What goes up must come down

Hypertension, or high blood pressure, is a risk factor that can lead to a 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% of the time, the cause cannot be determined.

Blood pressure changes throughout the day depending on many factors such as activities, stress levels, pain levels and emotions. Immediately after exercising, blood pressure can drop. 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.

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, 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.

High blood pressure can affect the body in many ways. It can affect how your kidneys and arteries, 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.

Treating high blood pressure with no known cause might have to rely on medication, together with a change in lifestyle. A person who keeps their 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 blood pressure to increase as people got older.

A 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 arteries such as people with diabetes, high cholesterol, history of myocardial infarction, paralysis and smoking. Ideally, it should be kept at 120/80 mmHg regardless of age.

Many people do not take high blood pressure seriously and wrongly assume that medicine will work magic. They also think that once their 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 50s came to see me because he had a headache. His blood pressure was as high as 200/120 mmHg.

A physical check-up and blood test could not determine the cause of the high blood pressure, but he was under a lot of stress. Luckily his organs were not yet damaged.

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 so we eventually parted ways.

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 the 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 my attention without a more serious condition.

Another patient, also in his 50s, came to see me because he felt tired and tight in the chest during heavy activities. He had a history of untreated high blood pressure for years, and his heart was slightly enlarged. Protein was found in his urine sample.

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.


Dr Nithi Mahanonda is a consultant cardiologist and interventionist at Perfect Heart Institute, Piyavate Hospital. Visit his website at www.drnithi.com.

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Writer: Dr Nithi Mahanonda
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