Thus, a more precise quantification of the differences in BP according to the body position, especially for those subjects in active hypertensive treatment, may be of extreme interest to support operators in their interpretation of BP measurement results. Blood pressure differences when lying down, standing up, and sitting, Surprising causes of high blood pressure, simple strategies to manage hypertension, Fluctuating blood pressure: Causes and treatments, Lower blood pressure with these natural home remedies, http://www.livestrong.com/article/167631-body-position-and-blood-pressure/, http://www.resperate.com/resperate-updates/why-a-difference-in-blood-pressure-readings-when-sitting-verses-lying-down, http://www.frankrusso.net/blood_pressure_positions.htm, http://www.everydayhealth.com/hypertension/what-your-blood-pressure-says-about-you.aspx, http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/blood-pressure/faq-20058230, http://www.medicinenet.com/script/main/art.asp?articlekey=17237, High blood pressure risk from sugar in processed foods higher than from added salt: Study, Healthy snack that helps lower your blood pressure. How long shall the patient rest before clinic blood pressure measurement? Blood pressure has a daily pattern. 23.Carel RS, Silverberg DS, Shoenfeld Y, Eldar M, Snir C, Mor G. 24.Eser I, Khorshid L, Günes UY, Demir Y. 22.Vittinghoff E, Glidden DV, Shiboski SC, McCulloch CE. BP was measured in all subjects nine times by the same person (EP) using the same, standard methodology: the patient was instructed by a specifically trained nurse to relax as much as possible, to keep quiet during the measurements, and to remove all clothing that covered the location of cuff placement on the left arm. Then, mean/median differences have been computed for each of the six comparisons: mean supine vs. mean Fowler's; mean supine vs. mean sitting; Fowler's vs. sitting (for both SBP and DBP). 32.van der Steen MS, Pleijers AM, Lenders JW, Thien T. Oxford University Press is a department of the University of Oxford. It actually increases systolic pressure by as much as 8mm/Hg. The required sample size was 221 subjects, and 250 individuals were conservatively enrolled. When your body is in a supine position, your heart does not have to work as hard to distributed blood throughout your body. Orthostatic hypotension is a type of low blood pressure that can occur when you stand up after lying or sitting down. http://www.medicinenet.com/script/main/art.asp?articlekey=17237. To avoid potential bias related to the order of the measurement, the sequence of the triplets was chosen at random and different for each patient. Previous studies indicated the change in hydrostatic pressure as the main cause;26,27 however, one or more unknown factors may also play a role in determining BP variability.29 In example, the change of body position produces a decrease in venous return and a resultant drop in cardiac output as blood accumulates in the lower extremities and in the abdominal vasculature (from supine to Fowler position).30. A small difference in blood pressure between arms is nothing to panic about. Nine measurements were taken: three measurements, in random order, in supine, Fowler's, and sitting position. However, for many people, blood pressure … Potential interaction and higher power terms were evaluated for all covariates, and multicollinearity was explored in all models using Spearman's ρ: no collinearity was observed between BMI and arm circumference, therefore, both variables were kept into the final models. The potential clinical implications of the above findings deserve some further consideration. When the arm is at the level of the heart, systolic pressure can be 8 mmHg higher, such as when a patient is in the supine position rather than sitting. In most cases, blood pressure is taken while a person is sitting down with the arm dropping onto a table. Despite BP significantly decreased with increasing the order of the measurement at multivariate analysis, the direction of the large differences was not univocal: for both DBP and SBP from 30 to 50% of the subjects showed a large increase in BP passing from the first to the second or third (or from the second to the third) measurement in all positions. Concerning SBP, almost one-third of the sample showed a large difference in at least one comparison (first vs. second measurement; first vs. third; and/or second vs. third) regardless of the position. Some nurses also measure blood pressure while a person is standing. Finding blood pressure differences between arms can be a sign of atherosclerosis, which is basically plaque buildup in arteries. Participants and study design. Follow these tips to avoid a reading that could be higher or lower than it really is. Subjects studied were a bi-ethnic, middle-aged cohort of 6,951 normo tensive men and