Shawna Nesbitt, M.D. Answers Questions On: Hypertension and Hypotension

Hypertension is consistent, systemic high blood pressure that is related to blood vessel disease. Ongoing, widespread elevated blood pressure damages the small blood vessels throughout the body, including in organs such as the kidneys, brain, and heart.

Many things can cause an elevation in blood pressure – including the heart, the kidneys, pain, anxiety, emotional stimuli, and certain hormones – and we can have high blood pressure at any point in time and not have hypertension.

The issue with clinical hypertension is that something is raising the blood pressure over the long term.

A common reason that hypertension doesn’t respond to treatment is that patients don’t really understand what it is and how treatments affect them, or they may be taking ineffective medication regimens – not taking enough medicine or the right combination of medicines.

There also can be intervening circumstances. For example, if someone is constantly in pain due to arthritis – or has chronic underlying anxiety – that person’s blood pressure is going to be elevated.

This is why it's impossible to treat only the blood pressure and not pay attention to the rest of the person. Treating the underlying condition is part of the paradigm for managing the hypertension.

Conditions such as multiple system atrophy (MSA) and movement disorders such as Parkinson's disease can affect people’s ability to sense changes in their blood pressure and position – a condition called orthostatic hypotension.

When people with orthostatic hypotension stand up, instead of their heart rates and blood pressure increasing to accommodate that, the blood drops to their feet and they can fall or pass out.  Some patients with the condition have high blood pressure when they're seated, but it drops so low when they stand up that they can faint.

Because these blood pressure fluctuations make it dangerous for patients to do simple activities, it can be very debilitating – especially since it often occurs as a result of another difficult condition.

Although orthostatic hypotension isn’t curable, we work with patients to find the right combination of medications and physical things they can do to manage it and improve their quality of life.

Finding the right medications and time tables for taking them is about finding the patient’s happy medium – a range in which the blood pressure doesn’t get so high that it’s risky and doesn’t drop so low that it causes him or her to fall or pass out.

In terms of physical things people can do to manage hypotension, we may advise them to wear compression stockings and abdominal binders, show them how to do things such as cross their legs to raise their blood pressure, and help them know when to eat a salty soup instead of drinking water.