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High Blood Pressure - Doctor Q&A

 
  1st Aug - 31st Aug 2011  
     
   
 
     

Hypertension (high blood pressure) usually has no symptoms, but causes damage to various body organs in the long-term. It is for this reason that high blood pressure is referred to as the "silent killer”. Over time, it can lead to heart and blood vessel conditions, including stroke and heart attack. Fortunately, there are ways to manage hypertension.

Seize this chance to ask any question you might have regarding high blood pressure. Our expert is here to help.

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DISCLAIMER
This discussion forum is intended for general information and is provided on the understanding that no surgical and medical advice or recommendation is being rendered. Please do not disregard the professional advice of your physician.

 
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Dr Ian Phoon Kwong Yun
Senior Family Physician
Pasir Ris Polyclinic

 
 
     
     
 
     
 

Posted by nuwater2002

Hi Dr. Ian Phoon Kwong Yun, Senior Family Physician.

I am 60yrs old taxi driver working 12 hour daily. About 5 years back I was on medication. At that point of time my Bp was 130/80

I took a switch to change my life style. I had been jogging twice a week. Each time about 5km plus exercising like push-up 80 times and sit-up 30 times and others. (All in took about 1.5hr per session)

On top of that I carry weight twcie a week as well, including exercise about almost 2 hr per session.

Now that I had disregarded my HB medication for 4 years now. Daily I still check my own Bp which is now 118/70

My question is it ok with this result without my medication. I am feeling fine now with good muscle mass. My weight is 75Kg height 1.65m and my proffession is taxi driver who drive 12 hour daily

Thank you in advance

Best Regards
Lim Ee Teh Stephen

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi Stephen,

  • High blood pressure is regarded as having a blood pressure (BP) of > 140/90 on multiple occasions, on different days in a clinic setting. A blood pressure of 130/80 in the clinic is considered “high normal” and does not usually need medicine.
  • At home, when you are more relaxed, the BP should be lower (vs the clinic one) and should be below 135/85. Your BP of 118/70 at home is normal.
  • So it seems you do not have high blood pressure, and need not be on medication. But do continue to monitor your BP Regular exercise and eating a healthy diet certainly can lower your risk of getting high blood pressure in the future. Your weight is 75 kg and height is 1.65m. That will make your body-mass index (Wt /[Ht]2 ) 27.5. Normal is from 18.5 – 23. So you’re a little overweight, but if it’s mostly due to lean mass, then that’s ok. If your waist circumference is > 90 cm, then you probably have a lot of abdominal fat, and need to lose it.

Regards,
Dr Phoon

     
     
 

Posted by tomwong

HI Dr Ian

My mom had a minor stroke about a year ago and she is currently on:

Clopidogrel
Atenolol
Losartan
Nifedipine
Atorvastatin and
Famotidine

For monitoring purpose, I measure her BP twice daily, once in the morning at around 7.15am and another time around 9pm in the evening.

Her systolic usually hovers around 110 - 130 while her dystolic usually hovers around 50 - 60 and her pulse is typically around 60 - 64pm(most likely due to Atenolol).

Is it normal for her dystolic being so low?

Appreciate your advice.

Tom

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi Tom,

  • For people with stroke (even minor ones), the blood pressure should be kept less than 130/80, to reduce the risk of future heart attacks and strokes. So it seems like her blood pressure is ok.
  • In the elderly, the diastolic (lower BP reading) tends to be lower. So having a diastolic of 50-60 mmHg is not uncommon, as long as your mother has no breathlessness or dizziness.
  • But if she does have some dizziness, see if it’s soon after getting up from lying or sitting, as a transient drop in the blood pressure when she does this can occur (known as postural hypotension). If she does experience this, then ask her to get up slowly and in stages, to allow the body time to get used to the new posture.

Regards,
Dr Phoon

     
     
 

Posted by catherinetiah

Dear Doctor Phoon,

Can you please advise what are the dietary requirements suitable for a high blood pressure patient- what can/ cannot be eaten.

If the patient could be suffering from myocardial ischaemia (complications from HB pressure), what are the extra extra things to note- lifestyle/ food?

Can myocardial ischaemia be cured/ controlled by medicine and food?

Can the patient still take vitamins/ supplements- like calcium tablets for the bones, glucosamine tablets for joint pain also?

Pls help to advise. Thank you very much for your patience.

Thank you.

