In this blog I want to explore the relationships between lymphedema and blood pressure. Firstly, how blood pressure may represent a risk factor for the development of lymphedema, secondly, how someone with lymphedema could treat high blood pressure and lastly, if it is safe to measure your blood pressure if you have lymphedema or are at risk.
This blog is not medical advice, if you have high blood pressure and/or lymphedema, please seek the advice of a qualified medical practitioner.
You can read this blog from top to bottom or jump to any section using this Table of Contents
What is Blood Pressure?
Blood pressure is the force of the blood on the walls of the blood vessels. If you have high blood pressure over time, you can damage the walls of the blood vessels, heart, kidneys and eyes. If you have chronically increased blood pressure, then this should be treated. High blood pressure is also known as hypertension and the short form of that is HTN.
How is Blood Pressure Measured?
By placing a cuff over a branch of the aorta, and reading the pressure on a dial, you can measure both the systolic – the pressure when the heart contracts and the diastolic – the pressure when your heart is at rest between beats.
What is Normal Blood Pressure?
A normal blood pressure is 120/80mmHg (millimetres mercury).
What is High Blood Pressure?
New guidelines from the American Heart Association/American College of Cardiology defines high blood pressure as above 130/80. Previously, high blood pressure was defined as 140/90, but the change has come about as complications from high blood pressure were found to occur at a lower range. Specifically, high blood pressure damages blood vessels, it also forces the heart to work harder to pump the blood through the blood vessels.
There is no longer a category called “prehypertension”. This change means that now 46% of the American adult population has high blood pressure (American Heart Association, 2017). Your diagnosis should be made with two or three readings on at least two different occasions.
Is High Blood Pressure a Risk Factor for Lymphedema?
After reading over twenty five studies on lymphedema risk factors, I was able to find only six that examined blood pressure as a potential risk factors. I’ve summarized these for you in chronological order:
Lymphedema and Blood Pressure Research #1
This study goes all the way back to 1992 Austria. One hundred and thirty breast cancer patients had their blood pressure and weight measured and all received a mastectomy and radiation treatment for their cancer.
Fifty one of the women had high blood pressure which turned out to be the strongest risk factor for the development of lymphedema. Based on their analysis, the authors recommended that if women have high blood pressure, they should only receive radiation if absolutely necessary (Böhler, 1992).
Lymphedema and Blood Pressure Research #2
In this study, researchers interviewed 145 women with invasive breast cancer who had been through treatment for breast cancer about all kinds of factors including weight, weight gain, cancer treatment and whether or not they were being treated for high blood pressure (Geller, 2003).
The women who were receiving treatment for high blood pressure had a significantly protective effect against lymphedema. The authors postulated that treating the women for high blood pressure reduced the fluid leaking out through the capillaries (which the lymphatic system would be responsible for returning to the circulatory system).
While these researchers suggested that there is a need to better understand the role that treatment for high blood pressure may play in protecting women from arm lymphedema, I haven’t been able to find any research over the ensuing years to examine this.
Lymphedema and Blood Pressure Research #3
This study took place in Pittsburg, in 2006 by reviewing the medical records of women treated for breast cancer. This study was a case-control, that compared 52 women with lymphedema (“the cases”) to 104 women without lymphedema (“the controls”) (Soran, 2006).
Two controls were used for each woman with lymphedema and a control was matched based on: age (within 10 years), whether radiation was received or not and the type of operation (axillary lymph node dissection vs sentinel lymph node biopsy).
This research was done by accessing medical records for women who underwent breast cancer surgery between 1990 and 2000. But, it’s not clear what the average length of follow-up was. This is important to know, since lymphedema occurrence typically peaks four years after surgery, and it makes me question if some women were yet to develop it.
In this study, 25% of the control patients had high blood pressure and 29% of those with lymphedema had high blood pressure. Although 4% more had high blood pressure, this was not considered a significant finding.
Of those with lymphedema, nine had moderate or severe lymphedema, and of this group 56% had high blood pressure, but the authors did not report on the statistical significance of this compared to controls.
While this study did not report an association between lymphedema and blood pressure. Overall, I find this methodology less convincing that the prospective research.
Lymphedema and Blood Pressure Research #4
In 2008 researchers interviewed 494 women from the Los Angeles area about their experience with lymphedema within 18 months of breast cancer diagnosis. One of the interview questions was “before your cancer diagnosis, has a doctor or medical professional ever told you that you have hypertension”?(Meeske, 2008)
Participants completed a follow-up telephone interview 33 to 74 months after diagnosis. During this time they were asked if they had ever experienced arm lymphedema, specifically, “swelling due to an accumulation of fluid in their arm, not to be confused with swelling that occurs after surgery”?
