Written by Dr Harold Gunatillake- FRCS, MBBS Cey, Academy of Medicine, Singapore
The normal blood pressure for an adult male is considered to be approximately; systolic 130mm Hg. and diastolic within a range from 60-80mg.Hg. For an adult female the readings are approximately, systolic 120mm. Hg and diastolic, as for men, range between 60 to 80 mm. Hg (Hg stands for mercury). These respective figures should not change with age as was once thought.
When you are young and healthy, the blood vessels (arteries) seem to stretch, expand, and elastic. In such a situation the heart can pump blood without against much peripheral resistance. How many of us continue to have such a situation to boast of a normal blood pressure till late in life. We damage our natural organs, blood vessels, tissues, including the skin unknowingly, by not doing the right things during youth and adult life. Smoking, stress, lack of exercise, obesity, lifestyle diseases like diabetes, consuming high saturated fatty foods, all become responsible for this damage to the arteries, organs and tissues.
The arteries in the body gradually thicken and harden with age. This process is called “Arteriosclerosis”. Damage caused as mentioned above may result in addition to natural thickening, narrowing, and plaque formation within the vessels causing high blood pressure, heart disease, stroke, peripheral vascular disease, among others.
Whatever, your lifestyle has been, due to genetic reasons alone, high blood pressure will catch up with most people who live into older age. Blood pressure is the force of blood pressing against the walls of your arteries. When it’s too high, it raises the heart’s workload and can cause serious damage to the arteries. Over time, uncontrolled high blood pressure increases the risk of heart disease, stroke, and kidney disease.
Increase of blood pressure is an insidious and slow process, meaning the body gets accustomed to live without symptoms until breakdown. Over time, uncontrolled high blood pressure increases the risk of chronic diseases mentioned earlier. It has no outside symptoms for a long time. Internally, it quietly damages the heart, lungs, blood vessels, brain and kidneys, if neglected. Ultimately, it triggers a heart attack or stroke.
It is stressed that after the age of 40 years, it is a good idea for health reasons, see your doctor and check your blood pressure. You may also purchase a digital blood pressure apparatus from the pharmacy, and check yourself regularly.
Home monitoring makes sense if you have high blood pressure.
Your blood pressure changes from hour to hour, sometimes even minute to minute. It jumps around so much that you are more likely to get a good sense of your blood pressure if you check it at home rather than in the doctor’s office.
Just a few of the things that can influence your blood pressure:
• standing up from a chair
• watching an exciting show on television
• eating a meal
• listening to soothing music
• Stress and anxiety
• The time of day
• Certain medications, such as cough mixtures
• Immediately after exercise
In fact, the American Heart Association (AHA), American Society of Hypertension, and Preventive Cardiovascular Nurses Association urge people with high blood pressure, or at high risk for developing it, to own a blood pressure apparatus to check BP yourself.
There are many good reasons to follow their advice. Taking your blood pressure at home allows you to:
• You are relaxed and your blood pressure will be real. Up to 20% of people diagnosed with high blood pressure have white-coat hypertension. This is a temporary spike in blood pressure brought on by the stress of trekking to and seeing a doctor. Still others have what’s called masked hypertension—normal blood pressure in the doctor’s office but high blood pressure everywhere else
• At home you could regularly check the pressure unlike making an appointment with your doctor solely for the purpose of checking your blood pressure.
• About 60% of people with diabetes have high blood pressure, and it is mandatory to self-check the blood pressure at home regularly.
Most people over the age of 40 years are pre-hypertensive. This means that their blood pressures are consistently just above the normal level (described above). People in this range have twice the risk of developing heart disease than those with a lower reading. You may need only lifestyle changes without medication if you belong to this category.
As mentioned earlier the process of high blood pressure is insidious and when it reaches 180/110 and higher you may have a hypertensive crisis. If you feel you are dizzy, breathless, anxious, rest immediately. Get the ambulance and go to hospital immediately. In the crisis situation you can get stroke, heart attack, kidney damage, or loss of consciousness. Earlier stage you may get a severe headache, nosebleeds and feeling short of breath. Avoid getting into this situation as the blood pressure of the rest of your family will also be at stake.
Eat less salt
Salt which contains sodium is water retentive and can raise blood pressure due to greater burden on the heart. One should eat less than 1,500 milligrams of sodium per day. Always check the food labels. Most processed foods are heavy on salt. Cheese, canned soups, dry fish, and too much added salt into curries are other situations.
Having a drink a day will relax your nerves and arteries. Drinking too much alcohol can increase your blood pressure. One should not drink more than 12-ounces beer, four ounces of wine, and 1.5 ounces of spirits.
Drinking many cups of coffee a day can increase your blood pressure. Your safe limit is one or two cups a day. As one gets older coffee is recommended, supposed to stimulate brain cells and delays Alzheimer’s disease.
Being overweight places a strain on your heart and increases the chance of getting high blood pressure. You need to cut your fatty foods, added sugars, and stick to a Mediterranean type of diet with fruits, vegetables and less meat. Daily walk and other exercises burn calories. The DASH diet also helps to lower your blood pressure.
Avoid cold and flu medicine that contains decongestants, if possible. They increase your blood pressure. Anti-inflammatory drugs taken for arthritis may increase your blood pressure. Steroids, appetite suppressants, birth control pills and some anti-depressants can raise your blood pressure.
Omega 3 fish oil tends to soft arteries and may lower the blood pressure
Any form of exercise, like bicycling, walking briskly, jogging, for one hour a day will burn sufficient calories and also bring down the blood pressure due to a condition called, ”vasodilatation”.
Medication for hypertension
Your doctor may put you on a diuretic to pass more urine and sodium to lower your blood pressure.
Beta-blockers work by slowing the heart rate. Your doctor will put you on a beta-blocker if in addition to high blood pressure your heart rate is rapid, over 80 beats / minute. They are also used in abnormal heart rate called arrhythmia. They may cause insomnia, dizziness, fatigue, cold extremities, especially during winter months, and erectile dysfunction, as side effects.
Invariably, older people with high blood pressure are put on this medication to reduce the pressure. A chemical called “angiotensin 11 secreted by the kidneys, makes blood vessels contract, narrow and increase the blood pressure. ACE inhibitors, reduces the chemical and relaxes and open the arteries and lower the blood pressure.
The other kind of medication ARBs (angiotensin 11 Receptor Blockers) block receptors for angiotensin and lowers the blood pressure.
ACE inhibitors and ARBs are specially given for those people who suffer from early kidney failure with high blood pressure and diabetes.
Calcium channel blockers
This medication slows the movement of calcium into the cells of the heart and blood vessels. Calcium causes stronger heart muscle contractions.
These drugs have their side effects such as, heart palpitations, dizziness, constipation, and ankle swelling. Always take them with food and avoid grapefruit juices and alcohol because of possible interactions.
There are other medications to relax the peripheral arteries to reduce the blood pressure. They are called vasodilators.
Your doctor will prescribe the right combination of anti-hypertensive drugs for you. If you get side effects the doctor may change the medication.
The bottom line is –do not neglect taking your medication and anticipate a heart attack, or stroke. Never take alcohol at the time of taking the medication.