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Raynaud’s Phenomenon and Pulmonary Hypertension: What’s the Connection?

Posted on February 09, 2022
Medically reviewed by
Steven C. Pugliese, M.D.
Article written by
Marnie Willman

Raynaud’s phenomenon (RP) is a vascular problem that causes reduced blood flow to the extremities, most often the fingers. Some people living with RP will also experience reduced blood flow to the ears, nose, toes, and other parts of the body located far from the heart. This condition affects about 10 percent of the population, and its severity can vary.

Pulmonary hypertension (PH) — high blood pressure in the right side of the heart and lungs — is closely related to RP. The two conditions can occur together in individuals. About 95 percent of people with scleroderma, an autoimmune disease affecting the skin and connective tissues, also have RP. One study found that an estimated 6.4 percent of people with scleroderma also have pulmonary arterial hypertension.

What Is Raynaud’s Phenomenon?

Raynaud’s is a condition characterized by vasospasms, or episodes of narrowing of the blood vessels. RP symptoms usually develop when people are exposed to cold temperatures, stress, or anxiety. Fingers or other extremities begin to turn white or blue because blood vessels are blocked, stopping blood from flowing to these areas.

Raynaud’s can be divided into two categories: primary Raynaud’s syndrome and secondary Raynaud’s syndrome. Primary Raynaud’s syndrome accounts for the majority of cases; this type of condition occurs without a specific cause. Secondary Raynaud’s syndrome (also called Raynaud’s phenomenon) can be caused by biological, environmental, or physiological triggers. Triggers can include some pharmaceutical drugs, autoimmune conditions like scleroderma or rheumatoid arthritis, repetitive movements, or injury.

Symptoms of Raynaud’s Phenomenon

  • Extremities (usually fingers) turn white or blue.
  • Affected extremities feel cold, numb, or painful (pins and needles).
  • As blood flow returns to the area, the affected extremities may turn red and throb, tingle, or burn.

How Is Raynaud’s Phenomenon Diagnosed?

Diagnosis begins with a physical to rule out any other medical problems that could be causing your symptoms. After the physical, your doctor may perform a painless test called a nailfold capillaroscopy. During the procedure, your doctor will look at the capillaries near your nails under a microscope to ensure they appear healthy. Results will be normal for those with primary Raynaud’s disease and abnormal for those with secondary Raynaud’s. If your result points to secondary Raynaud’s, your doctor can then order a complete blood count, chemistry profile, and urinalysis to check for the underlying cause.

Other blood tests that can help your doctor determine what type of RP you have include:

  • An erythrocyte sedimentation rate test (looks for inflammation associated with RP)
  • An antinuclear antibody test (looks for immune proteins that attack one’s own tissues)
  • A test for rheumatoid factor and complement levels (indicates red flags for RP)

How Does Raynaud’s Phenomenon Affect myPHteam Members?

Members of myPHteam often discuss how their Raynaud’s symptoms affect them. Members have shared:

  • “At 70 degrees, I am a popsicle!”
  • “The tips of my fingers are hypersensitive due to Raynaud’s.”
  • “A pulse oximeter can’t read my oxygen because of the Raynaud’s.”
  • “The pain is so intense.”
  • “I had an early retirement due to Raynaud’s.”
  • “Raynaud’s is my biggest pain. I carry hot packs and wear gloves. I look silly since I live in Los Angeles, California.”

RP and primary PH can occur together; both conditions are related to blood pressure or blockage of blood flow. The association has been noted for decades, but doctors and scientists still don’t know if there is a deeper connection between these conditions beyond their shared cause.

It is also worth noting that women have up to seven times the risk of men of developing certain types of PH. Women are also more likely to develop RP.

Pulmonary arterial hypertension is a form of PH in which blood vessels in the lungs are blocked, narrowed, or damaged. Pulmonary arterial hypertension and RP have also been linked, but it remains unclear why.

Treating Raynaud’s Phenomenon and Pulmonary Hypertension Together

Because these two conditions have similar symptoms and biological mechanisms, many of the same treatment options are used for both RP and PH. Your doctor will start out with basics of pulmonary care, including encouraging you to keep your body warm and ensuring that you aren’t taking medications or consuming food or beverages that make the condition worse. Further steps to treat both conditions depend on the person, but they may include medication or lifestyle changes. In short, having RP doesn’t mean your PH is harder or more complicated to treat.

Many of the comorbidities (conditions that occur together in the same individual) that occur with RP are also present in those living with PH. These can include blood clots, liver disease (cirrhosis), congenital heart disease, or connective tissue disease. While we don’t know all of the causes of RP and PH, there is a lot of overlap between the conditions, their causes, and their comorbidities.

Does Treating Pulmonary Hypertension Increase Your Risk of Developing Raynaud’s Phenomenon?

The short answer is no. Treatment of PH involves using medications or lifestyle changes to increase blood flow and reduce blockages. These types of treatments should actually reduce your chances of developing RP rather than being a risk factor.

How Is Raynaud’s Phenomenon Managed?

Depending on the severity of symptoms, RP may be managed with lifestyle changes, medications, or medical procedures.

Lifestyle Changes

Making a few lifestyle changes can help you better manage your RP. Wearing warmer clothing to keep your body warm — especially gloves or pocket warmers to keep your fingers warmer — will ease your RP symptoms.

Quitting smoking is also a first step for better RP management. This will help you normalize your blood pressure and keep your body temperature higher.

Some foods like ginger and garlic are thought to improve RP symptoms, but scientific evidence is lacking. Ensure you’re getting a healthy, balanced diet to keep your body in the healthiest shape possible to reduce RP symptoms.

Medication

Some people living with RP need blood pressure medications such as calcium channel blockers to increase blood flow to affected areas. This is something to discuss with your doctor if you feel lifestyle changes aren’t enough or if you are still struggling with RP symptoms. Your doctor may also prescribe cholesterol-lowering medications or topical creams that can alleviate symptoms.

Surgery and Medical Procedures

There are two primary types of procedures your doctor may recommend if the above solutions aren’t enough to manage your RP symptoms. The first is nerve surgery, in which the doctor cuts the nerves that control the narrowing and opening of blood vessels in your affected hands and feet. This can lead to fewer episodes of RP that don’t last as long.

The second intervention is a chemical injection. Injecting a local anesthetic or Botox can block the nerves controlling vasoconstriction. This option is less invasive than surgery, but it is not a permanent fix. You might require routine treatments if symptoms return or worsen.

Talk With Others Who Understand

On myPHteam, the social network for people with pulmonary hypertension and their loved ones, more than 41,000 members come together to ask questions, give advice, and share their stories with others who understand life with pulmonary hypertension.

Are you living with Raynaud’s phenomenon and pulmonary hypertension? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Steven C. Pugliese, M.D. is affiliated with the Hospital of the University of Pennsylvania in Philadelphia, serving as the director of the pulmonary embolism response team, co-director of the comprehensive pulmonary embolism program, and an assistant professor of clinical medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Marnie Willman is a Ph.D. candidate in medical microbiology and infectious diseases at the University of Manitoba. Learn more about her here.

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