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi Catherine,

A healthy diet includes

  1. One with low salt. Salt is found in many of our food like sauces (chili, soya, ketchup), soup stock, salted peanuts, French fries, potato chips, instant noodles, and preserved foods like ham, bacon and sausages.
  2. High fibre. Fibre can be found in fruits and leafy vegetables, as well as in brown rice/noodles, and wholemeal bread.
  3. Low Fat/ Cholesterol. Fats are found in fried foods, butter, full cream milk, and fatty meats. Go more for steamed, grilled or baked foods. Take low fat products, and lean meats.

Myocardial ischemia means not having enough blood pumped to the heart muscles, usually due to the narrowing of the blood vessels to the heart. When the blood vessel is completely blocked, a part of the heart dies, and the person suffers a “heart attack”.

(medically known as an acute myocardial infarct).

A person with myocardial ischemia should follow the same healthy diet described above. In addition, your doctor may start you on a blood thinner (e.g. aspirin) to reduce the risk of a blood clot developing in the blood vessel of your heart. Patients with myocardial ischemia can still take supplements such as vitamins, glucosamine, and calcium.

Regards,
Dr Phoon

     
     
 

Posted by kkgoxplore

Dear DrPhoon,

Does radiation therapy to the neck and hypothyroidism cause the blood pressure to rise? After my RT last Dec, my blood pressure has elevated. Now after every meal (chewing and swallowing), my blood pressure elevates to 150/110. I am on Diovan but it does not help.

Thank you.
Goh

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi Mr Goh,

  • Yes, hypothyroid can sometimes cause the diastolic (lower blood pressure reading) to rise, but it should not cause high blood pressure if the thyroid hormone is adequately replaced.
  • It’s uncertain if the radiotherapy to the neck contributed to your high blood pressure, but it’s unlikely. There’re case reports (http://www.ncbi.nlm.gov/pubmed/12782644) whereby the pressure receptors in your neck are damaged years after the radiotherapy, causing the blood pressure to fluctuate widely.
  • However, hypertension (high blood pressure) is common and can occur independently.
  • Radiotherapy to your neck may cause your mouth to be sore, and reduce saliva production, making eating and swallowing uncomfortable and difficult. The stress of chewing and swallowing may cause your blood pressure to rise transiently because of this. Try taking your blood pressure 10-30 minutes after you’ve eaten.
  • If the blood pressure is > 140/ 90 even when not eating, your doctor may need to either increase the diovan, or add other blood pressure medication for you.
  • You should also exercise regularly, and have a healthy low salt, low fat, high fibre diet to help control your blood pressure.

Regards,
Dr Phoon

     
     
 

Posted by healthblur

Is it true that hot / short tempered people are at high risk of getting and having high blood pressure? Or is it just temporary (at the moment that you are angry)? Can you explain the basis of this? What's the best advice to someone who has short temper ... How to curb it? Thanks

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Being short tempered probably only raises your blood pressure transiently, due to the “fight or flight (or fright)” response. This response prepares the body to either fight, run away, or just freeze in its tracks. The response causes the heart rate to rise, and narrows your blood vessels to channel blood to your muscles, and thus raise your blood pressure.

A person with a bad temper can check his/her blood pressure (with a portable blood pressure set) when he’s/she’s not angry. If the blood pressure is still >140/ 90, then that person has high blood pressure.

A person with a bad temper is often impulsive. Counting to 10 before reacting to things may help. Learning to relax, be patient, breathing exercises, meditation, and sometimes religion can help control one’s temper.

Hope this helps.
Regards,
Dr Phoon

     
     
 

Posted by sbdccy

Hi. I always feel pain coming from the back of my neck. I consult the doctor before and said that it is stress heahache. But even i am not stress. I can still feel it. What might be the cause? Low/high blood?

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi sbdccy,

High blood pressure rarely causes any symptoms like neck ache, headache or dizziness. If the blood pressure taken at the doctor’s is normal, then it’s unlikely that the blood pressure is causing your neck ache.

Neck ache can be due to a neck strain, e.g. from sitting at a desk for a prolonged period of time, or may be due to disorders of the neck spine (e.g. degenerative conditions).

You can try taking some paracetamol (pain killers), put a warm towel or pack to your neck for 10 mins daily, and do some regular neck stretching exercises.

If your pain persists, do consult your doctor again. Further scans may need to be arranged for your neck.

