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The heart and blood pressure

December 9th, 2015

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Many of my patients who have high blood pressure have asked me with great concern whether they will have heart disease. I can’t answer for sure. High blood pressure is just a factor that contributes to the chance to developing heart disease. Usually, it causes the artery wall to harden, leading to myocardial infarction. However, high blood pressure is not a permanent curse and it can be lowered easily.

However, it is hard to prevent high blood pressure, and most people don’t show any obvious signs at the beginning. When the signs are obvious enough, it is usually rather difficult to treat, and most people end up taking medicine for the rest of their lives.

Healthy blood pressure should be no more than 130/85 mmHg. The first number 130 is when the heart contracts and sends blood to other parts of the body, causing pressure. The second number 85 is the pressure when the heart is lax. Please note that your blood pressure is not steady – it goes up and down during the day depending on your activities. When we are hungry, it can go up. When we are full, it might come down.

Dawn is when our blood pressure is at its highest, and interestingly, it is the time when most heart attacks and strokes occur.

When measuring the blood pressure, there must be some standard to make sure the numbers tell the truth. The patient has to be seated and have been in a relaxed position for at least 30 minutes. It is not advised to measure the blood pressure when hungry or immediately after a meal – it is better to wait 45-60 minutes after eating. Those who are nervous, stressed out or sick should not have their blood measured as parts of diagnosis or follow up treatment of hypertension.

If the condition fits, and the numbers are still higher than 130/85 mmHg, your blood pressure is high.

What do we do now? The first thing we need to do is to recheck it, just to be sure. Your doctor might ask whether you’ve just been in a fight, or annoyed by the long queue.

If the doctor concludes that you do have high blood pressure, blood test, urine test and X-ray test might be called for to determine the real cause. Unfortunately, only about 10% of the cases can find the actual culprit.

If you are lucky and the cause of your high blood pressure can be determined, the doctor can treat it and bring down the blood pressure. If the cause cannot be determined, you might need medicine to keep it in check, usually for life.   However, some people who can control their diet and exercise well, they may be able to stop the medication.

A lot of people misunderstand that after the blood pressure has come down, it is ok to stop taking medicine. Some even stop measuring their blood pressure because they are confident that they are fine now. This is very dangerous because, as I’ve said earlier, high blood pressure often shows no sign or symptom.

Some people do not need to rely on medicine for life, but they have to give their lifestyle a makeover by exercising and controlling their diet. This, a lot of patients have told me, is even harder than taking medicine.

The aim is to bring the early morning blood pressure down to 130/85 mmHg. Some patients wonder, how do you know how low it will go? What if it goes too low?

Usually, low blood pressure is experienced throughout the day, such as when we get up too fast and feel a little dizzy. After exercise, our blood pressure reduces as well.

But if you are concerned, invest in an automatic blood pressure measuring machine. I always advise my patients to measure it first thing in the morning, as soon as they wake up, before they get up to take a shower or eat breakfast. This is a good time to see the actual numbers.

There is always an exception, of course. A patient of mine in his forties has been my patient for years. Although he has high blood pressure, he has always taken an excellent care of himself. He exercised regularly and watched his weight very well. Each time he came to see me, his blood pressure was quite good.

He bought an automatic blood pressure measuring machine, and I gave him tips on how to measure it properly. I emphasized that he should check his blood pressure in the morning before leaving the bed, and write down the numbers.

I was amazed to see the numbers that he had written down. Every morning, his blood pressure was very high, and got lower in the afternoon. He didn’t feel any dizziness, though.

I asked him to bring the machine to the hospital so I could check whether it was working. It was. I gave him medicine to lower his blood pressure to bring down the early morning numbers. It turned out that his afternoon blood pressure got too low – 90/60 mmHg, and he was starting to feel dizzy.

I had a long talk with him to find out what the cause was, and finally I got my answer. I knew why his blood pressure was high in the morning.

I can’t tell you, but let me give you a hint. He had just married a 20-year-old.

Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.

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