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Friday, October 26, 2012

Friday Q&A: Low Blood Pressure (Hypotension)

Q: I've a question that I'm hoping you can address. I have low blood pressure and lately am finding that I am becoming VERY lightheaded moving from inversions, even simple ones like forward bend, to standing poses. I've spoken to my doctor about it and she has recommended the standard "eat move salt" approach, which I'm already doing. But I am wondering if there is any yogic therapy or advise for this issue?

A: You are not alone! I have students tell me they suffer from low blood pressure on a regular basis. Maybe “suffer” is not the right word, as some of these students don’t actually have any symptoms related to their lower than normal blood pressure, so they often just mention it in passing. But others will complain, as you are experiencing, of dizziness or lightheadedness with changing positions, especially when going from the ground to standing or inverted to upright positions.

To bring everyone up to speed, hypotension is usually defined as a blood pressure that is low enough to produce symptoms, which is usually below the numbers 100/70 when you get your blood pressure checked. Keep in mind that people in excellent aerobic condition, such as regular runners, will often have a resting blood pressure at or below this level. Of course, the blood pressure being a dynamic number that usually increases with increased demand on your body, like during a run, will rise to levels above the resting normal range without any untoward effects.

When someone has low blood pressure, as you do, and is having symptoms, it is wise to do a few things to rule out more worrisome causes, like check blood sugar to rule out diabetes, or check thyroid hormone levels to rule out an under-active thyroid gland. Other conditions to rule out are anemia, dehydration, or heart failure. To evaluate your heart itself if there is any suspicion of it being the source of your symptoms, you may be asked to get an ECG or heart tracing, an echocardiogram which uses sound waves to take moving pictures of the heart and valves, or even a cardiac stress test to see how your heart responds to increase demand via walking or running. And one final test, called a tilt-table test, can measure moment-by-moment changes in blood pressure as you are tilted up or down.This is ordered if your doctor suspects faulty brain signals (neurally mediated hypotension) as the cause of hypotension.

When symptoms are mild, the usual treatment is actually lifestyle/diet modifications, in the form of increasing salt in your diet, increasing water intake, wearing support stockings (which shunt blood from legs back to the heart, potentially increasing your blood pressure readings). If all else fails, there are several medications used to increase your blood pressure in order to see if your symptoms will resolve. According to the Mayo Clinic web site, there are several medications that are prescribed to raise the blood pressure:

“For example, the drug fludrocortisone is often used to treat this form of low blood pressure. This drug helps boost your blood volume, which raises blood pressure. Doctors often use the drug midodrine (Orvaten, Proamatine) to raise standing blood pressure levels in people with chronic orthostatic hypotension (which means hypotension that occurs due to change of position). It works by restricting the ability of your blood vessels to expand, which raises blood pressure.” 

As always, there are likely side effects to consider when deciding to try a medication for the symptoms.

Short of going through more testing, which might be a good idea in order to cover all your bases, is there anything that yoga might have to offer?  Well, one other recommendation the folks at Mayo Clinic offered may give you a way of coming out of forward folds that could impact your dizziness. In addition to moving slowly when going from supine or prone to standing, here’s what they suggest:

“if you begin to get symptoms while standing, cross your thighs in a scissors fashion and squeeze, or put one foot on a ledge or chair and lean as far forward as possible. These maneuvers encourage blood to flow from your legs to your heart.” 

The first suggestion sounds a lot like the leg position we use in Eagle pose (Garudasana).  You might try coming out of Standing Forward Bend (Uttanasana) with your legs crossed and squeezing as suggested and see if the dizziness lessens. The second suggestion sounds like Standing Leg Stretch (Padangustasana) done with a foot on a lift, such as we do onto a chair or top rung of a chair.  This later suggestion might be more applicable if your dizziness comes on when standing, as opposed to while changing positions. 

In addition to these ideas, you could carefully work with kumbhaka, or a hold at the top of the inhale, along with lengthening the inhale compared to the exhale. Start easy, with a one or two second hold. Try a 2:1 ratio timing for the inhale/exhale. This has a mild stimulating effect on heart rate and possibly blood pressure. You may want to practice these techniques separate from your asana practice, perhaps before starting. It might be possible to employ them during asana practice as well, although this is done less often, except in certain traditions, such as viniyoga or the yoga of Krishnamacharya.  So you could consider working with a teacher from those lineages. I hope this information is helpful.  I’d love to hear back if something improves, and all the best in resolving this situation!

—Baxter
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