condition it is still too high and should be treated.  I am already on a lot of medication (200 mg atenolol, 40 mg lotensin, 5 mg plendil per day). I am trying to exercise, but I am a single working mom and have trouble fitting it in.  I have managed to get in 30 min 3 to 4 times per week.  My BPs are still high sometimes - what else can I do?
Thanks,
Barb

[g]

If that is the case wouldn't that suggest that most of the world's population should be taking BP medication??  Surely most people's BP can top 130/85 without much difficulty when they are doing stressful stuff?  Okay, assuming only the most anxious personalities ... even then it's a huge number of people who are candidates for BP meds.  This whole area of non-sustained hypertension seems very vague to me and I've had little success getting consistent answers from anyone about it.  Also, for those people who have an 'over active' stress response like that are there any meds which can temper just the peaks in BP without dropping the BP too much at normal times.  Although I take atenolol to calm such a response in times of stress (and it's only 25mg's of atenolol) most of the day I feel lightneaded cuz my BP isn't real high all the time and the meds make my BP drop lower than normal.  I'm confused about the whole situation.  Every doctor I've ever seen has had a different opinion.  

G

[g]

John,
As I understand it ... and my own BP measurements would hold true ... the systolic pressure may fall slightly on standing and the diastolic increase slightly ... when lying the diastolic will be lowered and the systolic slightly elevated ... i don't know the physiology of it ... the last time I checked my own values:

Sitting: 115/71
Lying: 118/62
Standing: 108/78

I'm taking atenolol.

I'm not sure what the acceptable ranges in change are though.

G

[Cleveland Clinic, MD]

This is true that blood pressure is higher lying down and the reason is simple if you think about it.  When sitting or standing the heart has to pump "uphill" and the resulting pressure is lower.  There is normally a 10mmHg fall in blood pressure when standing.

[John]

What are acceptable normal limits of a diastolic blood pressure in lying and standing position in adults?Thank you. John

[Cleveland Clinic, MD]

< 90 seated is the current guideline for "normal" diastolic BP.

[Benny]

Are you saying there is 10 mmHg  fall in both (that is systolic and diastolic) or only in systolic blood pressure when measured in standing position? I thought that diastolic blood pressure is higher when measured in standing position.Thank you.Benny

[Benny]

Well my blood pressure is 120 over 80 in sitting position but it is 120 over 86-88 mmHg in standing position. Am I at risk and do I need treatment because of diatolic at 86-88 in standing position.What causes diastolic to be higher in (5-8mmHg) standing position?Thank you.Benny

[Barb]

There has been a lot comments to my question and so my follow-up question has gotten passed over.  I wanted to know what I can do to bring my BP down since I still experience highs in spite of all the medication I take. Dailey I take 200mg Atenolol, 40mg Lotensin and 5mg Plendil.  During busy or stressful times my BP can still range from 135-165/85-95.  At rest at home it is 115-125/77-85.  I am trying to fit in 30 min of aerobic exercise which I have been able to average doing 3-4 times per week.  It has helped a little.  Got any suggestions?  I realize that lower BPs are recommended for me because of the extra complication I have with ID diabetes.
Thanks,
Barb

[Cleveland Clinic, MD]

Benny - the drop in in systolic blood pressure.  Diastolic may rise but is not considered clinically important in this regard.

[Cleveland Clinic, MD]

Barb - There is not much data on this but I believe the lower the better.  It is during the times of elevated BP that damage to the organs occur.  I want my patients BP to be below this threshold for as much of the day as possible.  Granted it will rise during exercise and this is normal but otherwise it is not normal to have elevated blood pressure.  The only limitation to this approach is a too low a blood pressure at other times of the day leading to symptoms.

[John]

Well I know that <90 mmHg diastolic is a normal
blood pressure in sitting position. What about
in standing position?What would normal
(diastolic) blood pressure be in standing
position? What would normal blood prssure be during leisure walking around the house?Thank you.John

[Cleveland Clinic, MD]

80, 120/80

[Charles W.]

Two months ago I had a successful angioplasty with a coronary stent implant in the LAD artery region. Since that time I am troubled by transient episodes of "heavy heartbeat" or "thumping" with no attendant increase in pulse rate or chest pain. I have worn a 24 hour heart monitor, ekg, had a standard stress test (all showing no problems) and am in a hospital cardiac rehab program three days per week (no evident problems). I do have a diagnosed hiatal hernia and my cardiologist has suggested that the "heavy heartbeat" can be symptomatically associated with the hernia condition as there is no evidence of cardiac complications. Should I be overly concerned with this "thumping heartbeat" or can it indeed be symptomatic of the hernia?

[Cleveland Clinic, MD]

Usually symptoms of this sort are benign but be sure to keep your doctor informed of any changes.