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High Blood Pressure Readings Taken While Lying Down May Better Predict Heart Health Issues
Fact checked by Nick Blackmer
Getting your blood pressure taken while lying down may provide a more accurate reading that could point to cardiovascular risks, new research finds.
Researchers agree that the gold standard of having blood pressure taken—sitting up—is not wrong, even with the new study's findings.
Experts recommend people prioritize understanding their blood pressure numbers and acting on them, as high blood pressure can increase someone's risk of dangerous cardiovascular events.
Getting your blood pressure taken while you're lying down may provide more accurate results, new research finds.
There's a reason you get your blood pressure taken every time you go to the doctor's office. Blood pressure can often predict certain health severities that are important to take note of—the risk of stroke, heart disease, and even premature death.
That said, it's important to get the most accurate blood pressure reading for the sake of taking action for your health.
Earlier this month, the American Heart Association (AHA) presented findings regarding how the physical position someone is in while having their blood pressure taken can impact their blood pressure reading, which can in turn impact how well they're able to predict certain health risks.
It all comes down to from which position an adult receives a high blood pressure reading.
Adults who displayed high blood pressure while sitting upright and lying flat on their backs, had a higher risk of stroke, heart failure, premature death, and heart disease, compared to those who did not have high blood pressure when recorded at either position.
Additionally, adults who had high blood pressure readings while lying on their backs but not sitting upright had similar risks of these same heart health complications who had high blood pressure recorded while both sitting upright and lying down.
Lead study author Duc M. Giao, a researcher and a 4th-year medical student at Harvard Medical School, told Health that he "did not expect supine blood pressure to be such a potent predictor of cardiovascular disease events or for blood pressure to vary so much in the supine position" heading into the research.
So, are doctors doing something wrong by measuring blood pressure while the patient is sitting up versus lying down?
"Physicians measuring blood pressure while patients are sitting upright are not doing anything wrong and that is currently standard practice," Giao said.
Here's why your physical position matters to the outcome of a blood pressure reading and whether or not it's worth requesting to get your blood pressure taken in a different position than normal.
Getty Images / Luis Alvarez
Understanding How Physical Positions Impact Blood Pressure ReadingsThe data for the new study came from 11,369 adults who were part of the Atherosclerosis Risk in Communities (ARIC) study. Data on the participants' seated and supine blood pressure were gathered during the study's enrollment period which took place from 1987 to 1989.
The average participant age was 54, with 56% of participants identifying as female, and 25% identifying as Black. They were followed for 25 to 28 years, with final data collection taking place from 2011 to 2013.
16% of participants who did not have high blood pressure while seated were found to have high blood pressure while lying down. Separately, 74% who had high blood pressure while sitting upright also had high blood pressure while lying flat on their backs.
Those with high blood pressure at both positions showed a 1.6 times higher risk of coronary heart disease, a 1.83 times higher risk of heart failure, 1.86 times higher risk of stroke, a 1.43 times higher risk of premature death, and a 2.18 times higher risk of dying from coronary heart disease.
Additionally, those whose blood pressure readings were high while lying down but not when sitting upright showed similar elevated risks of heart health issues as those whose blood pressure was high in both positions.
According to Giao, a person's autonomic nervous system regulates blood pressure in various body positions "to provide stability."
"However, gravity causes blood to pool in the lower extremities when seated and upright," he said. "If the body is unable to regulate these changes there will be changes in blood pressure between both lying, seated, and standing positions."
Gregory Katz, MD, a cardiologist at NYU Langone Heart and assistant professor at the Leon H. Charney Division of Cardiology at NYU Grossman School of Medicine, said that it's important to put studies like this in context.
As in, you shouldn't be alarmed if you're getting your blood pressure read while sitting upright during your next annual physical.
Katz explained that anything that raises adrenaline levels will also raise blood pressure. So if someone is stressed or in pain, their blood pressure will rise.
"So, in looking at this study, you have a small number of people who have a discrepancy between blood pressure sitting down versus blood pressure when they are lying [down]," he said.
According to Katz, this could be because there are people who, when their blood pressure is taken, will always be at "elevated cardiovascular risk."