Regards,
Dr Phoon

     
     
 

Posted by hazelyeong

Should blood pressure taken from both arms be the same? Some say it will be slightly different, some say it should be the same, if not the blood pressure monitor may be faulty etc. I would also like to know if blood pressure monitors bought off the shelf (like Guardian) is as reliable as those used by doctors. Thank you!

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi Hazel,

Generally the blood pressure in both arms should be similar (but not necessarily identical).

The upper (systolic) and lower (diastolic) blood pressure readings should not differ by more than 20 mmHg and 10 mmHg between arms respectively.

If it does, do check with your doctor.

Both blood pressures should be taken after sitting and resting for about 5 mins, with the arm resting on the table at about chest level, and the palms opened and facing upwards [for the arm blood pressure (BP) set]. For those BP sets that measure pressure at the wrist, the wrist should be raised to the level of the heart. If the BP in both arms are similar, you’d only need to check one arm the next time.

Most arm BP sets are accurate and reliable, including the one sold by Guardian. The wrist BP sets are usually not as accurate as the arm ones.

If you’re unsure if your BP set is reading correctly, do check this with your doctor.

Regards,
Dr Phoon

     
     
 

Posted by peggie

Since my first pregnancy, i came to know that i am a low blood pressure person. 0n 15 July 2012, after finished my lunch at the food court, suddenly felt cold sweat and blur vision. Rested and went back home to take a nap. Woke up was ok and fine as normal. Went back to work and thought it may be good to see the doctor. Got shock that my blood presure shot up to 160. Doctor asked me why and anything happen that trigger the situation. Everything was normal. I was given 1 week to see him. Since then i monitored my bp everyday around 10 pm. It range from 130 - 150 / 60 - 85. At the same i took black fungus, red dates, wolfberry with ginger soup with lecithin after my meals. Just this few day, my bp drops to 111/64. My BMI is 21. Do i consider myself back to my normal pressure or otherwise? Please advise me. Thanks

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Normal average clinic blood pressure (BP) should be less than 140/90 mmHg, while normal home BP should be less than 135/85. The reason is that at home, you’re usually more relaxed, thus we expect a lower BP.

One high BP at the clinic does not make you have high blood pressure (hypertension). If your home BP, on average, is less than 135/85, then you do not have high blood pressure. But I do note that the upper limit of your reading is 150 mmHg (systolic), which is high (i.e. more than 135 mmHg). If this happens often (e.g. 50%), then you do have high blood pressure. Do take some readings in the morning too, as blood pressure tends to be higher at these times.

Bring all your home BP readings for your doctor to review.

Normal BMI is 18.5 – 23, so your BMI of 21 is normal.

Regards,
Dr Phoon

     
     
 

Posted by glsim80@hotmail.com

Dear Doctor:
There are rumour saying that once you start taking high blood pressure medication, you must continue otherwise your blood pressure will get even higher. Is this true? and why?

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi,

As with many chronic diseases like asthma and diabetes, there’s no “cure” once established, but we can get it under control.

In most cases, high blood pressure has no specific cause, and multiple factors may be at play e.g. strong family history (genetics), high salt intake, being over-weight, being sedentary, smoking, and excess alcohol. With time the blood vessel walls thicken and become stiffer.

High blood pressure (hypertension) is silent in most cases and does not cause headaches, or dizziness, but it can still damage your internal organs like your heart and kidneys. It’s thus known as a “silent killer”.

Feeling well does not mean your blood pressure is ok. It needs to be measured.

Before you’re diagnosed with hypertension, there should be several readings taken, at least 2 minutes apart (if on the same day) and on different days. If your clinic BP is always or mostly > 140 /90, or your home blood pressure is > 135/85 (because at home you’re more relaxed, and the blood pressure should be lower), then you have hypertension (high blood pressure). Once this is established, then treatment is lifelong.

Treatment of hypertension includes

  • Starting to exercise regularly. Aim for 150 mins per week of moderate intensity aerobic type exercises like jogging, brisk walking, cycling, swimming or dancing.
  • Having a healthy low salt, low fat and high fiber diet.
  • Medication

Usually 1) and 2) are tried first unless the blood pressure is very high, or there’s evidence of organ damage such as weak kidneys (in which case medication should not be delayed). If 1) and 2) does not bring down the pressure, then medication needs to be added, and in most cases, will be lifelong.

Medications should not be seen as an alternative to exercise and healthy eating, but complementary. If one medication does not control your blood pressure, then either the dose needs to be increased, or more medication will need to be added, until the blood pressure is controlled.