women, ages 45 to 64 y, and were free of coronary heart disease at baseline. No differences in BP were observed according to heart rate. However, although the mean difference in SBP from supine to sitting position (3.1 ± 8.5mmHg) was higher in obese subjects, such difference remained significant in nonobese subjects (1.7 ± 9.2mmHg), the rates of subjects with large variations were similar in nonobese individuals (data not shown), and obesity was not associated with BP in multivariate analyses. Hypertension affects hundreds of millions of subjects worldwide and currently represents a major public health issue in the agenda of all developed countries.1,2 Both for the identification and clinical management of hypertensive subjects, the measurement of blood pressure (BP) is a crucial practice. Systolic is the actual beat of the heart and diastolic is when the heart relaxes. By contrast, DBP increased of 1.8 and 2.9mmHg, respectively (both P < 0.001). All sorts of conditions can have an impact on your blood pressure reading. In example, a large “random” variation was detected if, in one of the three supine position measurements, the SBP (or DBP) of one subject was 140mmHg in the first (or second) measurement and <131 or >149mmHg in the second (or third) measurement. The higher your arm cuff is raised the lower the pressure will be. However, there are no recognized cutoffs in BP differences that may discriminate clinical relevancy. The ANS normally controls constriction (narrowing) and dilation (widening) of blood vessels and so helps regulate a person's BP. Relationship between office blood pressure (BP) in the supine position and abulatory blood pressure recorded during the awake hours in 168 patients with a history of mild to moderate essential hypertension. At multivariate analysis, mean SBP significantly decreased if measured in Fowler's and sitting positions, as compared to supine. Although we cannot be sure that the duplication of BP measurement is enough to overcome BP variations across recordings, taking the mean value between two measurements reduces the possibility of a large measurement error or a large random variation. In contrast, DBP significantly increased. Indeed, besides statistical significance, if only the average difference from one position to another is considered, the clinical relevance of the BP variations according to body position may be of limited clinical importance, because the mean differences in both SBP and DBP across positions never exceeded 2.9mmHg. Therefore, in the clinical management of hypertensive subjects, if BP is measured before therapy in one position and after therapy in another position, the clinician may opt for imprecise or incorrect therapeutic strategies in a relevant proportion of subjects. American Journal of Hypertension advance online publication 16 June 2011; doi:10.1038/ajh.2011.106. Taking blood pressure lying down is the obvious method used when a patient is hospitalized, but in a doctor’s office a patient is usually sitting in a chair. By lowering the arm in supine position, SBF decreased As shown in Table 1, the absolute differences across positions were relatively small, the largest being the difference in DBP between supine and sitting positions (−2.8 ± 6.4mmHg). 27.Netea RT, Bijlstra PJ, Lenders JW, Smits P, Thien T. 29.Kato T, Kikuya M, Ohkubo T, Satoh M, Hara A, Obara T, Metoki H, Asayama K, Hirose T, Inoue R, Kanno A, Totsune K, Hoshi H, Satoh H, Imai Y. However, the study has some limitations that must be considered: first, it is monocentric, the sample is relatively small, and the amount of “large variation in BP” has been arbitrarily set at 10mmHg, but results may vary if other thresholds are considered. Regional changes of skin blood flow (SBF), total blood volume of the finger (TBVF), pulse pressure (PP), heart rate (HR), systolic, and diastolic blood pressure (BP) were analyzed in 10 healthy young subjects in supine and upright positions. Your position during a blood pressure check can influence your readings. The results of multivariate analyses have been detailed in Table 2. d'Annunzio” of Chieti. Some doctors refer to it as postural hypotension. Finally, after one minute the blood pressure was again taken in this last position with supine position with crossed legs. The Distribution of Retinal Venous Pressure and Intraocular Pressure Differs Significantly in Patients with Primary Open-Angle Glaucoma. The authors declared no conflict of interest. Dr. Marchione and the doctors on the Bel Marra Health Editorial Team are compensated by Bel Marra Health for their work in creating content, consulting along with formulating and endorsing products. Finally, the number of subjects with at least one “random” large BP difference in each position was summed to obtain the proportion of subjects with at least one large difference in BP in at