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Care During Chemotherapy and Beyond

Blood Pressure Changes



Includes: High blood pressure (hypertension), and managing low blood pressure (hypotension)

COMMON EXAMINATIONS FOR BLOOD PRESSURE CHANGES

  • Blood pressure monitoring - Your healthcare provider may take your blood pressure when you visit the office to check for changes in blood pressure. Your blood pressure is the force of blood flow against the walls of your artery. Arteries carry blood from your heart to your body. This is a part of your vital signs. Your vital signs include your blood pressure, your heart rate or pulse, your respiratory rate (how fast or slow you are breathing in a minute), and your temperature. These alert your healthcare provider to certain diseases or conditions that may be present. 
  • To measure your blood pressure, your healthcare provider will place your arm (it is also possible to measure blood pressure using the wrist, finger or any extremity) into an inflatable cuff. If an electric monitor is being used, the cuff will inflate and automatically record your blood pressure readings. 
  • If your healthcare provider is measuring your blood pressure by hand (manually), the cuff usually will be positioned on your arm, and the stethoscope placed in the bend of your elbow. The cuff will be slowly inflated and deflated, and your healthcare provider will be able to determine your blood pressure readings in the form of a top number your systolic blood pressure reading and a bottom number, your diastolic blood pressure reading. 
Some causes that may lead to changes in blood pressure readings include: 
  • Recent intake of caffeine, alcohol or cigarette smoking. This potentially causes an increase in your blood pressure.
  • When you have your blood pressure taken, rest in a comfortable and relaxed position for at least 5 minutes, if possible. 
  • If the blood pressure cuff is too large, it is possible that your blood pressure changes to a falsely lower reading. Also, if the blood pressure cuff is too small, it is possible that your blood pressure changes to a falsely elevated reading. Your healthcare provider should measure the diameter of your arm, and use the appropriate sized blood pressure cuff. 
  • If you are using your arm for a blood pressure reading, your healthcare provider should ensure that the lower edge of the cuff is at least 1 inch above the bend of your elbow. 
  • If you take your blood pressure at home, and you purchase a monitor, make sure that your blood pressure cuff gives a similar reading to the cuff in your doctor's office. Electronic blood pressure cuffs need to be checked periodically, to ensure that they are giving an accurate reading.

What is a normal blood pressure?
When your blood pressure is taken, there are two readings given. These are the systolic and the diastolic blood pressure readings. Your systolic blood pressure is the top number that you get. This refers to the pressure of the blood, on the walls of your arteries, when the heart muscle contracts. This is when the blood pressure is the greatest. The bottom number, or your diastolic reading, refers to the pressure in your arteries at all times, when the heart is resting in between heartbeats.

The normal blood pressure is 120/80, although most people do not have blood pressure of exactly 120/80.  Low blood pressure is much less common than high blood pressure. 

  • People with high blood pressure, or hypertension, are at risk for organ damage (kidney, and heart especially), in the long term. Most people with high blood pressure do not have any symptoms. High blood pressure over a long period of time potentially causes extra stress on your heart muscle. If you have a blood pressure of 140/90, on 2 or more checks, you may be diagnosed with high blood pressure.
  • Even if you have a normal blood pressure of 120/80, your healthcare provider may want the bottom (diastolic) number to be lower, if you have certain diseases. This includes diabetes, especially if you have protein in your urine. Protein in your urine from diabetes means that you have kidney damage, and you are at risk for worsening function of the kidneys in the future.  Lower blood pressure can reduce stress on the kidneys, and reduce the chance of kidney damage.
  • There are many causes of low blood pressure as well.  If you have low blood pressure, you are at risk for fainting, or "passing out."  If lower blood pressure is due to a more serious condition, such as acute blood loss or infection, your doctor will focus on treating the underlying condition.

COMMON BLOOD PRESSURE PROBLEMS

HYPERTENSION (HIGH BLOOD PRESSURE)

What is hypertension? 

