Blood pressure is one of the most important automatic functions your body manages without you ever having to think about it. Under healthy conditions, your nervous system constantly adjusts blood pressure to keep your brain and organs supplied with oxygen, whether you’re lying down, standing up, exercising, or simply getting through your day. When someone has dysautonomia, these automatic adjustments don’t work the way they should, and blood pressure can become unpredictable. Understanding why this happens can make symptoms feel less mysterious and help you better communicate with your healthcare providers.
Blood pressure is regulated by a branch of the nervous system called the autonomic nervous system. This system acts like a built-in autopilot, balancing two major forces: one that speeds things up and tightens blood vessels, and one that slows things down and helps the body rest. When you stand up, gravity pulls blood toward your legs and abdomen. A healthy autonomic response counters that by tightening blood vessels and increasing heart rate just enough to keep blood flowing to your brain. This is why most people don’t feel dizzy or lightheaded when they change positions.
In dysautonomia, this reflex doesn’t work properly. Some people experience exaggerated drops in blood pressure when they stand, which can cause dizziness, blurry vision, fatigue, weakness, or even fainting. Others experience the opposite: their heart races excessively while blood pressure struggles to stabilize, leaving them feeling anxious, shaky, or short of breath. For some, blood pressure becomes unstable throughout the day, swinging high, low, or both. These fluctuations aren’t random; they are signs of the autonomic nervous system having difficulty coordinating vascular tone, heart rate, and blood distribution.
A big part of this problem comes down to how the autonomic nervous system senses and responds to changes in pressure. Tiny pressure sensors in your arteries, known as baroreceptors, are constantly sending information to the brainstem about how much pressure is in the system. If those signals are delayed, inaccurate, or overwhelmed by stress, illness, or injury, the brain can’t respond quickly enough. Muscles in the blood vessel walls may not tighten when needed, or they may tighten too much. Blood can then pool in the lower body instead of circulating efficiently. When the brain receives less oxygen for even a few seconds, symptoms occur.
Managing dysautonomia often involves stabilizing these pressure changes. Simple strategies like increasing fluid and salt intake, wearing compression garments, rising slowly from lying or sitting, and doing recumbent exercise can reduce blood pooling and support better circulation. For some people, targeted neurological rehabilitation, medications, or specific physical therapies can help improve the brain’s ability to regulate blood pressure more effectively. Each person’s pattern is unique, and treatment must be tailored to the individual.
Understanding why your blood pressure behaves the way it does is empowering. Dysautonomia is not “in your head,” and the symptoms you feel are real physiological responses to an autonomic system that’s working overtime to adapt. With the right tools and support, many people experience meaningful improvement, better symptom control, and a clearer path forward.
Benjamin Pupo
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