Twenty four percent of this group developed lymphedema at an average of four years follow-up. Women who had reported a history of high blood pressure were found to be two times as likely to develop lymphedema compared to those without a history of high blood pressure.
Lymphedema and Blood Pressure Research #5
In research by Togawa, 2014, they followed 666 female breast cancer survivors, to find associations between lymphedema and other risk factors. These women were followed for 10 years and were asked all types of questions including socio-demographic information as well as cancer treatment related questions and other health parameters including blood pressure, body weight, hormonal factors and compared that to their self-reported lymphedema symptoms.
Over a 10 years of follow-up 190 women (29%) reported symptoms consistent with lymphedema. On average, this occurred 10.5 months after their breast cancer diagnosis. The factors that were associated with lymphedema onset were:
- Total mastectomy vs partial mastectomy (HR 1.37)
- Chemotherapy vs no chemotherapy (HR 1.48)
- More than 10 lymph nodes removed vs no lymph nodes removed (HR 1.83)
- BMI over 30 vs BMI under 25 (HR 1.59)
- High blood pressure vs normal blood pressure (HR 1.49)
HR is short for hazard ratio. It is a statistically model that can quantify the degree of association. For example a hazard ratio of 1.49 means there is a 49% increase risk of lymphedema if you have high blood pressure versus normal blood pressure.
While this type of analysis can’t prove cause and effect, it does allow you to state that high blood pressure is associated with a 49% increased risk of lymphedema. These researchers stated that further research is needed to understand the role of high blood pressure and lymphedema (Togawa, 2014).
Interestingly, when the high blood pressure factor was examined more closely, some nuance, was noted, namely that the high blood pressure only increased lymphedema risk in black women.  But…in this study, the black women were also more likely to be prescribed diuretics that the other women, so that could interfere with the results.
Lymphedema and Blood Pressure Research #6
Similar to the studies above, this research was also trying to identify risk factors for the development of lymphedema in a cancer population. In this study, 305 women with breast cancer who underwent treatment in Galati, Romania were analysed.
Unlike the previous analyses, this one did not find an association between high blood pressure and the development of lymphedema. The risk factors that they did identify were; the number of lymph nodes removed and radiation treatment over the lymph node region (Rebegea, 2015).
Why did this study show a different result? It could be simply that high blood pressure is not a risk factor for lymphedema and the previous studies results could not be validated. It could also be that, in this study the number of women with lymphedema was too low to see a pattern.
Of the 305 women, only 18 or 5.9% developed lymphedema. Of the fifty nine women who had high blood pressure, six of them developed lymphedema during the follow-up period. The numbers just may not have been high enough to see a pattern.
This study also does not specify the length of the follow-up period or the method of diagnosing the lymphedema, so it’s possible that more cases would have been detected, given more time or a different diagnostic method.
Summary of Lymphedema and Blood Pressure Research
Four out of the six studies that examined blood pressure (or history of high blood pressure) and lymphedema risk found an association. This does not prove that high blood pressure causes lymphedema, only that there is an association or a possible risk.
Despite these findings from 1992 to 2015, it does not seem to be considered in many studies since, that have set out to examine lymphedema risk factors.
I’ve read over 20 studies on the topic of lymphedema risk factors and most don’t examine blood pressure. What they do look for, and find, are these risk factors:
- The number of lymph nodes removed
- Axillary lymph node dissection vs. sentinel lymph node biopsy
- Chemotherapy vs. no chemotherapy
- Taxol vs. no taxol
- Radiation vs. no radiation
- Post-operative infection
I even read one from Toronto, that found that low breast density was associated with lymphedema, which is a unique risk factor, not examined before (Kwan, 2020).
While breast density is interesting and could highlight the medical team to screen and educate these patients, blood pressure is a modifiable risk factor…and it makes me wonder why more research teams aren’t looking at it…am I missing something here?
The other important consideration is that all six of these studies were done in women after treatment for breast cancer. It is not known if these results can be transferred to other cancer treatments that also damage or remove lymph nodes, or any non-cancer lymph damaging surgery for that matter. But, given that the understanding of physiology – that a greater pressure inside the blood vessel will force more fluid out into the interstitial spaces (the lymphedema spaces) then, I think it’s reasonable to consider high blood pressure a potential aggravating factor for all lymphedema types.
Here is a summary of the above studies on Lymphedema Risk and Blood Pressure
How Does Blood Pressure Increase Risk of Lymphedema?
