Fluctuating Blood Pressure: Causes And How To Treat It

Blood pressure measures the amount of pressure blood puts on the walls of a person’s arteries. “Fluctuating blood pressure refers to a condition where someone’s blood pressure fluctuates significantly over time, potentially becoming dangerously irregular,” says Laura Purdy, M.D., a board-certified family medicine physician and chief medical officer of OpenLoop, a digital health care company.

As arteries carry blood from the heart to the rest of the body, their functionality is crucial to a person’s health. Blood pressure is measured with two readings:

• Systolic blood pressure measures the pressure being placed on the arteries while the heart is beating.
• Diastolic blood pressure measures the pressure being placed on the arteries in between heart beats, while the heart is resting.

Fluctuating blood pressure (labile hypertension) is blood pressure that’s difficult to keep within a healthy physiologic range, adds Alexandra Kharazi, M.D., a cardiothoracic surgeon at CVTS Medical Group Inc in San Diego, California and author of Heart of Fear.

A normal blood pressure reading sits below 120/80 millimeters of mercury (mmHg). High blood pressure, also known as hypertension, is defined by readings higher than 130/80 mmHg in stage 1 and more than 140/90 mmHg for stage 2 hypertension^[1]Measure Your Blood Pressure. Centers for Disease Control and Prevention. Accessed 7/31/2023. . If a person’s blood pressure changes quickly between readings without an obvious reason, they’re considered to have fluctuating blood pressure.

“When blood pressure continually fluctuates outside its usual range, it should be cause for alarm and potentially require professional medical help,” says Dr. Purdy.

Several factors can cause fluctuating blood pressure, including:

• Stress. “Blood pressure is supposed to go up as a response to stressful situations,” explains Mark Drucker, M.D., owner of the Center for Advanced Medicine and lead doctor at Beyond Slim, a healthy living community based in Encinitas, California. “During stressful situations, blood pressure increases to get more blood to vital organs, such as the brain or muscles. However, when the stress is over, blood pressure needs to come back down.”
• White coat syndrome. Some people find that their blood pressure readings are higher when they visit a health care provider’s office. Known as “white coat syndrome,” this condition is caused by anxiety, nervousness or previous negative experiences within health care and affects up to one in three people, according to the Centers for Disease Control and Prevention (CDC)^[2]Measure Your Blood Pressure. Centers for Disease Control and Prevention. Accessed 7/31/2023. .
• Medications. “Some medications, such as decongestants, nonsteroidal anti-inflammatory drugs (NSAIDs) and certain antidepressants may lead to unpredictable fluctuations in blood pressure as an unexpected side effect,” says Dr. Purdy.
• Stimulants. Stimulants, such as cocaine and methamphetamine, can cause blood pressure spikes, according Dr. Kharazi.
• Hormonal changes and pregnancy. “Shifting hormone levels can significantly impact blood pressure levels,” explains Dr. Purdy. Hormone levels change with a person’s age, which can alter blood pressure in both men and women. Pregnancy can also alter a person’s blood pressure readings and cause patients to develop hypertension or preeclampsia, a serious high blood pressure disorder that affects all organs in the body of a pregnant person. Preeclampsia can also cause strokes and seizures to occur.
• Underlying health conditions. A number of pre-existing health conditions can cause fluctuating blood pressure, including Parkinson’s disease, kidney disease and diabetes. A type of tumor known as a pheochromocytoma can also cause hypertension or fluctuating blood pressure, as it can release hormones that affect a person’s blood pressure, according to Dr. Kharazi.
• Diet. Eating a diet high in salt, particularly in people with underlying high blood pressure or who are sensitive to sodium, can cause dangerous spikes in blood pressure adds Dr. Kharazi. Drinking alcohol and caffeine, especially right before a blood pressure reading is taken, can also casue fluctuations in a person’s blood pressure.
• Exercise. The amount a person exercises can impact their blood pressure, especially if the reading is taken soon after they complete strenuous exercise. Exercise increases blood pressure temporarily and may cause it to drop below baseline for a short period after during recovery.
• Smoking. Smoking can cause a temporary blood pressure spike, which may influence a person’s fluctuating blood pressure.
• Pain. High blood pressure can also be a result of acute and chronic pain, specifically in older people with orthopedic conditions.

