Manor Field Blog #4 Lying and Standing – Know your numbers!

There is a campaign in the UK for people to know their numbers. This refers to an awareness of your blood pressure.

Now, there are all sorts of numbers associated, depending whether you are young or old, have diabetes or not and so on.

Blood pressure is essentially the pressure of blood in your arteries when your heart is contracting – the top number, that is, systolic (the name for heart contraction is ‘systole’) and the lower number when it relaxes, diastolic (diastole is when the heart relaxes).

If the numbers are too high you can be in trouble, although in general only in the longer-term (over years) from the effects of raised blood pressure such as stroke, heart attack, kidney failure.

Very occasionally blood pressure goes very high very rapidly; that is usually considered an emergency and not what I am discussing.

Equally, just as high can be bad, too low can be a concern.

As an extreme example, if your blood pressure gets too low, blood stops flowing to certain organs and eventually you collapse.

Now, collapse is my point.

And the reason why, people should know their numbers, not just sitting at rest in an upright position as is recommended, but, ideally, lying and standing.

Indeed, NICE (The National Institute for Clinical Excellence), the holy of holies of what you should do in health and care advises that everyone over the age of 65 who experiences a fall, should have their blood pressure measured when they are lying and standing.

There is a whole science of this that I will not detail here.

The main focus relates to –

1. Falls
2. Dizziness when you stand

If when you stand-up you become light-headed or dizzy, or, even worse, you collapse or lose consciousness, this is something to address.

This is a medical condition called ‘Postural Hypotension’ or ‘Orthostatic Intolerance’ if you are posh. I prefer the former.

The most common causes for this are dehydration, it can occur after blood loss or sepsis (severe life-threatening infection) and in people taking medicines to lower their blood pressure.

As I described in Blog #3 in relation to de-prescribing, sometimes people are prescribed medicines that were once right but have become too strong or unnecessary.

Sometimes this condition develops on its own; it is also associated with diabetes or Parkinson’s disease.

What should you do?

Please don’t everyone rush to their GP; indeed, most people should be able to do this themselves at home (part of knowing your numbers) with a blood pressure machine available inexpensively on the internet.

(There is a thing that blood pressure should be measured manually i.e. the old-fashioned way with a hand-pump and stethoscope – I am happy for the measurement to be done anyhow, so long as it is done.)

If, when moving from lying to standing your blood pressure drops more than 20mm in the systolic (top) measure or more than 10mm in the diastolic (bottom) measure, this is perhaps the time to see your doctor, nurse or pharmacist.

For example –

Blood pressure lying-down 140/70

Blood pressure standing-up 150/85

This is fine, this is normal, this is what should happen.

Blood pressure lying-down 140/70

Blood pressure standing-up 100/60

This is postural hypotension and something to get checked-out.

Other people who should get checked-out are those who are experiencing frequent falls, in medicine we define this as more than three falls in a six-month period. This group of people need a thorough review, not just their blood pressure, but this is a starting point.

Know your numbers!

NEVER STOP TAKING PRESCRIBED MEDICINES WITHOUT SPEAKING TO YOUR DOCTOR, NURSE OR PHARMACIST