Not controlling your blood pressure can raise your risk of heart attacks, stroke, and kidney failure. Remember that it is silent. If you choose not to take your medication, you should continue to monitor your blood pressure, and if it remains high, the risk of organ damage is there. All these medications have been rigorously tested in clinical trials and are generally safe.

Best regards,
Dr Phoon

     
     
 

Posted by labbit87

Hi Dr Ian,

My mum is 50 years old this year. She is a housewife and she has been consistantly measuring her blood pressure. She is not under medication for high blood pressure but everytime she goes to the doctor, the doctor will record a bp of over 140/90. But when she measures it at home in the afternoon or at night, her records hover around 120/80. But if she measures it in the morning, she also gets a higher bp close to 140/90 and she feel light-headed in the morning sometimes. Is this considered high blood pressure, when the bp is high only in the morning?

Thank you,
Eileen.

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi Eileen

Different environments can affect your blood pressure (BP), which may be higher in the clinic or at work due to stress or nervousness. It’s usually lower at home. This is known as the “white coat effect” (as traditionally doctors wear white coats).

High blood pressure is regarded as having a blood pressure (BP) of > 140/90 on multiple occasions, on different days in a clinic setting. At home, when you are more relaxed, the BP should be lower (vs the clinic one) and should be below 135/85.

If your home BP is normal and only high in specific situations, then it’s due to the “white coat effect” and you do not have true high blood pressure.

Your blood pressure tends to be highest on waking up in the morning, and lowest after you’ve slept. Eileen, try asking your mother to check her blood pressure not immediately on waking, but to sit and rest for 10 minutes before checking her blood pressure. It may be a little lower.

If generally the home blood pressure readings are < 135 /85 without medication, then medication is not needed. But do take your BP recordings to show your doctor at your next visit, so that you can discuss the treatment options. Do try to take about 3-4 readings per week, and at different times of the day to get a good idea of your BP trend.

Regards,
Dr Phoon.

     
     
 

Posted by meowy

Dear Dr Ian, (1) Are slow, relaxing and lazy exercises like yoga or swimming as efficient as doing jogging exercises in lowering blood pressure ? Many adults will tend not to exercise if exercising is too strenous or tiring for people who did not exercise regularly. (2) I know of a senior citizen who regularly takes high blood pressure medication everyday, but went into a coma sometime after taking medication when the person was at travel at Jiuzhaigou which is probably about 2000m+ altitude. The person has since recovered consciousness after some weeks at the local hospital. Since there are so many senior citizens travelling to China on travel packages, what precautions should old uncles and aunties take with their daily HBP medication if it's just a leisure travel to some small scenic mountain in China ?

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi meowy,

Moderate aerobic exercise, preferably done 150 minutes a week, is the best form of exercise for high blood pressure. This includes jogging, brisk walking, swimming, cycling, or dancing. Yoga and stretching can also be done to complement the above exercises, but should not be done exclusively.

Those that are sedentary tend to stay sedentary, because they always find exercise too “strenuous”. We should overcome this mindset, and break the vicious circle. We need to tell ourselves that we need to start moving regularly to be fitter. It can start with a 10 minute brisk walk 2x a week. This can slowly be increased to 5x a week, and the duration of the walks can be lengthened to 20-30 minutes. This will help us to achieve that 150 minutes of exercise a week. If we build up our stamina over time, it should not feel strenuous.

In places of high altitude, most people who lose consciousness or feel dizzy or breathless suffer from altitude sickness. This isn’t because their blood pressure is too high or too low, but because there isn’t enough oxygen in their blood, because the air is so thin.

My advice to those who wish to visit such places is this:

  1. Keep fit with regular exercise before the trip.
  2. Pack a portable blood pressure set to monitor their blood pressure there.
  3. Spend about 1-2 days at lower altitudes first, and progressively move to higher altitudes (rather than go straight to the highlands). This will allow your body more time to acclimatise.
  4. Know your limits. If you feel a little unwell, stop and rest, and let the tour guide know.

Regards,
Dr Phoon

     
     
 

Posted by leelianhuay

When I take by blood pressure at home even on sundays or on vacation leave, both the systolic & diastolic readings are below 130/80. However, whenever i take my readings during office hours (in the office premises) the readings are always above 140/90. I also note the readings taken at the polyclinic are even higher than those taken in my office. Please advise if I should proceed to take blood pressure pills. I am 57 years old. Thank you.

