Ruth Kam Heart & Arrhythmia Clinic
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Those numbers that indicate your blood pressure tell an important story about your state of health. Here’s what you need to know about blood pressure.
The body’s circulatory system is made up of a ‘pump’ – your heart – and a complex network of ‘pipes’ – your blood vessels. The pumping action of the heart generates the force with which blood is moved along these pipes. This force is called blood pressure. Without this force, nutrients and oxygen cannot be delivered to living cells in the body and neither can waste materials be removed from them.
Blood pressure in numbers
Blood pressure is measured in millimetres of mercury (mm Hg) and expressed through two numbers, one above the other. The top number is called the systolic blood pressure and the bottom number is the diastolic blood pressure. Systolic pressure refers to the pressure generated when the heart contracts. It is the driving force to push the blood forward. Diastolic pressure is the pressure generated when the heart relaxes in order for blood to fill up its chambers again. Both figures are important.
High numbers and low numbers
In general, the normal range of blood pressure is 90-139/50-89 mm Hg and this number fluctuates throughout the day. For instance, blood pressure tends to be higher during the day and lower at night. Therefore no two blood pressure readings in the same person taken at different times will be exactly the same. Blood pressure is also affected by stress, anxiety, food, exercise and by what we have consumed in the past few hours. Lack of sleep may cause elevated blood pressure as well. Some medications, such as painkillers, nasal decongestants containing ephedrine or pseudoephedrine, weight loss medications, antidepressants and migraine medication can also increase blood pressure. When numbers are chronically high or low, there is a risk oflong-term complications that require medical attention.
High blood pressure(> 140/90): When blood pressure is chronically high, the risk of many diseases increases. Hypertension is closely related to obesity, diabetes and high cholesterol levels. High salt intake, age, and cigarette or cigar smoking are some of the risk factors for hypertension. Hypertension may also be caused by autoimmune and kidney diseases. Uncontrolled hypertension can, in the long term, lead to kidney failure, heart attack, heart failure and stroke. It is also a leading cause of dementia and atrial fibrillation.
In most cases there are no symptoms, but some people may experience headaches, palpitations, breathlessness or dizziness. It is important to regularly screen for high blood pressure.
Low blood pressure (< 90/60): In hypotension, extreme fatigue, dizziness and fainting spells can occur. When there is a sudden dip in blood pressure, there is usually an underlying reason such as blood loss, dehydration, infection or heart attack. It may be a medical emergency because if blood pressure is very low, one can go into a coma and experience multi-organ failure. The underlying cause must be corrected before the blood pressure can be normal again. Some people with persistently low blood pressure feel well and have no evidence of heart disease. If that is the case, then this is not a cause for concern.
living with high BP
Lifestyle modification by diet, exercise, weight reduction, smoking cessation and stress reduction can help to reduce high blood pressure. These should always be employed, with or without the use of drugs. Drug treatment is necessary when the initial blood pressure is very high, when there are already complications associated with hypertension, or when lifestyle measures fail to bring the blood pressure back to normal.
Measuring BP at home
Most automatic digital blood pressure monitors using an arm cuff are quite reliable, although those that use wrist cuffs tend to be less accurate. When measuring your own blood pressure at home, make sure you are seated in a comfortable position. Have the arm cuff placed correctly, and relax. Do not talk while the blood pressure is being measured. You may measure it from either arm, but do not expect two readings to be exactly the same, even if they are taken within a few minutes of each other. A difference of 10-15 mm between the left and right arm is acceptable. There is no “best time” to measure the BP, so you can measure it at any time of the day or night. If the monitor gives an error message or indicates arrhythmia, be sure to get the doctor to measure your blood pressure manually to check why your pulse is irregular.
DR RUTH KAM
Cardiologist

MBBS (Singapore)
MRCP (Int Med) (UK)
M Med (Int Med) (Singapore),
FAMS (Cardiology), FRCP (Edin)
Ruth Kam Heart and Arrhythmia Clinic
3 Mount Elizabeth #08-06
Mount Elizabeth Medical Centre.
Tel: 6333 6866
www.arrhythmia.com.sg