Related: 13 Effective Ways to Lower Your Blood Pressure
Choosing to Get Blood Pressure Taken While Lying DownAccording to Giao, people who have elevated blood pressure while in a seated position should consider checking their supine blood pressure, too.
"This could help identify supine hypertension, which is a strong predictor of fatal and nonfatal cardiovascular events," he said.
Katz reiterated how important it is to put findings from very specific trials like this one in context.
"I think that the message here for patients is that high blood pressure is bad, and identifying that you have high blood pressure is a really important part of cardiovascular intervention," he said. "But, I hesitate to identify the specific patient or group of patients that need to have their blood pressure taken while lying down."
Looking ahead, Giao said he and his colleagues will compare supine blood pressure in the clinical setting with blood pressure measurements overnight.
But for now, he said his research suggests that elevated blood pressure measurements "can be detected while supine if measured and could be a useful method of detection of increased cardiovascular risk in the clinic setting."
He stressed that people with known or suspected cardiovascular risk could consider asking their provider for their supine readings to be checked as well.
While Katz agrees that there is a possibility of different circumstances leading to different blood pressure readings, his main worry is overcomplicating the process for patients.
"I think the more you overcomplicate it the more you are likely to confuse people and to give patients an additional task to do or additional thing to be anxious about," he said.
At the end of the day, all of this underscores just how important being on top of one's heart health is.
"Just knowing your numbers is important and high blood pressure is one of the most important numbers to know for people who want to understand their heart disease risk," Katz said. "Being proactive and having their blood pressure read is something you can do to take control of your health."
Related: What Is a Healthy Blood Pressure Reading—And How Can You Keep Yours in a Normal Range?
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When Is Blood Pressure High Enough To Go To The Hospital?
Medically reviewed by Jeffrey S. Lander, MD
If your blood pressure spikes dangerously high, it is a medical emergency. A high spike in blood pressure may occur in people with known high blood pressure, in those who are pregnant, or in people with no known history of high blood pressure.
A blood pressure of 180/120 millimeters of mercury (mm Hg) and higher along with the presence of additional symptoms, such as chest or back pain, shortness of breath, vision, changes, or difficulty speaking, signals a hypertensive crisis that needs immediate emergency treatment at a hospital.
If you don't have additional symptoms, your healthcare provider is less likely to recommend treatment in a hospital but will take measures to control your blood pressure.
This article will explore how high is too high when it comes to blood pressure. You will learn what numbers will lead to a diagnosis of high blood pressure, and what blood pressure readings or symptoms should prompt a visit to a hospital emergency department.
High Blood Pressure: When to Go to the HospitalIf you visit a healthcare provider regularly, you may notice blood pressure readings that have climbed steadily over time. If you fail to control it, your rising blood pressure can reach dangerous levels. This can also happen suddenly with certain health events, such as a stroke.
Emergency-level high blood pressure is considered either hypertensive urgency or a hypertensive emergency, as defined below, based on what symptoms you have and whether your blood pressure decreases with additional measurements:
Hypertensive urgency is a blood pressure of 180/120 and higher with no significant symptoms.
Hypertensive emergency is a blood pressure of 180/120 and higher with the presence of symptoms that could signal additional problems.
Symptoms that can cause concern alongside high blood pressure and lead to a diagnosis of hypertensive crisis include:
Hypertensive urgency should prompt a call to your healthcare provider if you've already been diagnosed with high blood pressure. If you are already being treated for high blood pressure, hypertensive urgency may lead to a change or increase in your medications.
However, if you are having symptoms of a hypertensive crisis or your blood pressure spikes suddenly without a history of hypertension, do not wait to seek medical care. Call 911 immediately or head to your nearest emergency department.
Hospital Treatment for Dangerous High Blood PressureThe first step in treating dangerously high blood pressure is to determine if it is an isolated event, part of a chronic blood pressure problem, or related to some other medical emergency.
