Does Blood Pressure Lower When You Lie Down?

High blood pressure - also known as hypertension- is one of the leading causes of stroke and heart disease in the US, and these conditions result in the highest number of deaths each year. According to research, 47.3% (or 116 million) adults in the USA are living with high blood pressure, and only 26.1% (23.9 million) have it under control¹.

According to the CDC², a larger percentage of men (50%) have high blood pressure, as opposed to women (44%). Non-Hispanic black adults have the highest number of hypertension cases (56%) followed by non-Hispanic white adults (48%), non-Hispanic Asians (46%) and Hispanic adults (39%).

Normal versus high blood pressure

Blood pressure³ refers to the pressure exerted on the walls of the arteries as your heart pumps blood. Blood pressure measurements are taken in two numbers, measured in millimeters of mercury (mm Hg).

The top/first number is the systolic blood pressure, and it indicates how much pressure is being exerted on the artery walls when your heart pumps blood. It is the highest of the two numbers, and an increase above normal is a cause for alarm. The bottom/second number is the diastolic blood pressure, and it is the measurement of the pressure being exerted by your blood on the artery walls when your heart is resting between beats.

120/80 mm Hg is considered the normal blood pressure reading for an adult. An increase in either the systolic or diastolic blood pressure can indicate hypertension. There are different blood pressure categories depending on how high either of the measurements is.

They include:

Elevated blood pressure

Elevated blood pressure occurs when your systolic blood pressure ranges from 120-129 mm Hg, with the diastolic blood pressure less than 80mm Hg. Individuals with elevated blood pressure are on the road to high blood pressure unless they take immediate action to control and reduce their blood pressure.

Stage 1 hypertension

Stage 1 hypertension is also known as prehypertension, and it occurs when the systolic blood pressure is about 130-139 mm Hg and the diastolic blood pressure around 80-89 mm Hg. If you have stage 1 hypertension, the doctor is likely to recommend lifestyle changes to help control hypertension before it advances.

Stage 2 hypertension

This type of hypertension occurs when your blood pressure consistently ranges at 140/90 mm Hg or higher. Your doctor is likely to recommend blood pressure medication in addition to lifestyle changes to help lower this type of blood pressure. It is also essential to keep checking the pressure regularly as further increases could lead to organ damage or heart failure.

Hypertensive crisis

This is the highest stage of hypertension, and it refers to a blood pressure reading of 180/120 mm Hg⁴ or above. This condition requires immediate medical attention. If your blood pressure escalates to 180/120 mm Hg, and you begin experiencing symptoms like shortness of breath, numbness, headache, chest pains, change in vision, and weakness, you should call 911 immediately as this could be a sign of organ damage.

Causes of hypertension

There is no primary cause of hypertension, but certain health conditions and lifestyle choices are known to increase the likelihood of developing this condition. Normally, hypertension develops on its own over a long time and does not often exhibit symptoms. As you grow older, your blood vessels naturally lose their elasticity, and their ability to accommodate the rush of blood decreases, which might lead to high blood pressure.

Some medical conditions that can lead to high blood pressure include:

Elevated blood pressure

As mentioned earlier, elevated blood pressure is when your blood pressure is higher than normal. When elevated blood pressure is left uncontrolled, it puts you at risk of gradually developing chronic, long-lasting hypertension in the future.

Diabetes

30% of patients with type 1 diabetes⁵ and 50% to 80% of patients with type 2 diabetes have hypertension. This is because diabetes damages the small blood vessels, causing arteriosclerosis, which forces the blood to be pumped with greater force, thereby increasing blood pressure.

Hyperthyroidism

Hyperthyroidism is a condition in which your body produces excess thyroid hormone⁶. This hormone decreases the resistance of blood vessels to pressure exerted by the blood, thus increasing the heartbeat. This condition can potentially lead to hypertension.

The lifestyle choices that can contribute to the development of hypertension include:

Unhealthy diet

Sodium is essential⁷ for the body to function normally, but excess consumption can be detrimental to your health and can lead to hypertension⁸. Sodium is present in the salt we use in food, processed food, and restaurant foods. Your body only requires small amounts of sodium to function, and excess levels cause fluid retention that results in the heart increasing the pressure at which it pumps blood.

What’s more, this can also put you at risk of stroke and heart disease. Inadequate consumption of potassium⁹ can also increase your blood pressure. Your body needs potassium for the heartbeat to stay regular, and insufficient potassium levels cause the blood pressure to increase.

Lack of exercise

Less fit and less active people have a 30-50% greater risk¹⁰ of developing high blood pressure. Being active makes your heart and muscles strong and helps the heart pump blood as required. Exercise also helps manage stress and promotes weight loss¹¹, positively impacting your blood pressure.

Excessive consumption of alcohol

Long term excessive use of alcohol¹² can increase chances of developing hypertension.  This is because alcohol increases the hormone renin in the body, a hormone that causes blood vessels to constrict, causing the heart to pump blood at a higher pressure. Adults of legal drinking age should either choose not to drink or limit their intake to one drink or less in a day for women and two drinks or less in a day for men¹³.

