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Medical Edge Newspaper Column from Mayo Clinic

DECREASED BLOOD PRESSURE WHEN STANDING COULD INDICATE ORTHOSTATIC HYPOTENSION

DEAR MAYO CLINIC: I have a friend whose blood pressure goes up when he lies down and goes down when he stands. Any suggestions as to cause/treatment? — Camanche, Iowa

ANSWER: Blood pressure varies throughout the day. Normally, blood pressure increases when you are active, such as during exercise, and decreases when you are resting. When you stand, sit or lie down, the body automatically accommodates for the change in position.

Your friend should work with a doctor to document the changes in his blood pressure, especially noting how much the blood pressure changes and if the changes are consistent.

If his blood pressure falls by more than 20 mm Hg when he stands, he has orthostatic hypotension — a condition where the reflex (called baroreflex) that regulates blood pressure is defective. One result is light-headedness when standing. With orthostatic hypotension, it’s not unusual for the blood pressure to increase when lying down (supine hypertension).

There are many causes of orthostatic hypotension, which is increasingly common after age 70. Causes include:

— Disorders of the autonomic nerves, which regulate blood vessel constriction and thus blood pressure. Autonomic disorders can be caused by diabetes, amyloidosis (an abnormal buildup of a protein in the nerves) and an autoimmune process in which the body’s immune system inappropriately attacks the autonomic nerve fibers.

— Multiple system atrophy (also known as Shy-Drager syndrome). This is a rare disorder that causes progressive damage to areas of the nervous system that control blood pressure, heart rate, sweating, breathing, digestion, and sphincter and sexual function. Multiple system atrophy is often accompanied by other neurologic findings such as ataxia (incoordination) or signs of Parkinson’s disease.

— Failure of the autonomic nervous system alone.

— Certain drugs, such as diuretics, used to control blood pressure.

Treatment is aimed at correcting the orthostatic hypotension and, if possible, the underlying cause of the condition. Finding the best treatment can be challenging because medication to treat low blood pressure poses the risk of increasing at-rest blood pressure to dangerous levels.

Researchers at Mayo Clinic have identified a medication option that seems to avoid this concern. In studies published in 2004 and 2006, researchers found that the drug pyridostigmine (brand name Mestinon) improved patients’ standing blood pressure without elevating blood pressure when lying down.

Because of the potential complexity of the condition, I suggest seeking evaluation and treatment from a subspecialist in autonomic disorders.

— Phillip Low, M.D., Neurology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Orthostatic Hypotension
Appointment Information
More Information on Hypotension

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Mayo Clinic Women’s HealthSource offers recommendations to help you reduce your overall cancer risk. Research suggests that there is power in numbers — meaning that the more prevention strategies you practice, the more you can reduce your overall risk of cancer.

Cancer prevention guidelines include:
— Don’t smoke.
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— Engage in daily moderate and weekly vigorous exercise.
— Eat five or more servings of vegetables and fruits a day.
— Choose whole grains over processed grains.
— Limit red meat to about three ounces a day.
— Limit intake of fatty foods, particularly those of animal origin.
— Limit alcoholic drinks to one (for women) and two (for men) daily.

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.