Why does high blood pressure cause shortness of breath

Q: Can high blood pressure cause shortness of breath?

From a cardiovascular standpoint, its common to see people short of breath if theyre experiencing heart failure. It commonly exists in conjunction with diabetes, high blood pressure, or atrial fibrillation. Leaky or stenotic (too narrow) heart valves can similarly cause shortness of breath.

Understanding High Blood Pressure -- Symptoms

What Are the Symptoms of High Blood Pressure?

In the vast majority of cases, there are no clear symptoms of high blood pressure (also known as hypertension), which can lead to heart disease, stroke, kidney failure and eye problems if untreated. The only way to find out if you have high blood pressure is to get your blood pressure checked on a regular basis. This is especially important if you have a close relative who has high blood pressure.

Table of Contents Show

Understanding High Blood Pressure -- Symptoms
What Are the Symptoms of High Blood Pressure?
Call Your Doctor About High Blood Pressure If:
Background therapy
Anticoagulant medicines
Calcium channel blockers
Targeted therapy
Epoprostenol
Heart-lung transplant
How do I know if my shortness of breath is heart related?
Does high blood pressure reduce oxygen levels?
Can high blood pressure cause shortness of breath?
Can high blood pressure cause fatigue and shortness of breath?

If your blood pressure is extremely high, there may be certain symptoms to look out for, including:

Severe headache
Fatigue or confusion
Vision problems
Chest pain
Difficulty breathing
Irregular heartbeat
Blood in the urine

If you have any of these hypertension symptoms, see a doctor immediately. You could be having a hypertensive crisis that could lead to a heart attack or stroke.

Call Your Doctor About High Blood Pressure If:

Your diastolic pressure -- the second, or bottom, number in a blood pressure reading -- suddenly shoots above 120 ,or your systolic pressure, the first number, is over 180; you may have malignant hypertension (also known as ''hypertensive emergency''), a life-threatening condition that can result in heart attack, stroke, kidney and eye problems.
You are experiencing severe headaches, nausea, blurred vision, and confusion or memory loss; this may be a sign of malignant hypertension.
You are pregnant and develop hypertension; symptoms may include severe headache and sudden swelling of the legs. High blood pressure during pregnancy can affect not only your own health, but also the health of your unborn child.
You're taking drugs for high blood pressure and experiencing worrisome side effects, such as angioedema (swelling of your mouth or tongue), drowsiness, constipation, dizziness, or loss of sexual function; your doctor may prescribe a different anti-hypertensive drug.

If your pulmonary hypertension is caused by an underlying condition, your treatment will focus on tackling it. If the cause is treated early, it may be possible to prevent permanent damage to your pulmonary arteries (the blood vessels supplying your lungs).

If you have pulmonary arterial hypertension (PAH), you will be referred for treatment at a centre that specialises in PAH. There is one centre in Scotland at the Golden Jubilee National Hospital in Clydebank.

A number of different medicines can be used to treat PAH and other types of pulmonary hypertension. You will usually be started on conventional therapy or background therapy, and your treatment will then be changed or increased as necessary. Further treatment is called targeted therapy.

Background therapy

Background therapy includes:

anticoagulant medicines
diuretics
oxygen
digoxin

These are explained in more detail below.

Anticoagulant medicines

PAH can increase your risk of venous thromboembolism, which is when a blood clot forms in a vein and then breaks free. The clot can become trapped in a blood vessel, blocking the vessel and the blood supply. If this blocks one of the blood vessels supplying your lungs, this is called a pulmonary embolism.

Anticoagulant medicines reduce the ability of the blood to clot. Taking anticoagulants, such as warfarin, may therefore reduce your risk of venous thromboembolism.

These medicines can cause side effects, such as increased bleeding, so you will be carefully monitored while taking them.

Diuretics

Diuretic medicines are used to remove excess fluid from the body by increasing the production and flow of urine. Diuretics may be used in pulmonary hypertension to treat any fluid retention and swelling (oedema). This can occur if pulmonary hypertension starts to cause heart failure (when your heart struggles to pump blood around your body).

Possible diuretics that may be used include:

furosemide
amiloride
spironolactone

Diuretics can cause some side effects, such as:

mild tummy upset
postural hypotension – when your blood pressure drops suddenly after movement – for example, feeling dizzy after standing up
a dry mouth
rashes
headaches
confusion

Diuretics can also disrupt your levels of electrolytes (minerals in your blood, such as potassium) and affect your kidney function. Because of this, your kidneys and blood will be monitored while you are taking diuretics.

Oxygen

If you have low oxygen levels in your blood, you may need to be treated with oxygen. This involves inhaling air that has a higher amount of oxygen in it than normal. This increases the amount of oxygen in your blood and should improve your symptoms.

Digoxin

If your pulmonary hypertension leads to heart failure, you may be treated with digoxin. This increases the strength of your heart muscle contractions and can slow down your heart rate.

Calcium channel blockers

Calcium channel blockers are medicines normally used to treat high blood pressure (hypertension). They work by relaxing the muscles that make up the walls of your arteries. This widens your arteries and reduces your blood pressure.