Smoking

The tobacco and nicotine contained in cigarettes make the blood vessels narrower¹⁴, which necessitates increased pressure in the pumping of blood… causing high blood pressure. An individual with hypertension should avoid smoking as it can exacerbate the condition.

Stress

Stress is known to increase blood pressure temporarily. Unmanaged stress levels can lead to stress-related habits like overconsumption of alcohol and smoking, further increasing blood pressure.

Risk factors for hypertension

Unlike lifestyle decisions that are correctable, some other unavoidable factors place one at risk of developing hypertension. These include:

Obesity

Being obese or overweight predisposes you to hypertension. This is because the heart is forced to pump blood and oxygen harder, thus increasing blood pressure. Additionally, obesity can also cause other serious life-threatening issues like type 2 diabetes and coronary diseases¹⁵, which contribute greatly to the development of hypertension.

Genetics and family history

Hypertension tends to run in the family, and individuals with a family member (especially a parent) with hypertension are at a high risk of developing the same condition¹⁶. Also, members of the same family are often exposed to the same environment and might share other factors like an unhealthy lifestyle, thus increasing their general risk of hypertension.

Age

Hypertension tends to be higher among older people¹⁷ (65 years and above) than younger ones. This means that the older you grow, the higher the risk of getting high blood pressure.

Race

Research shows that non-Hispanic black adults are at a higher risk of developing hypertension than any other race. This could be because black adults in the US tend to be more sensitive to salt, thus increasing their risk of high blood pressure.

Medication

Some medications¹⁸, especially those that increase blood pressure, can put you at risk of hypertension. They include antidepressants, hormonal birth control pills, decongestants, and  non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin. 

Complications of Hypertension

When high blood pressure levels are left unmanaged, they can cause several complications, some of which are fatal. They include the following:

Heart failure

When your heart continuously pumps blood against the high pressure in the blood vessels, its muscles begin to thicken, a condition known as left ventricular hypertrophy¹⁹. The thickened muscles might have even a harder time pumping blood and oxygen to the body, eventually leading to heart failure.

Heart attack

High blood pressure can cause atherosclerosis – thickening and hardening of the arteries - preventing blood flow to the heart muscle and leading to a heart attack.

Stroke

High blood pressure can cause blood vessels in the brain to clog and burst, leading to stroke.

Kidney failure

If you develop high blood pressure, the blood vessels around the kidney can be damaged, interfering with the ability of the kidney to filter blood and thus causing kidney disease or kidney failure.

Sexual Dysfunction

The damage of blood vessels from high blood pressure can lead to a reduced flow of blood throughout the body. A low blood supply in the pelvis can lead to erectile dysfunction in men and low libido in women.

Aneurysm

An increase in blood pressure can cause blood vessels to weaken and bulge, resulting in an aneurysm. If an aneurysm ruptures, it can be life-threatening.

Loss of vision

Hypertension can cause the blood vessels in the eye to narrow or thicken, which can hinder blood flow to the retina, thereby resulting in blurred vision or a complete loss of sight in the long term.

Dementia

When the blood vessels in the brain are thickened or narrowed, the blood supply in the brain can decrease. This can affect thinking, memory, and learning and, in extreme cases, can lead to vascular dementia.

Does your blood pressure change when lying down?

The positioning of your body alters your blood pressure readings. When standing, blood pressure is higher since the heart is above the legs and organs situated in the abdominopelvic cavity. The heart, therefore, has to pump blood more forcefully to get the blood in these regions to return to the heart, as it works against gravity.  When lying down, however,  the heart uses less force to pump blood as it is on the same level as the rest of the body.

What sleeping style should you take if you have high blood pressure?

There is a lot of debate about the best sleeping position for high blood pressure patients, and two positions are found to work best. The first is sleeping on your left side. It is argued that sleeping on the left side²⁰ of your body relieves pressure on the blood vessels on the right side that carry blood to the heart, thus reducing blood pressure. The second method is sleeping face down. According to research, sleeping face down can help lower blood pressure by at least 15 points.

Does evidence support lying down to reduce blood pressure?

The European Society of Cardiology²¹ recommends that people lay down and take naps during midday to help lower their pressure levels. Additionally, the American College of Cardiology claims that the average systolic blood pressure drops by about 3 mm Hg²² for each hour one lays down for a nap.

Does my blood pressure change when I move from one place to another?

Your blood pressure can indeed change when you move from one position to another²³. For example, this often happens when you move from a lying to a standing position. This change in position causes your blood to pool in the lower region of the body, causing a temporary drop in blood pressure, but the body does have a way of adjusting to these changes.

Still, sometimes it may take some time to adjust for certain reasons such as dehydration, low blood sugar, medication such as antidepressants, low heartbeat, and slow heartbeat, which may cause you to feel light-headed and faint for a while.

Which is the best position to measure my blood pressure?

The best time to measure your blood pressure is while seated upright. For accurate readings, you will have to be seated straight with your back supported by the chair. You should make sure your feet are flat on the floor and that your arm is at level with your heart, supported on a table or armrest.