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Different environments can affect your blood pressure (BP), which may be higher in the clinic or at work due to stress or nervousness. It’s usually lower at home. This is known as the “white coat effect” (as traditionally doctors wear white coats).

High blood pressure is regarded as having a blood pressure (BP) of > 140/90 on multiple occasions, on different days in a clinic setting. At home, when you are more relaxed, the BP should be lower (vs the clinic one) and should be below 135/85.

If your home BP is normal and only high in specific situations, then it’s due to the “white coat effect” and you do not have true high blood pressure.

Your blood pressure tends to be highest on waking up in the morning, and lowest after you’ve slept.

If generally the home blood pressure readings are < 135 /85 without medication, then medication is not needed. But do take your BP recordings to show your doctor at your next visit, so that you can discuss the treatment options. Do try to take about 3-4 readings per week, and at different times of the day to get a good idea of your BP trend.

Regards,
Dr Phoon.

     
     
 

Posted by joanne_ywc

I am a regular blood donor despite having high blood pressure. I wish to continue donating blood and have not taken an medication for hypertension even though my readings are above the normal range and consider mild hypertension. I change my eating habits and do brisk walking few times a week. Does taking a certain of medication still enable me to donate blood? Thank you.

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi Joanne,

You can still donate blood, but need to declare the medication(s) that you’re on to the donation centre.

If your blood pressure is high (even if mildly), you should take your medication.

Regards,
Dr Phoon

     
     
 

Posted by queksp

I have been taking my medicine Atenolol BP 50mg once every morning for four years. My blood pressure is quite constant 120/80. I watch out on my diet and exercise regularly. 1) Will the dosage increases as we grow older? 2) Is it true that due to the high blood pressure, our heart [the wall] grows thicker? 3) Once a while, I will have cold sweat and light headedness, is this the side effect of taking high blood pressure medicine?

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi queksp, Your medication may stay the same or it could increase. It does not necessarily get worse with age.

The heart, like any other muscle in the body, will get bigger (thicker) if it’s made to work harder. Controlling your blood pressure will help to prevent this.

Having cold sweats and light headedness can be due to several reasons such as:

1) Low blood pressure (which can be a side effect of the medication). The dizziness is usually on getting up from a lying or sitting posture. There is a transient drop in the blood pressure (known as “postural hypotension”) due to the pooling of blood in the legs. Getting up slowly helps to mitigate its effect.

2) Low blood sugar. This can happen if a meal has been missed or delayed

3) Heart attack, especially if there’s also chest pain and breathlessness.

4) Stroke. Usually it is also associated with weakness or numbness on one side of the body, and the speech may be slurred.

Do note the circumstances surrounding your symptoms, as it may help your doctor determine its cause. If it persists, do inform your doctor.

Hope this helps.

Regards,
Dr Phoon

     
     
 

Posted by liz_soh

Hi Dr Phoon, Thanks for taking the time to answer our questions! Both my parents (currently in their early 60s) have high blood pressure and they are on long-term medication. Would like to seek your advice on a couple of question: 1) Is there any known cause for high-blood pressure? 2) My parents started having high blood pressure in their 40s. Do my sibling and I have a higher risk of getting high blood pressure in our later years (e.g 40 years old onwards). 3) Heard that high-blood medication is taken for a lifetime. Is this true? If the blood pressure had been stable for many years. Can the patient be taken off the high blood medications? 4) Will there be any side or adverse effects from taking long-term high blood medication? 5) Is there any food that can help reduce high-blood pressure? Many thanks in advance! Regards Elizabeth

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi,

As with many chronic diseases like asthma and diabetes, there’s no “cure” once established, but we can get it under control.

In most cases, high blood pressure has no specific cause, and multiple factors may be at play e.g. strong family history (genetics), high salt intake, being over-weight, being sedentary, smoking, and excess alcohol. With time the blood vessel walls thicken and become stiffer.

High blood pressure (hypertension) is silent in most cases and does not cause headaches, or dizziness, but it can still damage your internal organs like your heart and kidneys. It’s thus known as a “silent killer”.

Feeling well does not mean your blood pressure is ok. It needs to be measured.

Before you’re diagnosed with hypertension, there should be several readings taken, at least 2 minutes apart (if on the same day) and on different days. If your clinic BP is always or mostly > 140 /90, or your home blood pressure is > 135/85 (because at home you’re more relaxed, and the blood pressure should be lower), then you have hypertension (high blood pressure). Once this is established, then treatment is lifelong.