Underlying conditions that can contribute to a hypertensive emergency include the following:
Preeclampsia (high blood pressure in pregnancy)
Stroke (an interruption in the blood supply to your brain) or head trauma
Scleroderma renal crisis (high blood pressure that leads to kidney damage in people with scleroderma)
Sympathomimetic intoxication (agitation due to intoxication)
Hyperthyroidism (overactive thyroid gland)
Other endocrine disorders
Missed doses of blood pressure medications
Uncontrolled high blood pressure
Pain
Acute urinary retention (inability to pass urine)
Kidney diseases
If one or more of these conditions are suspected, your healthcare team will not blindly or generically treat your blood pressure. Instead, the underlying cause will be addressed with a targeted treatment and the assumption that treating that cause will, in turn, treat your blood pressure.
For some of these conditions, you may be given medication to lower your blood pressure immediately or for a short time, but ongoing treatment will focus on resolving the underlying condition or problem. The amount of damage to organs like the heart, kidneys, lungs, and other organ systems will factor into how your blood pressure is treated going forward.
Issues caused by severely high blood pressure that require urgent treatment include:
Acute kidney injury (kidney damage or failure that occurs suddenly)
Hypertensive encephalopathy (high blood pressure from mental status changes)
Aortic dissection (a tear in your aorta)
Acute pulmonary edema (buildup of fluid in your lungs)
Heart attack
The source of your high blood pressure and how much damage it may have caused will be investigated with diagnostic tests like:
Clear issues involving an overload of fluid, pain, agitation, or drug withdrawal may also be treated separately.
If your high blood pressure is not improving with treatment of an underlying cause, you will likely be given intravenous medications that can quickly reduce your blood pressure to prevent secondary problems.
Which antihypertensive (medication to lower blood pressure) your healthcare team chooses may depend on what they determine to be an underlying or contributing cause.
Time MattersTreating excessively high blood pressure is a time-sensitive problem. Dangerously high blood pressure for even a short time can put you at risk of more problems, like a stroke.
If you have a blood pressure reading with a systolic (top) number in the 180s or higher and a diastolic (bottom) number in the 120s, your goal typically will be to identify and treat the underlying cause and/or your blood pressure quickly.
One study that compared the use of intravenous nicardipine to labetalol in treating hypertensive emergency found that nicardipine helped people achieve a target blood pressure within 30 minutes in more cases than labetalol. Your healthcare provider will use all of your personal health information and assessment data to choose the best possible medication for your situation.
Risks of Unmanaged High Blood PressureA hypertensive crisis is a medical emergency that must be treated quickly and effectively to avoid possibly fatal consequences.
Blood pressure can creep up slowly over time, though, and having high blood pressure that you don't manage well over long periods of time can take just as dangerous a toll on your body.
High blood pressure is commonly referred to as a "silent killer" since it can develop gradually over time with almost no symptoms until it creates a serious problem. Over time, high blood pressure—or hypertension—can contribute to a range of problems with your heart, brain, kidneys, and circulatory system.
You may receive a high blood pressure diagnosis in different categories.
Normal blood pressure: 120/80 mm Hg or lower
Elevated blood pressure: 120–129/80 mm Hg or lower
Hypertension stage 1: 130–139/80–89 mm Hg
Hypertension stage 2: 140–149/90 mm Hg or higher
Hypertensive crisis: 180/120 mm Hg and higher
Uncontrolled blood pressure over time can lead to chronic and acute problems such as:
Stroke
Memory loss
Loss of consciousness
Vision damage
Kidney damage
Heart attack
Aortic dissection
Chest pain
Pulmonary edema
Eclampsia
Severely high blood pressure is dangerous for just about everyone, but people with specific medical issues may be at an even greater risk than others. Some conditions that can increase your risk of dangerous complications in a hypertensive emergency include:
Diabetes
Coronary artery disease
Previous stroke
High cholesterol
Chronic kidney disease
Congestive heart failure
Substance use disorder
If you have any of these conditions and notice your blood pressure is rising, seek immediate treatment or call your healthcare provider.
After a Hypertension Episode: Ongoing ManagementTreating a hypertensive emergency doesn't stop with one medication. Your healthcare provider will need to determine why your blood pressure climbed so high and how to prevent it from happening again. If you are already being treated for high blood pressure, your healthcare provider may adjust some of your regular antihypertensive medications.
