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What goes up must come down

December 30th, 2015


What goes up must come down

Hypertension or high blood pressure is a risk factor that can lead to narrowed coronary artery and other arteries throughout the body, and it can plague people of any age. There are many reasons why a person’s blood pressure is high, but about 80 percent of the time, the cause cannot be determined. However, if there is a known reason, the doctor will try to fix it, as it is better to nib it in the bud than to spend the rest of our lives taking pills.

Blood pressure is the force exerted by blood pushing against the walls of blood vessels. It is usually measured by wrapping a cuff around the arm, pumping the air in until the cuff feels tight, and releasing the air to listen to the sound of the blood passing through.

Blood pressure changes throughout the day depending on many factors such as activities, stress level, pain level and emotions. Immediately after exercising, blood pressure can drop down. This can also happen while eating.

So, to determine a person’s blood pressure, it has to be measured when the person has been resting for at least 30 minutes. If it is measured after a meal or after a stressful discussion, it might not be reliable. Be sure to rest at least an hour after exercising before checking the blood pressure.

Early morning is when our blood pressure is at its peak, which, coincidentally or not, is also the time when most heart attacks and strokes occur.

There are many blood pressure measuring tools available out there, and the automatic ones give pretty accurate results. However, it is best to have it checked by a doctor or a nurse to calibrate the automatic machine. If you have just eaten, exercised, or been through a stressful moment, alert the person who is checking your blood pressure.

High blood pressure can affect the body in many ways. It can affect how your kidneys and arteries at the brain, eyes and limbs function. Usually, there is no obvious symptom, and by the time the symptom shows, the organ is already damaged. Therefore, people with high blood pressure must be monitored by doctors from various fields to be on the safe side. The kidneys, heart, brain and eyes must be checked to make sure they are still functioning well, and if anything goes wrong, early treatment is more effective. Constant checking also allows us to prevent any complications or treat them as quickly as possible.

Treating high blood pressure with no known cause might have to rely on medication, together with a change in lifestyle. A person who keeps the weight within the healthy range and exercises regularly won’t need so many pills to keep the blood pressure down.

In the past, people believed that it was normal for the blood pressure to increase as people got older. It should not be that way. The healthy blood pressure is 120/80 mmHg, and should remain so for the rest of our lives. It can go a little higher, but should not exceed 130/85 mmHg, especially for those who risk having narrowed artery such as people with diabetes, high cholesterol level, history of myocardial infarction, paralysis and smoking. Ideally, it should be kept at 120/80 mmHg regardless of age.

The hardest thing about treating patients with high blood pressure is the fact that the symptom does not always show. Some patients might experience mild headache or dizziness from time to time, but since blood pressure fluctuates throughout the day, the measurement at one point cannot speak for the condition in general. Self-care is therefore extremely important, so a team of doctors should work together on giving tips. The team involves cardiologist, medicine doctor, nephrologist, endocrinologist, neurologist, cardiac rehabilitation doctor and nutritionist.

Many people take high blood pressure not seriously and wrongly assume that medicine will work magic. They also think that once the blood pressure has come down, there is no need to continue taking the medicine, and they end up returning to the hospital with far more serious problems such as paralysis, a stroke, myocardial infarction or kidney failure.

Years ago, a patient of mine in his 50’s came to see me because he had a headache. His blood pressure was as high as 200/120 mmHg. Physical check-up and blood test could not determine the cause of high blood pressure, but he was under a lot of stress. His organs were not yet damaged by the sky-high blood pressure. I prescribed some medicine and told him to exercise and watch his weight. After a few months, his blood pressure came back down to normal – 130/70 mmHg. I assumed he would stick to his healthier lifestyle, and we parted ways since then.

Five years later, he came back to see me because his right arm felt weak. From the X-ray result, I saw that there was some bleeding in the right side of his brain. He confessed that he had stopped taking blood pressure medicine because he had thought he was well enough, and throughout the five years, he had been fine. It was very fortunate (or unfortunate?) that this silent problem caused a blood vessel in his brain to rupture and brought him back to attention without more serious condition.

Another patient, also in his 50’s, came to see me because he felt tired and tight in the chest during heavy activities. He had had history of untreated high blood pressure for years, and his heart was slightly enlarged. Protein was found in his urinesample. His cardiologist and his kidney doctor agreed that he needed an X-ray angiogram (dye test), and it was found that while his heart was fine, the artery that supplied blood to his right kidney was very narrowed.

He was treated by balloon angioplasty and stent placement, so his blood pressure came down from 210/110 mmHg to 130/80 mmHg within just three months. His tiredness disappeared as well.

You can never be too careful when it comes to your blood pressure. Have it checked regularly. If it is already high, try to determine the cause and treat it accordingly. Do not stop taking medicine without consulting your doctor. Always exercise and keep your weight within the healthy range. It is a much preferable option than watching your body ruined.

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


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