Possible calcium channel blockers include:

nifedipine
diltiazem

Calcium channel blockers may work for people with idiopathic PAH (PAH with no known cause), but the effect in other types of PAH is less clear.

You will need a vasoreactivity test to find out if calcium channel blockers will be suitable for you. This involves taking some of the medication and then checking the blood pressure in your pulmonary arteries to see if it has fallen. If it has, you may be prescribed calcium channel blockers.

Targeted therapy

If calcium channel blockers were not suitable for you, or if they are no longer effective, further treatments can be tried. These are called targeted therapies and include the following medicines:

bosentan
sildenafil
iloprost
epoprostenol

These are explained in more detail below.

Bosentan

Bosentan tablets may be taken to improve your symptoms and your ability to exercise. You usually take two tablets twice a day (in the morning and evening), although the dose can vary.

You may spend a day in hospital starting treatment and should then be able to return home and carry on taking the medicine. If after 8-16 weeks your condition has not improved (or has got worse), you may be given additional treatment as well as or instead of bosentan.

Bosentan can increase the levels of some enzymes in the liver, which can lead to liver damage. Enzymes are proteins that speed up and control chemical reactions in the body, such as digestion. Because of this, your liver will need to be monitored once a month for as long as you are taking bosentan.

Bosentan will not be suitable for you if you:

already have a problem with your liver
are taking ciclosporin (a medicine that suppresses your immune system)
are pregnant

Women who could get pregnant must use contraception if they are taking bosentan. Bosentan can interact with hormonal contraception, such as the combined contraceptive pill, so it is better to use an alternative method, such as condoms.

Sildenafil

Sildenafil tablets are usually taken three times a day to improve your ability to exercise.

You may spend a day in hospital starting treatment and should then be able to return home and carry on taking the medicine. How long you can take sildenafil for will depend on your condition. If at any time your condition gets worse, you may be given additional treatment as well as or instead of sildenafil.

Sildenafil may not be suitable for you if you:

are also taking medicines or drugs that contain nitrates – organic nitrates are often used to treat angina, and amyl nitrate is a recreational drug commonly known as 'poppers'
have a severe problem with your liver
have recently had a heart attack or stroke
have severe low blood pressure
have certain eye conditions

Iloprost

Iloprost is inhaled through a nebuliser. This is a device that turns the liquid medicine into a mist that you breathe into your lungs. You may need to take iloprost around six to nine times a day. Each dose can take up to 10 minutes to inhale.

You will need to stay in hospital for up to three days to be trained in using the nebuliser and to monitor your response. After this time, you should be able to return home and keep taking the medicine yourself.

How long you need to take iloprost for will depend on your condition. You may need to continue taking it, possibly alongside other treatments, until your condition worsens and you need epoprostenol (see below).

Iloprost may not be suitable if:

you have a peptic ulcer
you have recently had a heart attack or stroke
your pulmonary hypertension is caused by pulmonary veno-occlusive disease (a rare condition that causes high blood pressure in the lungs)
your pulmonary hypertension is unstable, with advanced right heart failure

Epoprostenol

Epoprostenol – its full name is epoprostenol sodium – may be used if you do not respond to other treatments. Epoprostenol needs to be given through an intravenous infusion, which means a constant drip of medicine goes through a narrow tube into a vein in your arm.

Treatment with epoprostenol will begin in hospital. It may take one or two weeks to find the correct dose for you. After this time, it is possible, with special training and equipment, for you or your carer to learn how to take this medicine yourself at home.

Once you have started taking epoprostenol, you may not be able to stop. Coming off epoprostenol can cause your pulmonary hypertension to rapidly return, so you may need to take epoprostenol for the rest of your life. This is why epoprostenol is considered last, after other treatments have not worked or if your condition has got worse.

Epoprostenol may not be suitable for you if you have heart failure caused by a problem with the left side of your heart, or if you have or develop pulmonary oedema (fluid on the lungs).

Heart-lung transplant

For severe pulmonary hypertension, a heart-lung transplant may be a treatment option. This involves transplanting the healthy heart and lungs from a donor into you. However, because of a shortage of donors, these are rarely carried out. There are probably fewer than 10 heart-lung transplants a year in the UK.

Does high blood pressure reduce oxygen levels?

High blood pressure can damage your arteries by making them less elastic, which decreases the flow of blood and oxygen to your heart and leads to heart disease.

Can high blood pressure cause shortness of breath?

From a cardiovascular standpoint, it's common to see people short of breath if they're experiencing heart failure. It commonly exists in conjunction with diabetes, high blood pressure, or atrial fibrillation. Leaky or stenotic (too narrow) heart valves can similarly cause shortness of breath.

Can high blood pressure cause fatigue and shortness of breath?

Another cause of fatigue could be due to pulmonary artery hypertension. This is when you have high blood pressure in the vessels that carry blood between your heart and lungs. Along with fatigue, it can cause chest pain, shortness of breath, and lightheadedness.