You'll also get information on when to call your healthcare provider in the future. If you are on daily blood pressure medication, you and your healthcare provider should have a clear plan of what to do if your numbers begin to climb.
Blood pressure that is routinely elevated requires standing medication. Blood pressure that is intermittently high may need medications on an as-needed basis. Generally, if you have a blood pressure reading higher than normal with no symptoms, your healthcare provider will want you to wait five minutes and then take another measurement.
Continued high blood pressure on repeated readings, high blood pressure that doesn't improve with your regular or as-needed medications, or hypertension that comes with other symptoms should prompt additional calls to your healthcare provider or a visit to the emergency department.
Rehospitalization With High Blood PressureThe goal of treating a hypertensive emergency is immediate blood pressure reduction, but with hypertensive urgency, the goal is to lower your blood pressure in a day or two. Your healthcare provider may be hesitant to lower your blood pressure by more than 25% at a time, even when it's high.
Some conditions, like a stroke, may also be treated with something called permissive hypertension. In this scenario, your healthcare provider won't let your blood pressure get too low with treatment—instead, keeping it a bit above normal levels in order to ensure you get enough blood flow to your brain and other tissues.
If your healthcare team is struggling to get your blood pressure under control on a regular basis, your medications may be adjusted on an outpatient visit, or you could be readmitted to the hospital for further testing, observation, and medical management.
SummaryA blood pressure with a top number in the 140s to 160s is dangerous as a rule, but blood pressures that spike into the 180s or 200s are considered an emergency. If you are having symptoms like light-headedness or chest pain, immediate treatment is necessary. If your blood pressure is high but you have no additional symptoms, your healthcare provider may want to admit you to the hospital, but your blood pressure will be treated less urgently.
Getting good control over your blood pressure is important as a maintenance measure, but it's critical that you call your healthcare provider or seek care right away if the top number rises close to 200, This level of hypertension can increase your risk of stroke or other possibly fatal complications.
Read the original article on Verywell Health.
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High Blood Pressure At 18 Puts You At Higher Risk For Heart Attack At Midlife
High blood pressure is a well-known risk factor for heart attack, stroke and other types of cardiovascular disease.
While this link has been well-studied in middle-aged and older people, less is known about the long-term cardiovascular risks due to high blood pressure at younger ages.
Now, a large long-term study suggests that these risks begin to accumulate even in adolescence and young adulthood.
In the study, researchers found that males with high blood pressure at age 18 were more likely to have a heart attack, stroke or other cardiovascular event over the following decades, compared to those with normal blood pressure.
This higher cardiovascular risk occurred for all blood pressure categories above normal, starting with elevated blood pressure, the first level before stage 1 high blood pressure.
The findings also showed that cardiovascular risk increased gradually across all blood pressure categories. And it applied to both elevated systolic blood pressure as well as elevated diastolic blood pressure.
Researchers estimated that 1 in 10 adolescent males with stage 2 high blood pressure would have a major cardiovascular event before retirement.
However, those with normal blood pressure at age 18 would not.
"It makes sense that blood pressure levels at relatively young ages affect our cardiovascular outcomes later in life," said Dr. Jennifer Wong, cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, Calif. Jennifer Wong was not involved in the study.
This is similar to how "other observational trials have shown that physical activity levels in youth can affect someone's cardiovascular outcomes later in life," she told Healthline.
Blood pressure measures are given as two numbers, such as 140/90 mmHg. The first number, systolic blood pressure, measures the pressure in your arteries when the heart beats.
The second number, diastolic blood pressure, measures the pressure in your arteries when the heart is resting between beats.
Normal blood pressure is below 120/80 mmHg. Stage 1 high blood pressure is a systolic blood pressure of 130-139 mmHg or a diastolic blood pressure of 80-89 mmHg.
For the observational study, published September 25 in the Annals of Internal Medicine, Swedish researchers used a national database of males enlisted in the country's military between 1969 and 1997.
Enlistment was mandatory for all adult male citizens during that time. Some men were excluded from the study due to illness or disability. For others, researchers did not have complete data.