One theory is that hypertension increases the risk by an increase in capillary filtration due to increased hydrostatic pressure. When capillary filtration increases, the lymphatic drainage is insufficient, the fluid then accumulates in the interstitial space leading to swelling (Togawa, 2014).
A second theory is that high venous blood pressure can cause an increase in the intralymphatic system and lead to retrograde lymphatic flow. Some types of blood pressure medication, aimed at lowering arterial blood pressure, may also lower venous blood pressure (Geller, 2003).
While it has been established that diuretics are not recommended to treat lymphedema, is it possible they could be used to help prevent it? Could treating the high blood pressure be protective against the development of arm lymphedema? According to studies, the answer to this is not clear at this time (Geller, 2003).
Is Measuring Blood Pressure Safe when You Have Lymphedema?
Is it safe to measure your blood pressure when you have lymphedema or are at risk of developing lymphedema? One study from 2017 did look at blood pressure and lymphedema risk…but interestingly, they examined not the blood pressure itself, but whether having your blood pressure measured with a blood pressure cuff (a sphygmomanometer) was a risk or not (Asdourian, 2017).
This is definitely an important question, as many people at risk of lymphedema are very fearful of blood pressure measurements. I do find it interesting that they only looked at the number of blood pressure measurements and not what the reading was for their analysis.
The study included 327 women who underwent bilateral surgery for breast cancer both mastectomies and lumpectomies with either no lymph nodes removed (16%), sentinel lymph node biopsy (71%) or axillary lymph node dissection (13%) and followed for 6 to 68 months post surgery (median 27 months).
Having one or more blood pressure measurements versus none did not change the risk of lymphedema (Asdourian, 2017). Although the authors did emphasize, that despite their findings, they do not consider these sufficient to do away with current precautions provided to patients.
The current position paper from the National Lymphedema Network on risk reduction states that “blood pressure cuffs used improperly or with extreme pressure may excessively constrict tissues”. They do classify blood pressure measurements as a controversial topic and give some practical advise which is:
- Use the uninvolved or not at-risk arm to measure
- Request a manually pumped blood pressure versus machine pumped
- Request that the pressure be pumped to only slightly higher than the usual upper level pressure to avoid applying excess pressure
Treating High Blood Pressure
High blood pressure is known as the “silent killer” and is responsible for the second largest number of preventable heart disease and stroke deaths, second to smoking (American Heart Association, 2017). There are several types of anti-hypertensive medications. Here is a summary of some of the more common ones (this is not a complete list) and their compatibility with lymphedema (where information was available).
List of High Blood Pressure Medications
*Calcium channel blockers can cause dilation and the arteriolar capillary without an increase in venous capillary and therefore an increase in lymphedema.
It was difficult to find information on antihypertensive medications and lymphedema, so be sure to consult with your pharmacist and physician to find the safest, most-effective medication for your situation.
What is a Hypertensive Crisis?
Sometimes you need medication right away. A blood pressure of 180/120 or more requires urgent medication and possible hospitalization if there are signs of organ damage (American Heart Association, 2017).
Other times, your blood pressure is mildly elevated and before starting medication, you can make changes to your diet and lifestyle to lower your blood pressure. Here are some strategies to lower blood pressure without mediation.
Non-Medication Treatments for High Blood Pressure
Lifestyle choices are a great first step in treating high blood pressure, if your numbers are between 130/80 to 140/90 (Heart & Stroke Canada, 2022). Those changes include:
- A lower salt (sodium intake)
- A higher potassium, calcium, and fibre intake (DASH diet)
- A lower saturated fat intake
- Physical activity of 150 minutes per week with moderate to vigorous intensity
- Achieving and maintain a healthy body weight
- Not smoking
- Limiting alcohol (there is no safe limit of alcohol consumption to prevent hypertension)
- Stress management
Diet for High Blood Pressure
As mentioned above, a diet that is high in potassium, calcium, fibre and lower in sodium and saturated fats is best for high blood pressure. This is called the DASH diet. DASH stands for Dietary Approaches to Stop Hypertension.
Essentially, this is a diet that includes
- Eight to 10 servings of fruits and vegetables a day
- Whole grains
- Two to three servings of low fat dairy products
- Healthy proteins such as lean meat, fish and legumes
Bottom Line on High Blood Pressure and Lymphedema
In six studies that examined risk factors for the development of lymphedema, high blood pressure was found to be a risk in four of the studies. Other risk factors for lymphedema in a cancer population include:
- Number of lymph nodes removed
- Radiation or not
- Chemotherapy or not
- Tamoxifen
- Infection
- Inflammation
- Body weight and weight gain
- Blood pressure
- Low breast density (one study only)
When you look at that list, some of these are modifiable risk factors and these are the ones to focus on in the pre-surgical education phase. If high blood pressure is indeed a risk factor, then this creates another opportunity for risk reduction.
