Blood Pressure crashing from exercise

This isn’t directly T1 related, except insofar as everything is T1 related, but it’s driving me a little nuts–a little scary in fact–and I haven’t gotten much in the way of useful explanation from my PCP or specialists yet.

I’m really struggling with a bizarre, self-contradictory problem with my BP. In general I’m hypertensive. Been controlling that for decades with Losartan and exercise. Recently I went in for a nurse practitioner appointment for something unrelated to any of the above, and the routine BP they took was 160 over 80. Caramba. So my PCP called me in for a second appt to discuss wtf is up with my BP all of a sudden. At the same time, though, I’m having all this trouble with low BP. Going faint from standing up, bending over, but most weirdly of all from exercising in the warm weather. One outcome from my recent Dr appt was to finally get myself a home BP monitor (Omron). I’ve asked about this fainting stuff, saw a cardiologist, did a stress test, nothing turned up. “You’ve got high BP not low BP, so we don’t really get it.” But now that I’m able to test what it’s actually doing I’m seeing it drop, like a lot, at these times.

Most frustrating is that I’m trying to get aerobic exercise in and it’s really interfering with that. I was so looking forward to doing a long bike ride today, but almost as soon as I got out there I could feel the symptoms I’ve been having. Low muscle energy, feeling faint, and weirdest of all an ache across the back of my neck and upper shoulders. Feels a bit like hypoglycemia in fact, though BG was good, 110-120. I pushed on through my regular route but when I came to the point where I’d intended to go out on the longer ride I decided I just couldn’t do it. REALLY FRUSTRATING. Got back home and yeah, my BP was 93 over 63.

I’ve read some stuff about how this thing can happen in aerobic exercise where the big muscles in your legs are actually taking over some of the work of your heart, pumping blood around, and so when you stop you can feel faint. So that’s maybe part of it except the phenomenon seems contingent on heat, or maybe even more specifically bright sunlight (how weird is that) because I’ve had it happen when it was really sunny but mild temps–like today, upper 70s–and without involving much exercise (walking up an outdoor stairway), and NOT had it happen when it was relatively the same temp but cloudy out. It’s also NOT dehydration–I’ve had lots of water today before and during the ride, so I’m pretty sure that’s just not it.

Anyway, it’s driving me nuts–I’m SO frustrated about the ride I was planning to day and just not being able to do it. This is a critical part of keeping my BG in regulation and it’s deeply disturbing not to be able to do it. Has anyone else enountered this?

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Sounds like Postural Orthostatic Tachycardia/Hypotension Syndrome (POTS). I have that and regulate it by taking a beta blocker and consuming lots of fluids with electrolytes/salt; however, I don’t have any primary hypertension (my blood pressure varies from good to low), so I’m not sure if the approach would be similar for someone who is sometimes hypertensive… Other things that can help include compression clothing, especially on the legs.

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Interesting–gives me something new to google anyway! Thanks!

Maybe try a different bp med.

in some orthostatic hypotension can be tied to neuropathy… not sure if that’s something you have, but possibly worth checking out.

It’s on the list of questions. I’ve asked my endo about it but I don’t seem to have any other indications of it.

I have orthostatic hypotension. Yes autonomic neuropathy can cause this problem, particularly expressing as postural hypotension. However my hypotension is caused by blood pressure medication, diuretic and my SGLT2 drug. I find that when I stand up after sitting for a while I have to be careful that I don’t faint.

Unfortunately, hot weather or hot showers are known to increase circulation and reduce blood pressure. It is likely that exercise in hot weather is causing your lowered blood pressure. Dehydration is also a major cause of lowered blood pressure. I have found that two things reduce my problems with orthostatic hypotension. First, I drink lots of water, probably a gallon a day. Becoming the slightest bit dehydrated is an invitation to problems. And second, as part of managing my hydration levels I supplement with electrolytes and also use a large amount of salt. You may find that taking a salt pill with water a half hour before exercising really helps.

ps. My kidneys work great, so my sodium levels are fine. But talk with your doctor before loading up on salt like I do

As a matter of fact your response reads almost like a transcript of my “Virtual Visit” with my PCP yesterday (we’re livin in the future now, baby!). I think of myself as doing pretty well on the hydration front but he pointed out the same thing you did about heat and vascular expansion causing low BP, said increasing volume (i.e., hydration) is the answer, and suggested salt and/or electrolytes could help as well. So your comment seems spot on. Including this:

–as in, I may not be doing enough in my rather casual way about compensating adequately for the BP medication. The problem does seem to have gotten worse in the last couple of weeks, coinciding with when we increased my Losartan dose, so maybe that’s not coincidental at all.

The salt pill thing is easy enough. What are you taking for electrolytes? PCP mentioned Gatorade but that’s not hardly carb-free and there’s that whole, y’know, diabetic thing about that.

