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Heart & Cardiology/high systolic with low diastolic BP



My mother has been lately suffering from a unique BP ailment.
She had a blackout recently in which she was semi-conscious.
Since then we have been monitoring her BP and have found that
her systolic BP hovers around 140-150 while her diastolic level
oscillates between 60-70. Yesterday night the upper one was 139
but the lower one dropped to 45 so I fed her some salty biscuits.

Is this variation in BP the reason for her blackout and


Please reply at your earliest. I am quite worried about her health.

Thanks a lot


I can tell that you are worried about your mother.  Based on the blood pressure readings you have given, your mother’s blood pressure is within normal limits (I am assuming that she is older than 60 years) for both the systolic and diastolic blood pressure.  The wide gap that you are noticing between her systolic and diastolic blood pressure is called the pulse pressure.  A normal pulse pressure is ~40 mm Hg, and is considered “wide” at ~60 mm Hg.  Based on your readings, your mother’s pulse pressure hovers at ~80 mm Hg.  There is nothing overtly dangerous about a wide pulse pressure, traditionally; it is a sign of aging (which is why I am assuming your mother is likely older than 60 years).  The reason for this widening pulse pressure is thought to be due to age-related changes or stiffening of the central arteries in the body.  The large arteries lose their elastic compliance over time, just like our skin loses its elasticity over time (“wrinkles”).  A wide pulse pressure has been associated with and may be a predictor of heart problems, especially in older adults, and a pulse pressure ≥60 mm Hg it is generally considered a risk factor for cardiovascular disease.  There is technically no “cure” for a wide pulse pressure, just treating the potential underlying causes (except of age, of course, no fountain of youth has been found to date).  Usually the things that we first think about in these cases are uncontrolled hypertension (high blood pressure), anemia, and hyperthyroidism – among other things – but that is a good place to start.  Treating high blood pressure and controlling excessive salt intake usually reduces pulse pressure.

To specifically answer your question, however, I don’t think that her blackout was due to the wide pulse pressure.  Blackouts are related to your mean arterial pressure (MAP), or perfusion pressure, it is calculated as: MAP = 2/3 of your diastolic pressure + 1/3 of your systolic pressure.  Your mother’s MAP is usually between 76-97 mm Hg.  A MAP ≥65 mm Hg is generally regarded as normal, meaning enough blood pressure to perfuse your brain and other vital organs.  A MAP can flucuate for sure, especially in the elderly, when they stand (orthostatic hypotension) or move around (autonomic dysfunction) – all of which can cause blackouts.  Therefore, based on the information you provided, I don’t think her current blood pressure issues caused her blackout but other related blood pressure issues might.

It is important that she have her sitting and standing blood pressures measured using proper technique and possibly even ambulatory blood pressure 24hr monitoring. I would advise a blood pressure diary also. My recommendation would be to find a local physician that you trust and present your concerns to them, so that they can be familiar with your mother’s health over time and provide attentive care when needed.  

Hope that was helpful,

---------- FOLLOW-UP ----------


I forgot to add that she has been suffering from Anxiety Disorder
as well owing to the excessive amount of tensions that she has taken
all her life so that might have affected her nerves leading to such

She has been taking :

Escitalopram 10 mg   and   Alprazolam 0.25 mg

for 6 months now.

Is the blackout related to stress and nerves then ?
If yes, is there a medicine for anxiety apart from the
above ones that can avoid such blackouts ?



Anxiety disorder does not cause true blackouts, and black outs in the presence of anxiety disorder require investigation as an independent entity. Anxiety medications are not likely to address the blackouts. If the blackout recurs then i would certainly recommend thorough evaluation by not only a cardiologist but also potentially a neurologist as further tests will likely be required.

Hope that was helpful,

---------- FOLLOW-UP ----------

QUESTION: It's not actually a blackout. She is conscious but keeps her eyes closed after she has darkness in front of her eyes. Does that not happen in Anxiety  -  darkness infront of eyes and sweating thereafter ?

All her cardeo tests are normal.



Anxiety may be associated with a form of 'panic attack' that may manifest as a feeling of impending passing out. Reassuringly the cardiac tests are normal so far. If the episodes recur frequently or there is a definite black out then i would certainly pursue a neurologic or further evaluation to ensure these aren't neurologic events such as TIA's. If there is concern for anxiety related psuedo-syncopal events then evaluation and treatment for anxiety is reasonable also.

Hope that was helpful,  

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Mustafa Ahmed MD


Cardiology, Interventional Cardiology, Cardiac Surgery, Hypertension, Pulmonary Embolism, Structural and Valve Disease


Board Certification Internal Medicine and Cardiology Interventional and Structural Cardiology


Multiple Publications In High Quality Peer Reviewed Journals. Internationally Recognized.

MD from The Royal Victoria University of Manchester, England Medicine, Cardiology, Interventional Cardiology, Research Training - University of Alabama

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