Hypertension - Blood Pressure Control

We continue with Dr Stephen Chew Tec Huan, a Consultant Nephrologist and Physician, for his insight into hypertension. In this post he will share with us some pointers on keeping blood pressure under control in the pre-dialysis patients.

Hypertension is usually silent. There maybe no symptoms even in the presence of severe hypertension unless complications set in. Hypertension can occur in the absence of any other medical problems and can be an isolated problem. According to Dr Chew, it is more frequent in obese individuals, patients with diabetes, patients with kidney disease, and can occur in association with high blood cholesterol levels. Some of these occur in the individual patients at different times of their lives, and it is important that the patient knows that he has to check regularly for these problems even if they were not first detected at the time he was diagnosed with hypertension. High blood pressure is like a time bomb, it exerts its effects slowly and progressively damaging kidneys, heart, brain and blood vessels to the legs and hands, and can explode (so to speak) by showing itself when the patients develop a catastrophic complication like a stroke or heart attack.

The first step is to know your blood pressure

There are many measures of the blood pressure and it may vary taken at different postures (eg standing versus sitting), it may vary according to the time a person has taken his medication for hypertension, and even may vary depending when it is taken (clinic blood pressures may be higher than home blood pressures). Special ambulatory machines can measure the blood pressure over 24 hours, and normal non-hypertensive individuals usually have a normal dip in their blood pressure in the night. In patients with hypertension due to kidney disease, this dip is usually absent, and ironically, the blood pressure actually surges in the early hours of the morning. Several measures of the blood pressure are more important a guage of effective control than single isolated readings.

Who should measure your blood pressure?

Ideally Yourself. And At Home, In the Morning, Before Medication. There may be exceptions to this, and your doctor can best advise you. Clinic blood pressure may be misleadingly high, leading to potential overtreatment; likewise, it may be deceptively normal if measured after medication. 24 hours BP measures are inconvenient to do all the time although they are possibly the best measures of how well the blood pressure is controlled through the day.

Some useful tips to consider.
1. Buy a blood pressure machine for home use especially if you can't measure your blood pressure with your doctor over at least over several periods.

2. Try to buy machines that use an arm wrap instead of a wrist wrap; they're better indicators of your true blood pressure.

3. Bring your home machine to your doctor when you see him. He can verify the accuracy or degree of reliability of your machine.

4. Take the BP at home, rested after 5 minutes, in the morning, same arm, before medication. Record the time you took it as well. Do it for at least one week for every month. If you do it daily, all the better.

5. The ideal target blood pressure is best discussed with your doctor. In general anything above 140/90 is considered hypertension, although what your target BP ought to be should be individualised after discussing with your physician.

That's all for the moment. Do stay in-tune for more insights.

Keywords: blood pressure, hypertension, kidney failure, diabetes