Maintaining a normal blood pressure level is vital to a healthy life. It is easy to monitor and should be something we never take for granted, as having too high or low pressure is a health risk. On this topic, we have the privilege to speak with Dr How Ann Kee, who is a Consultant Cardiologist & Cardiac Electrophysiologist with Sunway Medical Centre, Sunway City.
Dr How shares with us about the dangers of having high blood pressure. High blood pressure (hypertension), is when your blood pressure, the force of blood flowing through your blood vessels, is consistently too high.
WHO recommends a target blood pressure of <140/90 mmHg in all patients with hypertension without comorbidities; and a target systolic blood pressure of <130mmHg in patients with known cardiovascular disease, diabetes mellitus or chronic kidney disease.
Q1: What are the causes of high blood pressure or hypertension?
In most adults, there is no identifiable cause of hypertension. This is called primary (essential) hypertension. Some people have hypertension caused by an underlying medical condition, i.e. secondary hypertension. The common medical conditions that can lead to secondary hypertension are kidney disease, thyroid disease, hormonal problems (endocrine disorders), obstructive sleep apnoea, narrowing of the arteries supplying the kidneys, certain medications like birth control pills, steroids, pain relievers and some recreational drugs.
Q2: What are the factors that increase the risk of hypertension?
There are many factors that may increase the risk of hypertension. Modifiable risk factors include unhealthy diets—excessive salt consumption, high saturated fat and trans fats diet, low intake of fruits and vegetables, sedentary lifestyle, being overweight, smoking and over consumption of alcohol. Non-modifiable risk factors include aging and family history of hypertension.
Q3: What are the common symptoms of hypertension?
Hypertension can be a “silent killer”. Most people with hypertension are unaware of the problem because they may have no symptoms. Some people can have headaches, nosebleeds, vision changes, nausea, vomiting, fatigue or chest discomfort.
Q4: What are the common health risks associated with hypertension?
Hypertension is a major cause of premature death worldwide. Left untreated and uncontrolled hypertension can lead to heart attack, heart failure, stroke, kidney failure, vision loss due to damage blood vessels in the eyes and narrowing of arteries in the legs (peripheral artery disease, PAD). Sexual dysfunction is also a common health problem associated with hypertension. Hypertension can lead to erectile dysfunction in men or lower libido in women.
About half of the patients with hypertension do not have their cardiovascular risks adequately assessed. Basic investigations should aim to screen for presence of secondary causes of hypertension, co-existing cardiovascular risk factors, target organ damage (TOD) and target organ complication (TOC). Co-existing cardiovascular risk factors are such as diabetes mellitus, dyslipidaemia and kidney disease.
Q5: How do blood pressure changes with age?
Our vascular system changes with age. As we age, there is a reduction in elastic tissue in our arteries, causing them to become stiffer and less compliant; therefore, blood pressure increases.
Q6: What can I do to quickly bring down my blood pressure if it suddenly spikes?
There are some fluctuations of blood pressure throughout the day, declining while relaxing and momentarily increasing while being excited, under stress or exercising. If the blood pressure suddenly spikes, it is advisable to lie down and take deep breaths. This helps to slow the heart rate and decrease the blood pressure. When you feel stress, hormones are released and constrict the blood vessels and this can lead to spike in the blood pressure.
Q7: Is it advisable to be on medication for high blood pressure, and what are the side effects, if any?
Persistent high blood pressure causes target organ damage and complications. It is advisable for a person with hypertension to be on medication.
Some people experience side effects with hypertension medications. Most of these are mild and may resolve over time. Common side effects include cough, dizziness or light-headedness, feeling tired, weak, drowsy, lack of energy, nausea, vomiting, headache and possible allergic reaction. If you have side effects after taking the medication, it is best to inform your doctor. Most of the time, making changes to the dose or change of medication can help to reduce the side effects.
Q8: Other than medication, how else can I control high blood pressure effectively?
Good blood pressure control prevents heart attack, stroke, and kidney damage, as well as other health problems. Besides medications, blood pressure can be better controlled by some simple non-pharmacological measures, including:
- Reducing salt intake.
- Eating more fruit and vegetables.
- Being physically active on a regular basis.
- Living tobacco free—Avoid smoking, vaping or use tobacco or nicotine products.
- Reducing alcohol consumption.
- Limiting the intake of foods high in saturated fats.
- Reducing and managing stress.
- Have adequate sleep and rest—Sleep deprivation, or getting less than 6 hours of uninterrupted sleep at night, can increase blood pressure.
Q9: What kind of diet is best for someone who suffers from hypertension?
Excessive salt intake can lead to high blood pressure. Keep sodium intake of less than 2300 milligrams per day. Reducing daily sodium intake to 1500 milligrams is desirable and it can lower blood pressure even further.
Eating more fruits, vegetables, whole grains, nuts, plant-based protein, lean animal protein and fish is good for health. It is advisable to replace processed meats, refined carbohydrates and sweetened beverages with healthier options.
Q10: Low blood pressure is also a health risk. What causes hypotension?
Low blood pressure might seem desirable. However, abnormally low blood pressure (hypotension) can cause dizziness, weakness and fainting. Extreme hypotension can be life-threatening. A blood pressure reading lower than systolic 90 mmHg and/or diastolic 60 mmHg is generally considered low blood pressure.
Medical conditions that can cause hypotension include:
- Heart problems—Extremely low heart rate (bradycardia), extremely fast heart rate (tachycardia), heart failure, heart attack and heart valve problems.
- Severe infection (septicaemia)—When infection in the body enters the bloodstream can lead to life-threatening drop in blood pressure called septic shock.
- Severe allergic reaction (anaphylaxis).
- Orthostatic hypotension—People feel lightheaded when they stand up or change position suddenly.
- Dehydration, blood loss, hormonal problems (endocrine disorders), certain medications and lack of nutrients.
Q11: What can we do to raise blood pressure quickly when it dips?
You should sit or lie down immediately and raise your feet above heart level. If you are dehydrated, you should replenish lost fluids and seek immediate medical attention if the symptoms are severe.
Q12: What can you do to help relieve symptoms of low blood pressure?
If you have any symptoms of hypotension, you should visit your doctor to get your blood pressure checked and proper medical assessment.
Depending on the causes of hypotension, you may be able to relieve some of your symptoms by:
- Stay hydrated by drinking more water throughout the day.
- Drink less alcohol.
- Eating a healthy diet with fewer carbohydrates and smaller meals.
- Getting up slowly from sitting or lying down position.
- Avoid standing for long periods of time.
- Sit up and breathe deeply for a few minutes before getting out of bed.
- Wearing compression stockings.
- Increase your salt intake slightly because sodium raises blood pressure.
Q13: How do I maintain a healthy and normal blood pressure level?
By making some simple lifestyle changes, you can maintain a healthy and normal blood pressure and reduce your risk of heart disease. Healthy lifestyle includes exercise regularly, maintain good weight, eat healthy diet, reduce sodium in your diet, drink alcohol and caffeine in moderation, quit smoking, reduce your stress, monitor your blood pressure at home and see your doctor regularly.
Source: Dr How Ann Kee, Consultant Cardiologist & Cardiac Electrophysiologist, Sunway Medical Centre, Sunway City
Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice from Motherhood. For any health-related concerns, it is advisable to consult with a qualified healthcare professional or medical practitioner.
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