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Not everyone who has fluctuating blood pressure will experience symptoms, in which case the only way to diagnose the condition is via monitoring. According to Dr. Kharazi and Dr. Purdy, people are most likely to notice symptoms of high blood pressure first if they are experiencing fluctuating blood pressure. These symptoms may include:

• Dizziness or lightheadedness
• Blurred vision
• Fatigue
• Chest pain
• Shortness of breath
• Nausea
• Palpitations
• Sweating
• Headaches
• Nosebleeds
• Confusion
• Buzzing in the ears

While some patients will remain asymptomatic, low blood pressure fluctuations may produce similar symptoms, including dizziness, fatigue, confusion and a headache.

Fluctuating blood pressure can lead to a number of other health conditions and complications. “Unchecked fluctuation could increase risks, such as cardiovascular disease, stroke and organ damage,” says Dr. Purdy.

If an individual’s blood pressure is consistently spiking and producing high readings, they might be at risk of the complications connected to hypertension or high blood pressure. “High blood pressure puts you at high risk of serious complications, such as stroke or aortic dissection, which can be fatal,” explains Dr. Kharazi.

Hypertension can also increase a person’s risk of heart attack. “In addition to heart attack and stroke, having high blood pressure is a risk factor for other heart and brain ailments including congestive heart failure and dementia,” adds Dr. Drucker.

Whether a person’s fluctuating blood pressure can be cured completely depends on the underlying cause, explains Dr. Kharazi. “For example, in a patient with a pheochromocytoma [a type of neuroendocrine tumor that affects the adrenal glands], the cure can be a surgical resection.”

It’s crucial for an individual experiencing symptoms of high or fluctuating blood pressure to speak to their health care provider, who can make an accurate diagnosis and recommend treatment.

Fortunately, high blood pressure is typically treatable and preventable, and making lifestyle changes like diet modifications may help a person manage the condition, says Dr. Kharazi. “A healthy diet and avoiding recreational use of stimulants is protective against dangerous blood pressure spikes in nearly everyone.”

“Finding out why your blood pressure fluctuates requires frequent monitoring over a period of time in order to detect patterns or variations and seeking medical advice,” says Dr. Purdy. “A health care provider is best qualified to assess your individual situation by reviewing past medical histories and conducting any required tests or screening procedures.”

Fluctuating blood pressure often doesn’t have any symptoms, which may prevent patients from seeking a diagnosis. However, regular blood pressure monitoring can help determine if a person has fluctuating blood pressure. The following locations all offer resources for measuring blood pressure:

• A doctor’s office. Blood pressure is measured using an inflatable cuff, which is placed around your arm. As the cuff inflates, a gauge measures your blood pressure. A health care professional listens to an individual’s pulse with a stethoscope to measure their systolic and diastolic readings. A digital machine may also be used, which automatically provides a person’s blood pressure readings.
• A pharmacy: Most pharmacies have a digital blood pressure machine, allowing patients to easily measure their blood pressure in the store.
• At home: Blood pressure monitors for home use are available to purchase online or in a drug store like CVS and allow users to check their readings regularly.

Treatments for Fluctuating Blood Pressure

“Working closely with your health care provider to develop an individualized treatment plan tailored specifically to your unique needs and medical history is vital to keeping blood pressure within healthy limits,” says Dr. Purdy. The main treatments for fluctuating blood pressure include:

• Regular monitoring. It’s crucial that a person diagnosed with fluctuating blood pressure regularly monitors their blood pressure at the doctor’s office, at a pharmacy or at home. Regular monitoring may lead to quicker treatment, as irregular readings can be caught early.
• Lifestyle changes. “Leading a healthier lifestyle can have a substantial effect on blood pressure,” adds Dr. Purdy. “This involves making better nutritional food choices, engaging in regular physical activity, managing stress effectively and getting plenty of restful sleep each night while restricting alcohol and caffeine consumption.” Dr. Drucker notes that finding ways to manage stress, such as meditation, can also be beneficial.
• Quit smoking. Along with making healthier lifestyle choices, quitting smoking can greatly improve fluctuating blood pressure. Smoking damages a person’s blood vessels, which can cause blood pressure problems and lead to a greater risk of heart attacks, heart disease and strokes.
• Medications. If a person’s blood pressure regularly spikes or is unusually high, they may require medication to control blood pressure. Some medications, such as beta blockers, help the heart beat less forcefully, while medications such as ACE (Angiotensin-converting enzyme) inhibitors relax the blood vessels to allow blood to flow more easily. Other medications like Thiazide diuretics decrease the levels of water and salt in a person’s body, helping them maintain healthy levels of both. As there are several different blood pressure medications available, all of which work in different ways, it’s important for individuals to work with a healthcare professional to find the correct treatment regimen for their condition.