The best way to lower high blood pressure

Here are several actions you can take that can help lower your blood pressure:

Exercise more

By doing frequent exercises, your heart will get stronger and will be able to pump blood with less effort. The pressure on your arteries will also reduce, lowering your blood pressure. High intensity interval training (HIIT)²⁴ and aerobic and resistance exercises²⁵ have been found to help reduce blood pressure levels.

If exercising is too difficult for you, you can try out softer activities in the following forms:

• Walking up the stairs

• Gardening

• Swimming

• Bike riding

• Playing a team sport

• Tai chi or yoga

Lose weight

If you are overweight, losing at least 10 pounds²⁶ will help reduce your blood pressure. You can lose weight by exercising or by trying out weight-loss diets, but it is most effective if you combine the two.

Maximize potassium intake and minimize sodium

Increasing potassium intake and reducing sodium intake can significantly lower your blood pressure. Potassium lessens the effect of salt in the system and helps reduce the tension in your blood vessels.

Foods that are naturally high in potassium²⁷ would include lentils, potatoes, kidney beans, oranges, bananas, and soy beans. The National Institute of Health recommends that people with high blood pressure try out the DASH diet²⁸ (dietary approaches to stop hypertension).

DASH emphasizes the consumption of:

• Vegetables (4-5 servings)

• Grains (especially whole grains or oats)

• Little amounts of poultry and lean meat

• Fruits rich in potassium, like bananas

• Beans, nuts, and seeds

• 2-3 daily servings of fats and oils

• Cut down on refined carbohydrates and processed foods

Cut down on refined carbohydrates and processed foods

Most of the extra sodium in your food comes from processed foods and restaurant food. Foods like chips, pizza, and processed snacks do more harm than good to your body. Additionally, refined carbohydrates have high sugar concentrations that may increase your blood pressure even more than salt. Cutting down – or cutting off- these types of foods will help you lose weight and lower your blood pressure.

Cut down on smoking and alcohol

Cutting down on smoking and alcohol consumption can have a tremendous effect on your blood pressure. If you are not going to quit taking alcohol, make sure you drink responsibly by sticking to the recommended amount of drinks per day. Also, make sure to keep checking your blood pressure levels.

Reduce stress

Juggling the commitments of everyday life, such as work, family, and friends, often results in stress. However, you must find ways to reduce stress if you need to lower or maintain your blood pressure. Activities like taking a walk, therapy, listening to music, reading a book, or baking can help you process and manage stress. Additionally, you should avoid stress triggers and try to maintain a positive attitude towards life in general.

Get quality sleep

Naturally, your blood pressure dips down as you sleep. Your body needs at least 7 hours of sleep²⁹ a day to function normally and a lack of sleep can lead to serious health conditions³⁰. If you experience signs like daytime fatigue, irritability, and excessive sleepiness during the day, it could indicate sleep deprivation. To get a better night's sleep, avoid sleep disruptors like using your phone before bed and taking caffeinated drinks before bedtime.

Take supplements to lower your blood pressure

Some supplements have been seen to be effective in lowering blood pressure. They include:

• Whey proteins

• Omega-3 polyunsaturated fatty acid

• L-citrulline

Take prescription medication

Usually, if you have stage 1 or stage 2  hypertension, your doctor will most likely prescribe medication³¹ along with the lifestyle changes aforementioned. Hypertension medications include antihypertensive medicines, diuretics, calcium channel blockers, beta-blockers, ACE inhibitors, vasodilators, and angiotensin 2 receptor blockers.

You must take medicine as prescribed as failure to follow a prescription might increase your chance of experiencing a heart attack, kidney failure, or stroke³².

Living with high blood pressure

If you live with hypertension, you can still live a long and productive life. By embracing the right lifestyle and taking your medication as recommended, you can be sure of keeping your blood pressure in check. In addition to this, you will have to keep monitoring your blood pressure levels frequently to ensure you are still on the right path. If you are going to measure your blood pressure at home, the following tips³³ can help you get an accurate reading.

• Choose your monitor carefully and ensure it fits around your upper arm properly.

• Take your readings twice a day (morning and evening). Make sure to take them at the same time daily.

• Make sure you are positioned carefully with your back supported by the seat and your hand lying on a table or armrest.

• Use the same hand each time when taking a reading, and make sure to place the cuff over bare skin, not over clothes.

• Take repeat readings a few minutes after taking the initial reading.

• Record your readings daily on a journal to keep a log that you can show your doctor on the next visit.

The lowdown

Living with hypertension does not mean a reduced quality of life. It just means that you have to be more cautious with your lifestyle to avoid complications that might worsen your condition. It also means continuous checkups and regular monitoring of your blood pressure levels to ensure they are in check.

Being active by taking a walk, riding a bicycle, swimming, or doing intensive exercise can help keep your heart muscles strong, ensuring they can pump blood without too much pressure. Maintaining a healthy diet (such as DASH) and avoiding processed foods and refined carbohydrates with excess sodium can also help keep your blood pressure levels in check. Additionally, quitting alcohol and cigarettes can be instrumental to maintaining proper blood pressure levels and improving your quality of life in general.

If your blood pressure escalates beyond 170/90 mm Hg, call 911 immediately or consult with your doctor as soon as possible.