To monitor your blood pressure, use the arm with the least lymph node damage, request a hand pumped devices, and pump only as high as necessary.
When treating high blood pressure with lymphedema, avoid using calcium channel blockers and discuss the best medication options considering your lymphedema.
Whether you treat the high blood pressure with medication or not, change your diet to avoid alcohol, reduce sodium and saturated fat and increase your intake of potassium, calcium and fibre.
To read more about lymphedema and diet, check out
References for Lymphedema and Blood Pressure
American Heart Association. High Blood Pressure Redefined for the First Time in 14 years. 130 is the New High. Published Nov 13, 2017. Accessed Nov 18, 2022
Asdourian MS, Swaroop MN, Sayegh HE, Brunelle CL, Mina AI, Zheng H, Skolny MN, Taghian AG. Association Between Precautionary Behaviors and Breast Cancer-Related Lymphedema in Patients Undergoing Bilateral Surgery. J Clin Oncol. 2017 Dec 10;35(35):3934-3941. doi: 10.1200/JCO.2017.73.7494. Epub 2017 Oct 4. PMID: 28976793; PMCID: PMC5721227.
Böhler FK, Rhomberg W, Doringer W. Hypertonie als Risikofaktor für erhöhte Nebenwirkungsraten im Rahmen der Mammakarzinombestrahlung [Hypertension as risk factor for increased rate of side effects in the framework of breast carcinoma irradiation]. Strahlenther Onkol. 1992 Jun;168(6):344-9. German. PMID: 1621213.
Geller BM, Vacek PM, O’Brien P, Secker-Walker RH. Factors associated with arm swelling after breast cancer surgery. J Womens Health (Larchmt). 2003 Nov;12(9):921-30. doi: 10.1089/154099903770948159. PMID: 14670172.
Heart and Stroke. Keep Your Blood Pressure in Check. Accessed Nov 18, 2022.
Meeske KA, Sullivan-Halley J, Smith AW, McTiernan A, Baumgartner KB, Harlan LC, Bernstein L. Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women. Breast Cancer Res Treat. 2009 Jan;113(2):383-91. doi: 10.1007/s10549-008-9940-5. Epub 2008 Feb 24. PMID: 18297429.
Togawa K, Ma H, Sullivan-Halley J, Neuhouser ML, Imayama I, Baumgartner KB, Smith AW, Alfano CM, McTiernan A, Ballard-Barbash R, Bernstein L. Risk factors for self-reported arm lymphedema among female breast cancer survivors: a prospective cohort study. Breast Cancer Res. 2014 Aug 22;16(4):414. doi: 10.1186/s13058-014-0414-x. PMID: 25145603; PMCID: PMC4189147.
Kocak Z, Overgaard J. Risk factors of arm lymphedema in breast cancer patients. Acta Oncol. 2000;39(3):389-92. doi: 10.1080/028418600750013168. PMID: 10987236.
Kwan JYY, Famiyeh P, Su J, Xu W, Kwan BYM, Jones JM, Chang E, Yip KW, Liu FF. Development and Validation of a Risk Model for Breast Cancer-Related Lymphedema. JAMA Netw Open. 2020 Nov 2;3(11):e2024373. doi: 10.1001/jamanetworkopen.2020.24373. PMID: 33175175; PMCID: PMC7658732.
Meeske KA, Sullivan-Halley J, Smith AW, McTiernan A, Baumgartner KB, Harlan LC, Bernstein L. Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women. Breast Cancer Res Treat. 2009 Jan;113(2):383-91. doi: 10.1007/s10549-008-9940-5. Epub 2008 Feb 24. PMID: 18297429.
NLN Medical Advisory Committee. Position Statement of the National Lymphedema Network. Lymphedema Risk Reduction Practices. May 2012.
Rebegea L, Firescu D, Dumitru M, Anghel R. The incidence and risk factors for occurrence of arm lymphedema after treatment of breast cancer. Chirurgia (Bucur). 2015 Jan-Feb;110(1):33-7. PMID: 25800313.
Soran A, D’Angelo G, Begovic M, Ardic F, Harlak A, Samuel Wieand H, Vogel VG, Johnson RR. Breast cancer-related lymphedema–what are the significant predictors and how they affect the severity of lymphedema? Breast J. 2006 Nov-Dec;12(6):536-43. doi: 10.1111/j.1524-4741.2006.00342.x. PMID: 17238983.