Treatment of hypertension includes

  1. Starting to exercise regularly. Aim for 150 mins per week of moderate intensity aerobic type exercises like jogging, brisk walking, cycling, swimming or dancing.
  2. Having a healthy low salt, low fat and high fiber diet.
  3. Medication Usually 1) and 2) are tried first unless the blood pressure is very high, or there’s evidence of organ damage such as weak kidneys (in which case medication should not be delayed).

If 1) and 2) does not bring down the pressure, then medication needs to be added, and in most cases, will be lifelong.

Medications should not be seen as an alternative to exercise and healthy eating, but complementary. If one medication does not control your blood pressure, then either the dose needs to be increased, or more medication will need to be added, until the blood pressure is controlled.

Not controlling your blood pressure can raise your risk of heart attacks, stroke, and kidney failure. Remember that it is silent. If you choose not to take your medication, you should continue to monitor your blood pressure, and if it remains high, the risk of organ damage is there. All these medications have been rigorously tested in clinical trials and are generally safe.

Best regards,
Dr Phoon

     
     
 

Posted by rsim

Hi Dr Ian,

My mother has high blood pressure for years, more than 10 years and she has to take medicine[prescribed at the polyclinic] daily to control the pressure from increasing, thing is if she skip the medicine, the reading does goes up and sometimes she skip the medicine taking with intention as she strongly believe long period consumption of 'western' medicine is detrimental to one's body organs. So she prefer non-medication method from hear-say basis, like consuming certain vegetables, is there truth in this non-medication approach? How do we manage hypertension? Is medication the only option? And is it true that with hypertension, getting work-up, angry, excited must be avoided at all means because this will lead to heart attack?

Please be so kind to advise ,thanks so much.

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi,

As with many chronic diseases like asthma and diabetes, there’s no “cure” once established, but we can get it under control.

In most cases, high blood pressure has no specific cause, and multiple factors may be at play e.g. strong family history (genetics), high salt intake, being over-weight, being sedentary, smoking, and excess alcohol. With time the blood vessel walls thicken and become stiffer.

High blood pressure (hypertension) is silent in most cases and does not cause headaches, or dizziness, but it can still damage your internal organs like your heart and kidneys. It’s thus known as a “silent killer”.

Feeling well does not mean your blood pressure is ok.

It needs to be measured. Before you’re diagnosed with hypertension, there should be several readings taken, at least 2 minutes apart (if on the same day) and on different days. If your clinic BP is always or mostly > 140 /90, or your home blood pressure is > 135/85 (because at home you’re more relaxed, and the blood pressure should be lower), then you have hypertension (high blood pressure). Once this is established, then treatment is lifelong.

Treatment of hypertension includes

  1. Starting to exercise regularly. Aim for 150 mins per week of moderate intensity aerobic type exercises like jogging, brisk walking, cycling, swimming or dancing.
  2. Having a healthy low salt, low fat and high fiber diet.
  3. Medication

Usually 1) and 2) are tried first unless the blood pressure is very high, or there’s evidence of organ damage such as weak kidneys (in which case medication should not be delayed). If 1) and 2) does not bring down the pressure, then medication needs to be added, and in most cases, will be lifelong.

Medications should not be seen as an alternative to exercise and healthy eating, but complementary. If one medication does not control your blood pressure, then either the dose needs to be increased, or more medication will need to be added, until the blood pressure is controlled.

Not controlling your blood pressure can raise your risk of heart attacks, stroke, and kidney failure. Remember that it is silent. If you choose not to take your medication, you should continue to monitor your blood pressure, and if it remains high, the risk of organ damage is there. All these medications have been rigorously tested in clinical trials and are generally safe.

While being very excited or angry does add stress to the heart. We can’t always avoid these emotions. But we can learn to control them, through relaxation and deep breathing exercises. Learning to forgive, accepting imperfections, and looking to the brighter side of things can help us cope with our emotions. Regular exercise also helps our bodies to cope better with emotional stress.

Best regards,
Dr Phoon

     
     
 

Posted by pocoyosky

Hi Dr Ian,

Is hypertension curable? Or it can only be controlled by medication but not curable like having surgery or other means?

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi,

In most cases, high blood pressure has no specific cause, and multiple factors may be at play e.g. strong family history (genetics), high salt intake, being over-weight, being sedentary, smoking, and excess alcohol. With time the blood vessel walls thicken and become stiffer.

