Understanding low blood pressure

Dear doctor,

These days there is a lot of talk on high blood pressure and healthy lifestyles. Sometimes my blood pressure is high and sometimes its normal. My question is, is it better to have low blood pressure? Is there a way to get rid of it completely?

Richard

Dear Richard,

The blood pressure reading is a measure of the force at which your heart is pumping blood and the resistance to the blood flow within the blood vessels. These two measures give the two figures we use for blood pressure reading. Normal blood pressure is between 90/60mmhg and 140/90mmhg. Anything above 140/90mmhg is considered high blood pressure.

Normally, the lower the blood pressure the better, though a reading below 90/60mmhg is considered low blood pressure or hypotension. When hypotension is mild and there are no symptoms, then there’s usually no cause for concern. However, if there is reduced blood supply to the brain and other organs, then symptoms such as dizziness, fainting attacks, feeling tired, headache, neck pain, confusion, blurred vision and abnormal heart beat develop. When severe, it can lead to shock and even death. Symptomatic low blood pressure requires interventions, which may include medical treatments and lifestyle changes like taking more water and increasing sodium intake under medical guidance.

In a few people, about five to 10 per cent of those with high blood pressure, there is an exact cause for it such as kidney disease, hormonal disorders, pregnancy, anaemia, tumours, drugs or some medications. For these people, once the cause has been identified and dealt with, then the blood pressure can be sorted out.

In majority of the people, about 90 to 95 per cent of those with high blood pressure, there is no known cause why the pressure goes up. It goes higher with age and by the time it is being said to be high, it has been rising slowly over many years, and continues to do so. There are some things that are associated with this rise such as age (being over 40), being male, being African, having a close relative with high blood pressure, high-salt intake, high-calorie, high-fat diet; lack of exercise, obesity, taking too much alcohol, smoking and stressful lifestyle. Because the blood pressure rises over many years, it is not possible to cure it with medication taken for a short time. This is because the changes in the vascular system are not reversible.

Unfortunately, most of the time you cannot tell that your blood pressure is high unless it is measured. Therefore, you may be feeling fine, but the blood pressure is high and it continues to cause damage to the blood vessels and can cause stroke, heart disease, kidney failure and even loss of vision. To prevent these long term effects, you are put on medication to lower the blood pressure to normal levels. If the pressure readings are normal, then the medicine is working. If you stop taking the medicine, the blood pressure goes back up, which is why it is very important for you to keep taking the medicine.

In addition to that, reduce the amount of salt (sodium),  fat and starch in your diet to healthy levels, reduce alcohol intake, stop smoking, reduce weight to healthy levels, exercise, take a potassium-rich diet with lots of vegetables and fruits (avoid potassium supplements), have enough sleep and manage stress.

When the blood pressure readings are between 120 to 140mmhg systolic and 80 to 90mmhg diastolic, what is considered as pre=hypertension or high-normal pressure, the lifestyle changes can help delay or prevent development of high blood pressure. Additionally, if you are diagnosed to have high blood pressure stage 1 (systolic 140 to 159mmhg and diastolic 90-99mmhg), you may be advised to do lifestyle modification for six months while being monitored for lowering of blood pressure before being started on medication.  It is advisable for you to check your blood pressure and visit the physician regularly for monitoring, early intervention and to avoid complications related to blood pressure abnormalities.

I am 43 years old and I have been trying to get pregnant for some time. Can folic acid help improve my fertility? Phyllis

Dear Phyllis,

Folic acid is useful for different functions in the body, especially the formation of red blood cells. Folic acid/folate supplements (a form of vitamin B9) help to build up the folate stores in the body so that you have enough to “share” with the forming baby during pregnancy, and this is important to prevent development of disorders of the brain and spine (neural tube disorders). Because of this, it is advisable to start taking them once you intend to get pregnant so that once you conceive, the body already has enough stores, and to continue taking the folic acid supplements at least for the first 12 weeks of the pregnancy. The folic acid supplements, however, do not increase fertility.

For women, the highest number of eggs one will ever have are the ones present at birth and they decline over time. The “peak” fertile period is between the late teens and the 20s. After 30, fertility starts to drop, and this drop is most significant from around age 35. From age 40, the possibility of achieving a pregnancy is about 5-10 per cent with each cycle. This means that it is possible to get pregnant in your 40s, but it may take a bit longer. The other challenges with getting pregnant in your 40s is that there is a higher chance of abnormalities for the baby and a higher risk of complications during pregnancy.

The other possible causes of reduced fertility include abnormal ovarian function, hormonal disorders, fallopian tube obstruction and abnormalities of the uterus.

It is advisable for any woman above 40 planning a pregnancy to see a gynaecologist from before conception, and from very early in the pregnancy. In the case of delayed conception, the gynaecologist review can help isolate the exact problem and chart a course of management since different causes of reduced fertility have different treatments.

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