Why is my blood pressure going up and down
Why is my BP all over the place?
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hi guys my name is Sanjay Gupta I'm a
consultant cardiologist and today I
wanted to do a little video on blood
pressure and this video is entitled why
is my blood pressure all over the place
alright so one of the communist concerns
that people who have high blood pressure
have is that they will do them they will
do the blood pressure at one point and
the blood pressure would be what they
think is normal
another point they'll do it and the
blood pressure will be sky-high and all
the time the blood pressure will be low
and the blood pressure fluctuates a lot
and this causes a great deal of concern
because the patient thinks while I'm
taking my blood pressure medication why
is it so fluctuate and particularly when
the values are high the patient gets
really really concerned am I gonna have
a stroke is this what's gonna happen to
me
and also incidentally sometimes people
who have high blood pressure will then
start feeling dizzy at times
particularly first thing in the morning
when they get up and they get up get out
of bed and they feel dizzy and at that
time they go they go and speak to their
doctor and they say oh that's low blood
pressure and so the question is well if
you've got high blood pressure how can
you have low blood pressure what's going
on there and I thought I'd do a little
video to try and make you understand
this because if you understand it it
will take away some of this anxiety
caused by very high blood pressure
readings or very low blood pressure
readings thinking so the first thing to
understand is that when you're thinking
of blood pressure it helps to think of
pressure that is generated inside a
vessel so all half hearts will pump
blood out into our blood vessels okay
and we don't have just one block vessel
yes we have a one main blood vessel but
then that branches and has smaller
branches and smaller branches and
smaller branches eventually becomes
capillaries supplies the vital organs
and those capillaries become veins and
the veins come back to the heart so in
essence the vessel is a closed vessel
right okay it
that opening which is the heart pumping
blood in but otherwise the vessel is
closed so in a very simplistic sense you
can think of the vessel as a container
like like a balloon for example all
right our blood vessels if everything is
combined together would be like a
balloon all right now when you blow in
the balloon the pressure that is
generated inside the balloon is
dependent on two things how much is
going into the balloon how much you are
blowing into the balloon and how
stretchy that balloon is it's as simple
as that pressure is force over area
forces essentially how much you're
putting into that vessel area is how how
much volume how much space there is in
that vessel were in that vessel and in
particular if the vessel is stretchy
then as you put more in the vessel
stretches and therefore the pressure
doesn't go up as much because the area
has increased all right in people who
have high blood pressure or who have had
high blood pressure the problem is that
the balloon is no longer a balloon the
balloon has become a hot water bottle
all right so what happens in a hot water
bottle in a hot water bottle if you blow
air in you're blowing in but the walls
do not stretch and therefore the
pressure is higher in a hot water bottle
for the same volume all right now let me
just show you something
if you look at this if you draw a graph
against volume and pressure you will
find that if you had a balloon for
example B the more volume you increase
the more the pressure will build up all
right and the pressure will build up and
eventually as the balloon gets bigger
and bigger it gets harder and harder to
pump air in so you have to post
Lesly you put even
then less volume will cause a higher
pressure towards the end when it's
really stretchy so when you've got a
balloon for example in your blowing it's
easier to blow in at the beginning but
towards the end when it's really big the
amount of volume you have to put in is
only small and the pressure goes up
significantly right and that's why over
here it's going up like this but as you
get towards the end where the balloon is
getting bigger and bigger the amount of
volume you just need to do put in a
little bit of volume but look how much
it increases the pressure so a little
bit of volume here but the pressure has
gone up all this way right so that's
what happens in a balloon now let's
think of what happens in a hot water
bottle in a hot water bottle what will
happen is let me just show you this okay
so in a hot water bottle what's
happening is is this this second curve
here so the amount of volume you put in
is very small and the pressure goes up
many fold alright so you've only put a
little bit of volume in but the pressure
look at how much how much the pressure
goes up by okay so from here for example
if I put in somewhere here there's the
volume if I increase that look at how
much more the pressure has gone up
compared to in the balloon alright so
basically what happens therefore is that
if you increase the amount of volume in
that vessel for the same amount of
volume the pressure will go up more
right so everything will be magnified
because you don't have the stretchy
vessels which damp down this increase in
pressure anything you put in will be a
magnet bite so if you increase the
volume slightly the pressure will go up
significantly similarly if you decrease
the volume slightly the pressure goes
down significantly in a person who has
high blood pressure and that is why
people will say when I get up first
thing in the morning I feel dizzy
well you've the reason you're feeling