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So, I have similar issues on they hypo side (i.e., I do not have high blood pressure, but rather constantly run on the very low side of normal, but I do have pretty severe orthostatic hypotension and exercise-related hypotension). Like Brian, mine is almost entirely electrolyte and dehydration based (as well as genetics, probably). I don’t drink Gatorade, so my electrolyte regime is pretty straightforward:

  1. I take Magnesium and Potassium supplements in the morning. Chelated Magnesium seems to be the most effective. Potassium is hard to get in large quantities, because supplement makers are afraid (apparently) people will OD and cause themselves heart issues. So in addition to a teensy weensy morning supplement of 99mg, I eat a lot of spinach, kale, and asparagus.

  2. I add sea-salt (because it has magnesium, potassium, and selenium salts in addition to NaCl) to my drinking water. It helps for both dehydration and keeping electrolytes up (which are related of course). “Lite-Salt” can work really well also, and I prefer the potassium chloride / sodium chloride 50-50 mixes.

  3. I add a lot of salt to my foods (again sea salt or lite salt). My wife says it’s too much for her taste, so I tend to add more at the table.

At least for me, exercising and eating low-carb means I almost can’t get enough salts in my diet. That can be different for different people, especially with blood pressure issues, so be careful.

And my go-to gatorade replacement: 1 liter of spring water; 2 squirts of lime juice; 1 tsp of sea-salt; 2 tsp of creatine. It’s nasty but it works really well.

When do you take your Losartan? I had similar low daytime BPs with exercise (when on Lisinopril) and renal doc recommended taking my dose at bedtime instead of first thing in the morning. Now on Losartan, which I take at night, with rare daytime dips.
(Doc’s reasoning? “If you feel faint, at least you’re lying down”!)

Like @David49 I supplement with potassium, magnesium and zinc in the morning. I then am friends with the salt shaker all day. I have to admit, I probably take in 5-10g/day, but my sodium levels always test normal. If I do experience a bout of dehydration (which usually means leg cramps) I always keep a bunch of bottles of PowerAde Zero around, they are sugar free.


Really helpful replies guys, thanks! Definitely going to check out the supplements. I am basically hypertensive so not as sure about the salt part in general, though my last sodium level a month back was 142 mmol/L, with 136 - 145 mmol/L being normal. So at least a salt pill before exercising seems worth a try. And I like @Ms_Mody’s idea of taking the Losartan at night. BP is generally highest first thing in the a.m. so it may help with that too.

I know I have diabetic autonomic neuropathy in the form of gastroparesis. I was very active recently as I moved and felt several episodes of slight dizziness when rising from a kneeling position. I treat my hypertension with an ARB class drug - olmesartan medoxomil (generic Benicar).

I’d never heard of this before but I, too, experience dizziness after stooping for a moment to take care of my dogs. This is relatively new for me so perhaps diabetes is the explanation as well. It sounds like adding sea salt to one’s diet via food or water should be helpful for this condition?

Salt, but also likely more water/fluids. Dehydration is a huge factor, so the idea is to add fluids and also electrolytes (sea salt works) to help increase blood volume.

Thanks, yes, I will try out @David49’s substitute for Gatorade - 1 liter water with 1 tspn sea salt and 2 squirts from lime or maybe lemon :slight_smile:

I agree with what Brian said. I also will have hypotension after exercise, worse when standing up after sitting; in fact, there will be a delay of a couple minutes after standing up. It may be due to Losartan, and a stress test does not detect it. I am also on a SGLP2 inhibitor (Type 1), and that will cause the exercise hypootension. Be very careful adding salt to your diet! You are better off with Mag+Potassium in the AM. Stay hydrated - try Crystal lite with hydration salts. If you can pinch your sking it it does not immediately resume shape you are dehydrated. Heat will also be a big factor do to vasodilation and lack of vessel rigity, so running support hose (made by CEP and sold on Zappos) can help.


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When my blood pressure was crashing, it was due to a blood pressure lowering medicine that did too much. You might look up all your medicines to check if any of them are for blood pressure lowering. It did NOT make me dizzy - it just often made me fall down if I was standing.

Thanks @MikeR1 for the recommendations. I am going to look for a magnesium and potassium supplement. I try to eat foods high in potassium but it is hard to get the recommended daily amount.

I’m afraid for me, I often have inflammation (lupus) so usually my skin does not return to its normal state after touching, depending on the spot, and yes, heat! I’ve tried the compression socks and clothing but they are just so uncomfortable:(

I have increased my water intake but do add a couple of shakes of sea salt to each glass. It doesn’t taste good that way but bearable.

So in the last couple of days since increasing fluids and sea salt, I can say that I seem to get less severe dizziness from stooping. But I need a longer test period, and the dizziness certainly has not disappeared. And being early summer, we have had some pretty unbearable heat waves already:(

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I just re-read this thread, and your symptoms do sound like cardiac autonomic neuropathy. The pain across your back and shoulders is like a coat hanger. You need to get checked out for this and have postoral ECG tests done.

See this article by Vinik


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