least one position. In 166 patients attending a hypertension review clinic, we compared supine and sitting blood pressure measurements and first and second measurements (1 min apart) in each position to determine whether any differences seen might have implications for the routine measurement of blood pressure in these patients, as a group or as individuals. Aside from being aware of your arm position, here are some other tips to keep in mind when having your blood pressure measured: Don’t get caught up in comparing your blood pressure to others. Specific tables were created containing a computer generated random sequence of each position, and a different random table was used for each patient. Causes, symptoms, and treatment for orange urine, Getting rid of eye floaters: Home remedies and exercise. There are some common factors that can impact your pressure readings. After one minute of rest, the blood pressure was subsequently taken supine position. If you stand up from a sitting or lying down position and experience orthostatic hypotension, it is likely that your systolic blood pressure has decreased at least 20 mm/HG or your diastolic blood pressure has decreased at least 10 mm/HG within three minutes of standing. Both models were set as repeated regression analyses, using patient's id as the cluster level, and fitted assuming an exchangeable correlation structure, with robust standard errors (based upon sandwich estimator).22 All recorded patient's variables (age, gender, BMI, heart rate, arm circumference, number of prescribed drugs/day) were included in the models a priori, regardless of their statistical significance. 4, 9 Given that the differences between supine and sitting BP have been found to be relatively small, 4, 9 health … http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/blood-pressure/faq-20058230 Supine systolic blood pressure in the leg was higher than in the arm (132±23 mm Hg vs. 157±26 mm Hg, arm vs. leg, respectively; p<0.001). These findings suggest a lower BP variability at the second and third measurements, and seem to support JNC guidelines recommending only the second and third of three readings be considered.28, Finally, this study was not designed to elucidate the physiological mechanisms underlying the observed variation in BP according to body position. Figure 1 graphically shows the changes in blood pressure, comparing supine with standing values, in the dominant arm and the same-side leg in the entire group of participants. Finding a difference in pressure between sides of the body tells doctors that they need to investigate further to see if atherosclerosis is in the main blood vessel leaving the heart or in other parts of the body. d'Annunzio” Foundation, World Health Organization. 3.Ramsay L, Williams B, Johnston G, MacGregor G, Poston L, Potter J, Poulter N, Russell G. 4.Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ. To investigate the degree of random variation in BP, the same approach was used to compute the percentage of subjects with large differences in BP according to the order of the measurement within each position. Current guidelines suggests that BP can be measured indifferently in supine or sitting position, 3, 4 although it has been repeatedly documented that diastolic (DBP) 5, – 7 and, less convincingly, systolic (SBP) 8 BP can be higher if measured in sitting position. Accordingly, it may be indicated to measure the BP in the same position throughout the overall duration of the therapy. In the new blood pressure guidelines, they stated systolic blood pressure has been reported to be 3-10 mmHg higher in the supine (lying) than the seated position. The differences in either SBP and DBP according to the position have been initially investigated using Wilcoxon-matched-pairs signed-ranks test, separately for each comparison. 2.Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JLJr, Jones DW, Materson BJ, Oparil S, Wright JTJr, Roccella EJ. We cannot exclude that some other participants had Parkinsonism in early stages or autonomic dysfunction, as our visits were not focused on neurological disorders, however it seems unlikely that these issues relevantly biased the overall results. Proportion of subjects with large differences (≥ or ≤10mmHg) in systolic (SBP) or diastolic (DBP) blood pressure according to the position and order of the measurement. A relevant proportion of subjects showed large differences (≤ or ≥10mmHg) in mean SBP across positions: i.e., 30.0% comparing supine vs. sitting SBP. Notably, the order of the measurement within each position was also associated with a decrease in BP: compared with the first measurement, both the second and the third showed significantly lower values of either SBP or DBP. Measured in supine, Fowler's, and sitting position, mean SBPs were 139.3 ± 14.0; 138.1 ± 13.8; 137.2 ± 13.7mmHg, respectively, and