dizzy is because I overnight you've been
dehydrated because you haven't drunk
you get up in the morning you change
posture all right and that small
reduction in volume that in your body
will cause a big reduction in pressure
and that's why you feel dizzy
all right and then that's why people
come to me and clinic for example they
come to me and see me in hospital and
they'll say oh my god my blood pressure
sky-high why is it sky-high it was fine
yesterday now it sky-high and the reason
is that people come into hospital their
stress their heart rate has gone up the
amount of volume that's going in is much
higher and that is why that changes
magnified because the vessels aren't
stretchy and therefore the the increase
in heart rate has a much bigger impact
on the blood pressure and that is what
happens so the truth is that this
increased variability is just part and
parcel of having high blood pressure of
having less stretchy vessels all right
and that's just part and parcel of it
now the problem is that people say well
I'm taking medication but the problem
with the medications is that they
they're not dynamic the people take beta
blockers what do beta blockers do they
slow the heart down so in essence you're
putting less force in because the heart
rate is slower but you're still putting
this you're still putting force in it's
not dynamic it doesn't change in
conditions if the thing it's a it works
the same way or at all times where the
stretchiness the blood vessels just
stretch whenever they need to stretch
because the force has gone up so the
blood vessels spread with the heart
rates you know your heart rate maybe
instead of 80 your heart rate may be 60
but then when you walk your heart rate
will still go up to 80 so you'll still
get an increase in the heart rate which
will still magnify your blood pressure
change and also people who take things
like calcium blockers or or you know ACE
inhibitors again all you're doing with
those is you're opening up the blood
vessel you're not making the blood
vessel more stretchy you're just opening
it up so sure you've got a bigger hot
water bottle but it's still a hot water
bottle it's not become a balloon and
this is the problem so whenever you are
dealing with this scenario of high blood
all fluctuations in the heart rate
fluctuations in the volume status will
magnify in terms of blood pressure will
magnify the change in blood pressure
okay and people who are elderly for
example they put on blood pressure
tablets to lower the blood pressure and
next thing they find themselves on the
floor from time to time because that
small change in volume if they're a
little bit dehydrated if they develop a
little bit of an infection they become
dehydrated then that translates into a
big fall in blood pressure and that's
why they're blackout now the point is
that I wouldn't worry about that I
wouldn't worry about the variability
because that is part and parcel of just
having harder vessels okay and I would
be reluctant to change a person's
medications based on just a reading here
and there so you know if someone comes
to me and says oh well look I've got
high blood pressure
today when I've come to you the blood
pressure is 180 over 100 I said don't
worry about it don't we don't need to
start treating that if there is a lot of
variation and a person is really worried
I would prefer to do a 24-hour blood
pressure monitor and rely on an average
rather than relying on isolated readings
because my worry is that if you you
treat someone when their blood pressure
is very high you could paradoxically
push it down extremely low particularly
if it's just because their heart rate is
high etc and that may not truly reflect
what their blood pressure is like
normally so if you have high blood
pressure and you're struggling with
variability the first thing is that's
just part and parcel of having high
blood pressure the second thing is
instead of your GP or your doctor
worrying about treating your blood
pressure based on isolated readings I
would strongly recommend you have a 24
hour blood pressure monitor so that you
have an average reading and you try and
treat the average okay rather than
treating just the peaks and troughs so I
hope this was helpful and hopefully that
will take away some of the anxiety
associated with wide blood pressure
readings are so variable that is just
part and parcel of having less stretchy
vessels whatever your blood pressure
your changes are they will be magnified
in terms of blood pressure because your
blood vessels cannot stretch to
accommodate that extra increase in force
or decrease in volume increase in volume
or decrease in volume and and and so you
know it doesn't really matter in the
long run what matters when you have high
blood pressure is your average over a
24-hour period and you should try and
aim to bring the whole average down and
not worry so much about the up and down
readings and that's about it really so I
just want to say thank you so much
you've been very very kind my channel is
finally beginning to gain some traction
it's a it's an exciting time for me
because it's nice to see people coming
and watching me and appreciating the
fact that they feel that I have
something worthwhile to say so yeah I
just wanted to say thank you so much and
I wanted to wish you a really good luck
now one thing I wanted to do is I wanted
to show you someone who brings my blood
pressure down it's funny so I'll go and
get her just give me one second and his
ears this is Bluebell Gupta the head of
a head of security head honcho
and whenever my blood pressure is up I
come and spend some time with her and
she brings it down so she's amazing and
I love her very much and so say bye so
from me and from Bluebell Gupta thank
you so much for watching all the best
take care bye