High blood pressure (hypertension) is silent in most cases and does not cause headaches, or dizziness, but it can still damage your internal organs like your heart and kidneys. It’s thus known as a “silent killer”.

Feeling well does not mean your blood pressure is ok. It needs to be measured.

Before you’re diagnosed with hypertension, there should be several readings taken, at least 2 minutes apart (if on the same day) and on different days. If your clinic BP is always or mostly > 140 /90, or your home blood pressure is > 135/85 (because at home you’re more relaxed, and the blood pressure should be lower), then you have hypertension (high blood pressure). Once this is established, then treatment is lifelong.

Treatment of hypertension includes

  1. Starting to exercise regularly. Aim for 150 mins per week of moderate intensity aerobic type exercises like jogging, brisk walking, cycling, swimming or dancing.
  2. Having a healthy low salt, low fat and high fiber diet.
  3. Medication

Usually 1) and 2) are tried first unless the blood pressure is very high, or there’s evidence of organ damage such as weak kidneys (in which case medication should not be delayed). If 1) and 2) does not bring down the pressure, then medication needs to be added, and in most cases, will be lifelong.

Medications should not be seen as an alternative to exercise and healthy eating, but complementary. If one medication does not control your blood pressure, then either the dose needs to be increased, or more medication will need to be added, until the blood pressure is controlled.

Not controlling your blood pressure can raise your risk of heart attacks, stroke, and kidney failure. Remember that it is silent. If you choose not to take your medication, you should continue to monitor your blood pressure, and if it remains high, the risk of organ damage is there. All these medications have been rigorously tested in clinical trials and are generally safe.

Best regards,
Dr Phoon

     
     
 

Posted by julie liau

Dear Doctor Phoon

Can the onset of high blood pressure be a consequence of having Type 2 diabetes?

Thank you!

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi Julie

Diabetes is often associated with high blood pressure and high cholesterol.

There are many common risk factors for all 3 conditions such as a sedentary lifestyle, obesity, and a rich diet.

It may not be a direct cause-effect, but diabetes certainly can make high blood pressure harder to treat. Management of the blood pressure is the same as in those without diabetes, i.e. with medication, regular exercise, keeping a healthy weight, taking less salty foods, and don’t smoke.

Regards,
Dr Phoon

     
     
 

Posted by kwiris1956

it is possible to control hypertension with fruits, vegetables and exercise?

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi kwiris1956,

Certainly a healthy lifestyle such as regular exercise (150 minutes of aerobic exercise a week), a diet low in salt and fats, and high in fibre such as in fruits and vegetables can help to control your blood pressure.

Just as importantly, you should keep a healthy weight and avoid smoking.

But some patients will still need medication for their blood pressure, in addition to the above lifestyle.

The management of hypertension should not be seen as either diet/exercise or medication. They are often complementary, and can work together.

Regards,
Dr Phoon

     
     
 

Posted by kulkul

Hi Dr Phoon

I am a long term patient suffering from hypertension.

I am on 8 mg of atacand and 30 mg of nifedipine.

Recently I found that I have occurrents of palpitation, and was referred to TTSH.

I was asked to wear a monitoring device for a day.

Thereafter I was told that nothing significant was found.

As my own monitoring of my BP showed that at the end of each day, my BP was above 150/90, my doctor increased the Nifedipine dosage to 60 mg. (30 mg in the morning and 30 mg in the evening)

However, my BP readings drop to just above 100/60.

I feel dizzy at times. So I revert back to 8 mg atacand and 30 mg nifedipine.

Am I doing the right thing

Thank you.
KS Sim

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi KS,

It’s good that nothing significant was found on your monitoring device (Holter). Sometimes palpitations occur with too much coffee or when you’re anxious.

Normal blood pressure should be below 140/90. So a blood pressure of 150/90 is definitely high. But before you take your blood pressure, you should sit for about 5 minutes, as your pressure may be higher after moving around.

Sometimes the high blood pressure medications may cause a transient drop in your blood pressure when you get up from lying or sitting. This drop may cause a transient dizzy spell. You should note if your dizziness is associated with getting up or not. If it is, try getting up slower.

Also, you should monitor your blood pressure at least 3-4 times a week, at different times (morning, afternoon, evening), and record this down in a diary or chart. This is more helpful than looking at a single reading. Rather, you should look at the range of readings, and also note any patterns. Blood pressure tends to be highest in the morning, comes down in the evening. But the average pressure should be below 140/90. Show this chart to your doctor.