mean DBPs 80.1 ± 9.1; 81.9 ± 9.4; 83.0 ± 9.6mmHg, respectively. An even higher prevalence of large differences was observed according to the measurement order within the same positions, with no univocal direction (random variation). Discussion. Department of Medicine and Science of Aging, University “G. Here you can find an age and gender chart you can check to see what your healthy range is. Several older studies found that blood pressure was higher among study participants while they were lying down compared to sitting. Let’s take lying down vs. sitting as an example. Monitoring your blood pressure on a regular basis can give you the most accurate picture of what is happening with your blood pressure. There are three common positions that healthcare workers use when taking someone’s blood pressure. The instrument was clinically validated by the British Hypertension Society.19,20 For 12h before the measurements, patients were required not to smoke, to play sports, to eat chocolate or to drink beverages containing caffeine or other psychoactive substances (i.e., alcohol or Taurine). Although BP differences from supine to sitting position have long been recognized, and quantified by several studies,4,9,16,17 only one recent study on normotensive subjects evaluated how BP values varies when measured in Fowler's position.8 We carried out a cross-sectional study to describe and compare the BP values obtained in supine, sitting, and Fowler's positions in hypertensive subjects. Take Multiple Readings. Without blood pressure, our body would not receive the oxygen and nutrients it needs to function properly. The variability of mean BP by position was evaluated in six comparisons: supine vs. Fowler's; supine vs. sitting; Fowler's vs. sitting (for both SBP and DBP). True or False 8. Our heart is a pump, and it takes less work to pump blood to our brain when we are lying down. pressure was inflated quickly to a pressure about Male heart rate while supine (60 ± 4 bpm) 30 mm Hg higher than average systolic pressure was significantly lower (p < 0.05) than when expected for the subject. 5.Jamieson MJ, Webster J, Philips S, Jeffers TA, Scott AK, Robb OJ, Lovell HG, Petrie JC. After 5 min in supine and seated position, the R-R intervals and blood pressure (BP) were recorded. Systolic and diastolic blood pressure was the highest in supine … Is blood pressure higher in supine position than in standing position? Posture, Gravity and Blood Pressure Current guidelines suggests that BP can be measured indifferently in supine or sitting position,3,4 although it has been repeatedly documented that diastolic (DBP)5,–7 and, less convincingly, systolic (SBP)8 BP can be higher if measured in sitting position.4,9 Given that the differences between supine and sitting BP have been found to be relatively small,4,9 health professionals commonly do not consider or underestimate the effect of position when interpreting the results of BP measurements. Your blood pressure continues to rise during the day, usually peaking in the middle of the afternoon. If this is not possible for clinical reasons (i.e., the occurrence of a hip fracture which requires a supine position), the potential difference in BP should be taken into account by the operator. In addition to BP, the following variables were measured by the nurse: height (bare foot) and weight (underwear), heart rate (which is automatically measured by the oscillometric device during each BP measurement), and arm circumference (naked arm). In addition to the mean/median differences in BP, we explored the variability across positions in terms of the percentage of subjects with large variations (≤ or ≥10mmHg) for each of the six comparisons (Table 3). The average SBPs were 139.3 ± 14.0; 138.1 ± 13.8, and 137.2 ± 13.7mmHg in supine, Fowler's, and sitting position, respectively. The picture is further complicated by the frequent use in routine clinical practice of positions that are intermediate between supine and sitting, such as Fowler's position, in which the patients rest in their bed in a partial sitting position.1073.11,12 Fowler's position is commonly used to facilitate breathing and eventually reduce abdominal pain in immobilized subjects and/or patients with respiratory diseases or after surgery, but it may also be used in other patients just to relax abdominal muscles.11,13,–15. Systolic BP (SBP) and diastolic BP (DBP) were recorded using an automatic oscillometric device. However, it’s important to understand the impact that each position has on blood pressure levels. As a secondary analysis, we also computed the percentage of subjects with a “large difference” in BP in each of the six comparisons above defined. http://www.frankrusso.net/blood_pressure_positions.htm It often causes dizziness and even fainting. 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