  • Hypertension is when the blood pressure changes to an elevated rate in your arteries. Most of the consequences of hypertension occur over a long period of time. When your blood pressure changes to an elevated rate for many months, or years, damage to your internal organs may occur as a result.
There are 2 main types of hypertension: Primary and secondary
  • Primary hypertension occurs as a result of problems in your body, or electrolyte imbalances. This is also called essential hypertension. It also can occur if you are overweight, take in too much sodium, alcohol, or due to cigarette smoking. 
  • Primary hypertension is the most common type of high blood pressure, however in 95% of cases, no causes can be found.
  • Secondary hypertension may occur as a result of many diseases and conditions, including medications, heart problems from birth, kidney disease, estrogen use, or other diseases of the endocrine system. 
  • "White coat" hypertension is a category of hypertension, when the blood pressure changes to an elevated rate in the doctor's office, and the individual has normal blood pressure readings at home. High blood pressure readings in the office were once considered unimportant, as the blood pressures returned to normal at home. Now, many researchers conclude that people with white coat hypertension should be treated the same as those with regular hypertension. High blood pressure is high blood pressure, no matter what causes it when the reading was taken. 
  • Fifty million Americans have elevated blood pressure, but only a little more than half of them are aware of their diagnosis.
  • The percentage of individuals who have elevated blood pressure levels increases with age, and is greater in individuals who are of African American heritage.
Risk factors: Causes of hypertension are many. The risk factors for high blood pressure that you can change, also called modifiable, include:
  • Obesity
  • Lack of physical activity.
  • Sodium intake
  • Alcohol and drug use, caffeine intake.
Factors for high blood pressure that you cannot change, include: 
  • Genetics
  • Age
  • Race
  • Other diseases and conditions.

What are some high blood pressure symptoms to look for?

  • Most people do not notice any symptoms of high blood pressure. This is why high blood pressure is known as "the silent killer," because most people do not notice symptoms immediately. 
  • Some individuals may experience headaches when blood pressure changes to an elevated rate. 
  • If you are having an "acute" or suddenly serious event, you may experience nausea, dizziness, and loss of vision, severe headaches, or confusion. If these symptoms occur, seek emergency assistance.

Things you can do to manage high blood pressure:

The American Heart Association recommendations for elevated blood pressure:

With any elevated blood pressure readings, your doctor or healthcare provider may suggest that you:

  • Quit smoking
  • Exercise most days of the week, for at least 20 to 30 minutes at a time.
  • Try to reduce the amount of stress in your life by following relaxation techniques.
  • Eat a diet that is low in saturated fat and cholesterol, low in sodium, with lots of fresh fruits and vegetables. 
  • Lose weight if you are overweight.
  • Avoid alcohol use. Limit caffeine intake.
  • Again, with low blood pressure, safety and treating the underlying cause is the greatest concern.
  • Try to reduce the amount of stress in your life. Use relaxation techniques to decrease the amount of anxiety you have. If you feel anxious, place yourself in a quiet environment, and close your eyes. Take slow, steady, deep breaths, and try to concentrate on things that have relaxed you in the past.
  • If you have hypertension, you may be told to reduce the amount of salt you are eating in a day. Many times, it may be restricted to about 2 grams of sodium per day. A diet lower in salt potentially causes a decrease in the amount of work that is placed on your heart. You should discuss this with your healthcare provider how you can specifically use your diet to stimulate changes in high blood pressure. Also, eat a diet that is low in saturated fat, cholesterol, sodium, and with lots of fresh fruits and vegetables.

Other things you can do to stimulate changes in high blood pressure:

  • Make sure you tell your doctor, as well as all healthcare providers, about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies).
  • Remind your doctor or healthcare provider if you have a history of diabetes, liver, kidney, or heart disease.  
  • Keep a diary of your any abnormal symptoms, to report to your healthcare provider. These may include excessive fatigue, shortness of breath or chest pain.
  • Questions to ask yourself, may include:
    • Did my symptoms of blood pressure changes occur gradually, or did this episode come on all of a sudden?
    • Was I feeling anxious?
    • Did I perform any kind of activity, or was I resting?
  • If you are ordered a medication to treat your high blood pressure, do not stop taking it unless your healthcare provider tells you to. Take the medication exactly as directed. Do not share your pills with anyone. 
  • If you miss a dose of your medication, discuss with your healthcare provider what you should do. 
  • If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing problems that high blood pressure causes.
  • Keep all your appointments for your treatments.

Drugs and recommendations that may be prescribed by your health care provider:

Blood Pressure Values and Action by Health Care Provider
     
If the top number is: If the bottom number is: Your health care provider may:
Systolic BP 140-149  Diastolic BP 90-99 Confirm BP reading in 2 months
Systolic BP 130-139 Diastolic BP 85-89 Recheck BP in 1 year

Your doctor or healthcare provider may prescribe certain drugs to treat your hypertension. Diuretics and beta-blockers are the most common types of medications used to treat high blood pressure initially, upon diagnosis. 