If your dizziness resolved after reducing Nifedipine from 30 mg twice a day to once in the morning, then it’s possible that the higher dose may be causing your dizziness. After reducing your dose, you should continue to check your blood pressure regularly, and ensure your average reading is below 140/90. If not, you should discuss with your doctor other treatment options.

Meanwhile, do try to exercise regularly, and reduce taking salty foods (e.g. instant foods, salty soup, sauces, canned and preserved foods, junk food etc.)

Regards,
Dr Phoon

     
     
 

Posted by lee.chai.keng68

Dear Dr Phoon. May I know does biscupid aortic heart valve, low potassium in blood and autoimmune disorders causes BP problems? Due to multiple drugs allergies, prescribed to take lorsantanpssiumtg and amlopidinebesylate. For my BP Those steroids taken from 2000-2009 for my sinusitis seem to be causing my blood cholesterol to go up even with statins intakes. (??) I have asthma, vitamin D deficiency, dopamine deficit, kee and sinus surgeries done, etc. Due to autoimmune disorders, pain also cause my BP to fluctuate.

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi Chia Keng,

A bicuspid aortic valve is usually something you’re born with. If the valve is leaky (i.e. cause a back-flow of blood), it can widen the difference between you upper blood pressure reading (systolic) and your lower reading (diastolic).

Low potassium per se does not affect the blood pressure.

There are many different auto-immune conditions, so it’s difficult to comment. However having to take long term steroids (a treatment for many auto-immune conditions) can cause your blood pressure and cholesterol to rise.

Pain can transiently cause the blood pressure to rise. You should check your pressure when you are relatively relaxed and pain-free. Chart your blood pressure about 3-4 times a week at different times (morning, afternoon, evening) and show it to your doctor, who will then advise you on your blood pressure control.

Regards,
Dr Phoon

     
     
 

Posted by mayheng

Hi Dr Ian,

I have high blood pressure for the pass 15 yrs, I'm now 39, try very hard to have baby. I request the doc in polyclinic to switch my medicine to the type that suitable to have baby. But my pressure is always on the high side after the switch, the reading is always 150/110. I'm feeling very depress. What should I do? Please advise.

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi May Heng,

Controlling your blood pressure before you become pregnant is important both for your safety as well as your baby’s.

2 medications for high blood pressure is safe in pregnancy – Nifedipine and Methyl dopa. If your blood pressure is not controlled with one, your doctor may add both medication, and slowly increase both to their maximum dose, or till your blood pressure is below 140/90 mmHg.

Once your blood pressure is better controlled, then you can start planning for a child. But do remember that this is a more risky pregnancy (also because of your age), and you may want to consult an obstetrician to discuss these risks (perhaps after your blood pressure is better controlled).

Regards,
Dr Phoon

     
     
 

Posted by shv

When i wake up in the morning, I feel the blood pumping a lot, I have experienced pumping during excercise but after peaceful sleep?

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi shv,

The feeling of blood pumping is not really specific to any condition. Indeed, hypertension (high blood pressure) is mostly without symptoms. That is, one can feel completely well and still have high blood pressure. That’s why hypertension is also known as the “silent killer”.

Thus, high blood pressure must be measured, and cannot depend on feelings. Normal blood pressure should be below 140/90 mmHg.

Some causes of feeling the “blood pumping” include anxiety (e.g. rushing to get up to start the day), alcohol, and caffeine (e.g. in coffee).

Regards,
Dr Phoon.

     
     
 

Posted by amychoong

My visit today to Polyclinic shows a reading: 134/97/100 Doctor did a ECG which shows abnormal I was sent to A&E as having chest pain also. After spending almost the whole afternoon, the ECG test done at hospital is same as poly ie abnormal but X-ray and blood test are OK. Now I have to wait for 2weeks to do the treadmill test and until Jan 2013 to see cardiologist. I am concern why ECG is abnormal & why I am having such high pulse rate and discomfort on my chest. Unfortunately the visit to A&E did not give me any answer

     
 

Answered by Dr Ian Phoon Kwong Yun Senior Family Physician Pasir Ris Polyclinic

Hi Amy,

This forum is more for questions on high blood pressure. Your case seems a little complicated, and it’ll be difficult for me to comment without physically examining you and reviewing your test results.

It’ll be best to await for your treadmill test in 2 weeks. Your cardiologist usually will review the results soon after, and will advise you accordingly. Meanwhile, try to relax, and not worry too much.

Regards,
Dr Phoon

     
     
 
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