Should my diastolic pressure change when I stand up? 

I have diastolic dysfunction (diagnosed May 2013), stage one and I’m taking 5 mg lisinopril a day to keep my pressure down. When sitting, my BP is around 110/70 but when standing, the diastolic shoots up to 89-94! The systolic goes up to 128 or 114, or goes down to 104. Shouldn’t my diastolic go down when I stand up?

Submitted by Janice from Glen Ellyn, Illinois on 11/07/2013

by Domingo G. Gonzalez, Jr., MD

Normal blood pressure is usually considered 120/80 mm Hg or less. It is not treated with medicines generally until after it gets to 140/90 mm Hg or more. This is because there is no conclusive evidence that the benefits outweigh the risks of treating with medicines to blood pressure lower than 140/90 mm Hg. In between those numbers, patients are counseled to modify their activity, weight and diet in a more salubrious fashion. The goal of blood pressure control is to minimize the risk to the heart, brain and kidneys and in diabetics, the eyes. The blood pressure normally varies with activity and even though it is largely controlled, it will rise above treatment values during physical, emotional or mental stress or when partaking of certain products such as caffeine. This is a normal response and should not trigger an adjustment of the medical regiment for the patient. When a person stands or sits up a neurocardiogenic response is triggered. The heart beats stronger and faster, and the arteries and veins constrict. This makes both the systolic and diastolic pressures rise so that the brain and heart arteries can continue to receive necessary blood and nutrients as well as oxygen.