Some other drugs that are commonly used to treat high blood pressure may include: 

  • ACE inhibitors - These drugs work by opening, or dilating, your arteries. They will lower your blood pressure, which causes improved blood flow to your kidneys, and through out your body. Your healthcare provider may also prescribe these medications if you have diabetes or protein in your urine, to protect your kidneys. Some examples of this medication may include: Enalapril maleate (Vasotec®), Lisinopril (Zestril®), and fosinopril sodium (Monopril®)
  • Beta-blockers - can be used to slow down your heart rate, which causes improved blood flow through your body. You may take this drug if you have been diagnosed with irregular heartbeats, palpitations, heart failure, or high blood pressure. Some examples of this medication may include: Metoprolol (Lopressor®), propanolol (Inderal®), and atenolol (Tenormin®). 
  • Calcium Channel Blockers - These medications may be given to treat chest pain, high blood pressure, or irregular heartbeats. A few common drugs include Verapamil HCL (Calan®), and Diltiazem (Dilacor®XR).
  • Diuretics - may be known as "water pills" as they work to prevent or treat high blood pressure by making you urinate out extra fluid. Some examples of this medication may include furosemide (Lasix®), and Hydrochlorthiazide. You may receive this medication alone or in combination with other medications. 
  • Digoxin - Also called digitalis, this medication causes the heart rate to slow down, making it beat more effectively. This will pump blood through out the body better. It is also called Lanoxin®.
  • Vasodilators - are drugs that work by opening up or "dilating" the vessels. These may include isosorbide dinitrate (Isordil®). 
  • Do not stop any of these medications abruptly, especially if you are prescribed any anti-arrhythmia drugs or beta blockers, as serious side effects may occur.

When to call your doctor or health care provider about symptoms of blood pressure changes:

  • Shortness of breath, chest pain or discomfort; swelling of your lips or throat should be evaluated immediately- especially if you are taking new medications, or have a history of elevated blood pressure.
  • If you are having an "acute" or suddenly serious event, you may experience nausea, dizziness, and loss of vision, severe headaches, or confusion. If these symptoms of blood pressure changes occur, seek emergency assistance.
  • Feeling your heart beat rapidly (palpitations).
  • Bleeding that does not stop after a few minutes, blood in your urine or stool.
  • Any new rashes on your skin, especially if you are taking new medications.
  • Any unusual swelling in your feet and legs, weight gain of greater than 3 to 5 pounds in 1 week.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition, including blood pressure changes, causes and treatments. The information contained in this website about blood pressure changes and other medical conditions is meant to be helpful and educational, but is not a substitute for medical advice.


HYPOTENSION (LOW BLOOD PRESSURE)

What is hypotension?

  • Hypotension may be defined as a lower than normal blood pressure readings. There are many causes for hypotension. Some of the main causes may include: 

    • Some chemotherapy or biological drugs may cause low blood pressure, such as bleomycin or interleukin. Adverse effects of other drugs, such as rituxamab (Rituxan® ) or paclitaxel (Taxol®), may cause blood pressusre changes in either direction, higher or lower. 
    • You may have low blood counts (anemic), from causes such as recent chemotherapy treatments, or your disease.
    • Certain physical conditions - such as orthostatic hypotension. Orthostatic hypotension is often a result of a disease state, or dehydration.
    • As you get older, or as a result of certain conditions, the central nervous system has a more difficult time regulating blood pressure levels. When you change from a lying to a standing position rapidly, you may feel "faint" or lightheaded, as your blood pressure changes to a level below normal. 
    • Orthostatic hypotension may also occur if you are anemic, or dehydrated, as the fluid volume levels in your body are low. 
    • Medications - If you are taking certain medications to control your high blood pressure or heart rate, for example, these may cause changes in blood pressure to a lower level.
    • Irregular heart rhythm changes - if your heart is beating irregularly, it potentially causes your blood pressure to be low as a result. The blood is not pumping through your body very effectively, and your body is unable to compensate. 
    • Shock - "Shock" may occur from many causes that are related to your heart, lungs, trauma, infection or other diseases. This happens when the circulation of blood is not able to meet your body's needs of oxygen, fluid and nutrients. For example, if you have a severe blood infection, you may develop low blood pressure as a result. Treatment of shock consists of identifying the causes, and trying to correct it. 
    • Bleeding - if you are bleeding from your gastrointestinal track, or from some other location, you may be at risk for low blood pressure. This is because you are losing fluids, and fluid levels work to maintain normal blood pressure readings. Severe bleeding may lead to a form of "shock."

    What are some symptoms of blood pressure changes to look for?

    • You may be overly tired, or very weak (fatigued). It may be hard for you to do any kind of your normal activities. 
    • You may feel dizzy or "faint" when you stand up, or change positions slowly. You may feel like you are going "pass out." 
    • You may feel sweaty or nauseous, if you think you may faint or lose consciousness. 
    • If your low blood pressure changes to a lower rate due to a heart problem, you may feel your heartbeat, or palpitations. 
    • You may have a fever, chills or feel ill, if an infection causes your low pressure. 
    • You may notice that you are pale in color, or have blood in your stool. This may be due to bleeding from your gastrointestinal tract, or anemia from your disease or chemotherapy treatments.

