Dizziness Does Not Cause Elevated Blood Pressure
No, dizziness does not cause hypertension—the relationship is reversed: elevated blood pressure and its treatment can cause dizziness, but dizziness itself does not elevate blood pressure. 1
The Actual Relationship Between Blood Pressure and Dizziness
Dizziness as a Symptom, Not a Cause
Dizziness in hypertensive patients is unrelated to elevated blood pressure itself and occurs in approximately 20% of hypertensive patients due to associated neurological, peripheral vestibular, or other diseases—not from the hypertension. 2
Research demonstrates that vertigo and dizziness in hypertensive patients are more commonly caused by hypotension following antihypertensive medication use rather than elevated pressure. 2
Among 285 hypertensive patients studied, 78% hospitalized with presumed "hypertensive crisis" actually had other conditions (tension headaches, stroke, Menière's disease) where hypertension accompanied but did not cause the dizziness. 2
Blood Pressure Dysregulation Causing Dizziness
Dizziness is most frequently caused by blood pressure dysregulation, comprising a spectrum from constitutional and orthostatic hypotension to severe endocrinopathies and neurodegenerative diseases with autonomic dysfunction. 3
Orthostatic hypotension (OH)—defined as a supine-to-standing BP decrease of ≥20 mmHg systolic or ≥10 mmHg diastolic—causes postural unsteadiness, dizziness, or fainting and occurs in approximately 7% of men over 70 years old. 1
Supine hypertension associated with hypotensive reactions on head-up tilt (SH-HRT) occurs in 9.8% of patients with nonspecific dizziness, representing an underdiagnosed syndrome where patients have elevated supine BP but experience significant drops with position change. 4
Clinical Implications for Hypertensive Emergencies
When Dizziness Accompanies Severe Hypertension
In hypertensive emergencies, dizziness results from impaired cerebral autoregulation due to the rate and severity of BP elevation, not from the dizziness causing the hypertension. 1
Hypertensive encephalopathy presents with somnolence, lethargy, seizures, and cortical blindness when markedly elevated BP overwhelms cerebral autoregulation—dizziness is a symptom of this process, not a cause. 1
Emergency symptoms in hypertensive crises include headache, visual disturbances, chest pain, dyspnea, and neurological symptoms, with dizziness being a frequent but nonspecific symptom resulting from impaired cerebral autoregulation. 1
Treatment Considerations
Managing Dizziness in Hypertensive Patients
Treatment of dizziness in hypertensive patients should not focus solely on managing elevated pressure but must address the underlying disease causing the dizziness (vestibular disorders, neurological conditions, medication effects). 2
Clinicians should obtain lying and standing blood pressures periodically in all hypertensive individuals over 50 years old to detect orthostatic hypotension, which is a common barrier to intensive BP control. 1
Antihypertensive medications commonly cause dizziness as an adverse effect, particularly with β-blockers, α-blockers, diuretics, and nitrates, which can aggravate orthostatic hypotension. 1
Avoiding Common Pitfalls
Do not assume dizziness in a hypertensive patient represents a hypertensive emergency—most patients with elevated BP and dizziness have other causes requiring different management. 2, 5
In elderly patients, aggressive BP lowering may result in loss of cerebral autoregulation (curves shifted to the right), potentially causing borderzone infarcts with relative hypotension—monitor closely for dizziness, syncope, or neurologic symptoms. 1
Hypotension, syncope, and dizziness increase with intensive BP targets (SBP <120 mmHg vs <140 mmHg), though orthostatic hypotension rates may not differ significantly. 1