Overall, they had data on around 93% of the country's 18-year-old males during that time, including a single blood pressure measurement taken at enlistment.
Using a unique personal identification number for each Swedish citizen, researchers linked the enlistment records to hospital inpatient records and death records. They had inpatient records for over 99% of the men included in the study.
Based on the inpatient and death records, researchers identified men who had a cardiovascular event later in life, including heart attack, heart failure, stroke, bleeding in the brain, and death related to cardiovascular disease.
Researchers followed participants for an average of 36 years, and up to 50 years, after the initial blood pressure measurement.
They found that adolescent males with normal blood pressure at the time of enlistment had a 14.7% chance of having a major cardiovascular event later in life. In contrast, those with stage 2 high blood pressure had a 24.3% risk.
"Those with greater elevations of blood pressure had up to two-fold greater risks of future cardiovascular events later in life," said Nathan D. Wong, PhD, professor and director of the Heart Disease Prevention Program at the UCI School of Medicine in Irvine, Calif. Nathan Wong was not involved in the study.
The researchers point out in the paper that "clinically important differences" in cardiovascular risk appear around age 50, which they say suggests the need for close monitoring and possibly treatment at earlier ages.
Jennifer Wong agrees: "We have to pay attention to risk factors for cardiovascular disease — and elevated blood pressure is one of several risk factors that are potentially modifiable," she said. "So it's extremely important that we look at these early on in life."
Other cardiovascular risk factors that can be modified include cholesterol levels, dietary habits and whether someone is overweight or has obesity, she said.
Although the study included a large number of adolescents and followed them for several decades, there are several limitations to the research.
For example, because the study included only men, the risks due to high blood pressure in adolescence may be different for women. Nathan Wong pointed out, though, that other research suggests that the findings will be similar for women.
However, because the study was carried out in Sweden with little diversity in the population, the study results may not be the same for other countries or for other ethnic and racial groups, the researchers said.
In addition, the study is observational, so researchers could not account for other factors that can increase the risk of cardiovascular events, such as smoking, alcohol consumption and blood cholesterol.
Jennifer Wong said blood pressure measurement should be a routine part of every checkup at a doctor's office, including for children.
Beyond that, Nathan Wong encourages young adults to "know their blood pressure numbers" and take action to reduce their risk of future cardiovascular events.
"Prior studies show that even those with mild elevations in blood pressure often progress to developing [diagnosed] hypertension within a few years, hence the importance of addressing this earlier rather than later," he told Healthline.
"Furthermore, elevations in blood pressure are associated with other problems such as kidney disease and diabetes," he added.
Dr. Christopher Tanayan, cardiologist at Northwell Health's Lenox Hill Hospital in Manhattan, agrees that earlier blood pressure measurement and management is a good idea.
"Prevention is better than cure," he told Healthline, especially since "damage from high blood pressure typically happens slowly, over many years."
He recommends that even older adolescents aim for blood pressure levels below 120/80 mmHg. As the study shows, "the higher the blood pressure, the higher the incidence of bad events [later in life], starting with just 'elevated' blood pressure," he said.
Nathan Wong said most young adults with blood pressure below 140/90 mmHg can control their blood pressure through lifestyle management, including weight control, physical activity and sodium restriction.
Those with more severe high blood pressure may need medications, on top of lifestyle changes, to help control their blood pressure, he said.
While middle-aged and older adults are often prescribed medications to help lower their blood pressure, Tanayan cautioned that more research is needed to know if the benefits of these drugs in younger adults outweigh the risk of side effects, particularly for those in the "elevated" blood pressure category.
So "a study on the potential cons of aggressive treatment with medications on a young population must be done," he said.
A large long-term study found that 18-year-old males with elevated or high blood pressure had a higher risk later in life of cardiovascular events such as heart attack and stroke, compared to those with normal blood pressure.
Those in the most severe category — stage 2 high blood pressure — had around a two-fold increased risk of cardiovascular events.
Researchers say this suggests the need for earlier measurement and management of blood pressure. For some, blood pressure control can be accomplished with lifestyle changes such as maintaining a healthy weight, limiting sodium intake and exercising regularly.
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