    Things you can do to manage hypotension:

    • If you have low blood pressure, changes in position must be performed slowly. Rest for a few minutes in between lying, sitting and standing. 
    • Avoid hot environments, such as a shower or a bath, which may cause your blood pressure to be reduced. 
    • Avoid alcohol and certain drugs that may cause low blood pressure. Discuss these causes of low blood pressure with your healthcare provider. 
    • Drink lots of fluid. Drink 2 to 3 liters of fluid every 24 hours, unless you were told to restrict your fluid intake. This will decrease your chances of being dehydrated, and developing low blood pressure. 
    • Monitor for signs of bleeding. If you have tarry black stools, or maroon stools, notify your healthcare provider immediately.
    • Make sure you tell your doctor, as well as all healthcare providers, about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies).
    • Remind your doctor or healthcare provider if you have a history of diabetes, liver, kidney, or heart disease. 

    Drugs that may be prescribed by your doctor:

    Treatment of low blood pressure is based on correcting the underlying causes. 

    • If anti-cancer medication causes your low blood pressure, you will be monitored closely and corrective actions will be taken based on that medication.
    • If you are prescribed a medication for your high blood pressure, and your blood pressure changes too dramatically your dose may be decreased. 
    • If you are bleeding, or are dehydrated, your fluid and blood volumes may be low. This potentially causes low blood pressure. Your doctor or healthcare provider will treat this by giving you fluids, plasma, or blood.
    • If you have an infection that causes your low blood pressure, your healthcare providers will correct this with identifying and treating the source of infection in your body. Depending on the source of the infection, the type of antibiotics you will receive may vary.
    • Aspirin - depending on your overall health status, your healthcare provider may prescribe aspirin as a "blood thinner." Aspirin works by preventing platelets in your blood from forming blood clots (anti-platelet). This may be prescribed if you have had a blood clot, irregular heart rhythm, or a heart attack.
    • Beta-blockers - If your low blood pressure changes to a lower rate due to your heart beating irregularly, your doctor will prescribe medications to control your heart rate.  Beta-blockers can be used to slow down your heart rate, and improve blood flow through your body. You may take this drug if you have been diagnosed with irregular heartbeats, palpitations, heart failure, or high blood pressure. Some examples of this medication may include: Metoprolol (Lopressor®), propanolol (Inderal®), and atenolol (Tenormin®).
      • A side effect of beta-blockers is low blood pressure. If you are given this medication to control your heart rate, your blood pressure should return to normal. However, you must be careful, and take the medication exactly as directed by your healthcare provider.
    • Digoxin - Also called digitalis, this medication works by slowing down the heart rate, and making it beat more effectively. This will pump blood through out the body better.
      • Your doctor or healthcare provider should be testing your blood for the levels of digoxin in your blood stream.
    • Midodrine Hydrochloride - This medication may be given to you by your cardiologist or specialist, if you have low blood pressure when you stand up. You will likely receive this medication if your blood pressure changes to a low level when you change positions, and this causes you to feel dizzy, faint, or even "pass out."
      • If you are taking this medication for your low blood pressure, make sure to take it exactly as directed. If your blood pressure changes to a level too high when you lay down as a result of this medication, your healthcare provider may suggest that you sleep on one or two pillows, with the head of the bed elevated.

    When to call your doctor or health care provider about symptoms of blood pressure changes:

    • Notify your doctor or health care provider immediately and seek emergency help if you have chest pain, chest tightness, or sudden shortness of breath.
    • Notify your doctor or health care provider immediately and seek emergency help if you have a sudden sever headache, slurring speech or weakness on one side of your body and not the other.
    • Shortness of breath, chest pain or discomfort; swelling of your lips or throat should be evaluated immediately- especially if you are taking new medications.

    Notify your doctor or health care provider within 24 hours if you experience:

    • Fever of 100.5° F (38° C), chills, sore throat (possible signs of infection, especially if you are undergoing chemotherapy).
    • If you "pass out" or lose consciousness as a result of your low blood pressure.
    • Feeling your heart beat rapidly (palpitations).
    • Monitor for signs of bleeding. If you have tarry black stools, or maroon stools, notify your healthcare provider immediately.
    • Any new rashes on your skin, especially if you are taking new medications.

    Note: We strongly encourage you to talk with your health care professional about your specific medical condition including blood pressure changes, causes and treatments. The information contained in this website about blood pressure changes and other medical conditions is meant to be helpful and educational, but is not a substitute for medical advice.