Hypertension ( high blood pressure) usually causes no symptoms, but often leads to the damage of various body organs in the long-term.

Dr Lee Sze Haur, Senior Consultant from the Department of Neurology at National Neuroscience Institute and Dr Goh Ping Ping, Chief Senior Consultant from the Department of Cardiology at Changi General Hospital, give detailed answers to your questions.

Question by parn_hexnap

my brother in law just suffered a stroke 3 month ago. He is under rehabilitan services now and we hired a nurse to take care of him.

I have a few questions:

1. For a stroke patient, is he at risk of suffering another stroke?
2. Is there any diet that he should follow from now on ?
3. Will he be back to his ownself after the treatment? he is really depressed now as he needs help for everything all the time.

Thank You

Answered by Dr Lee Sze Haur, Senior Consultant Department of Neurology National Neuroscience Institute, Singapore

1. Depending on the cause of the stroke, the risk of a recurrent stroke is about 5 to 10% yearly.
2. If the stroke is due to hardening of blood vessels, the commonest cause of stroke, he will benefit from a diet low in fat, cholesterol and salt. If he is taking Warfarin, a blood thinner, for prevention of recurrent stroke, he should take a diet low in vitamin K.
3. The disability of his stroke seems severe as he is dependent on carers for everything. Overall among survivors, approximately 30% of patients recover almost completely or with minor impairments. Unfortunately, about 30% will remain permanently bed bound. The remaining will have moderate disability.

Question by pearlynwan

hi Dr. Lee

My brother has a blood pressure of 140/110, and he is not under any medication. Currently he is of 34 years old and always under high stress. would he be in a high risk of getting a stroke ?

TQ

Answered by Dr Lee Sze Haur, Senior Consultant, Department of Neurology, National Neuroscience Institute, Singapore

Your brother has high blood pressure, defined as a pressure equal to or more than 140/90 mmHg. High blood pressure is a significant risk factor for stroke.

A person with untreated high blood pressure is four times more likely to have a stroke. Treatment of high blood pressure with a healthy lifestyle and medications can reduce the risk of stroke by about a third.

A healthy lifestyle includes regular exercise, maintaining ideal body weight, minimizing stress, limit consumption of alcohol and eating more vegetables and fruits.

Question by john

Can you tell me how much does food/lifestyle versus stress versus hereditary factors play a role in determining one's regular blood pressure?

Is it true that short tempered people are at higher risk of serious high blood pressure, or is it just temporary (for the moment)? My wife tells me that I am heading for high blood perssure problems because of my temper, but when I check with the doctor once in a while, the reading is still okay.

Or will it suddenly become high and remain high someday because of this?

I actually watch my salt intake very religiously, to the point that I sometimes feel slightly dizzy when I get up. Is this low blood pressure symptom instead? What should I do? Thanks for advice.

Answered by Dr. Goh Ping Ping, Chief, Senior Consultant, Cardiology, Changi General Hospital

Food/Lifestyle and hereditary factors are both important in determining a person’s blood pressure. For stress, researchers are not sure whether it can really cause high blood pressure but it can definitely cause temporary spikes in the blood pressure which can be harmful.

Although stress alone does not cause the blood pressure to stay high all the time (i e in between the stressful episodes the blood pressure may be normal, there are undesirable behaviours linked to stress such as overeating, drinking alcohol and poor sleep pattern that can cause high blood pressure. Hence it is possible for a person who is frequently stressed out to develop high blood pressure over time.

This symptom of feeling dizzy when standing up suddenly is usually due to the body’s nervous system being too slow to cope with postural changes, thus resulting in low blood pressure. Diabetics and patients on blood pressure medications may experience this problem. It is advisable to check one’s blood pressure when this occurs to determine whether the BP is really low. If the symptom is severe or frequent, please consult your doctor as other more sinister causes such as bleeding, infection and hormonal problems need to be excluded.

Question by ycning

Dear Dr

I have read and have been told that one's blood pressure should not exceed 130/90 [regardless of age]. I recently bought a blood pressure machine [a reputable brand] and it indicates a min & max blood pressure unit, which it says, is per WHO standard. The min/max is graded based on sex/age. For example, in the male category, age 65-69, the systolic pressure is max=188 and the min=128. The distolic max=106 and min=72. This age/sex dichonomy makes sense to me. But does it mean that a person of 65 yrs is ok if his blood pressure is high boderline @ 188/106 or does it mean that he needs to get down to 130/90. Which set of reading is the correct one? Thanks.

Answered by Dr. Goh Ping Ping, Chief, Senior Consultant, Cardiology, Changi General Hospital

International guidelines define normal BP as systolic blood pressure < 130 and diastolic blood pressure < 85. High BP is defined as systolic >140 and diastolic >90. What is in between is called “high normal BP”. This is for all adults irrespective of age or sex. The goal of treatment is to get down to <140/90 for all and in particular, for diabetics who are at higher risk, < 130/80.

Question by wmwatt

I am a 53 year old female. I had an ECG and my heart rate is low, below 60. I exercise regularly and was told that this is consistent with people who exercise. However I have high blood pressure 170/120 and is under medication. Why do I have hypertension when my heart rate is low? I also have high LDL and also take medication for that. i weigh 54 kg and is 156M.

Thank you and Happy Lunar New Year.

Answered by Dr. Goh Ping Ping, Chief, Senior Consultant, Cardiology, Changi General Hospital

The blood pressure is the force of the blood pushing against the wall of the blood vessels during each heartbeat. How hard the force is mainly depends on the stiffness of the artery wall. High blood pressure is not due to fast heart rate. People with both fast and slow heart rate may develop high blood pressure.

For your case, your heart rate may be slow because you are on a certain type of blood pressure medicine (usually a class called betablockers).

Question by hamzad

Dear Dr,

My husband who will turn to 31 this year is suffering from high blood pressure since 2006.Firstly,from 2006 to 2008 October he used to have hypertension tablet of chemical name tenoren 50 mg once in the morning.Then he switched to Co-Diovan 80/12.5 mg tablet once in the morning.if he doesn't have his hypertension medicine one day he fills severe headache and pain in his neck,sometimes gets diarreahea too.We assumes that he got hypertension problem genetically and as well as from his stressfull profession. He is a lawyer by profession,weighs 85 kg and height is 5ft 6 inches.I want to know if he continues this hypertension tablet everyday for longer period of time is it harmful for his body?and also is there any treament to get rid of high blood pressure without having tablet everyday?

Happy lunar year.

Thank you.
Mrs Naushin

Answered by Dr. Goh Ping Ping, Chief, Senior Consultant, Cardiology, Changi General Hospital

He needs to continue his BP medicine on a long term basis to ensure that blood pressure is well below 140/90. This is necessary to prevent complications of high BP including stroke, heart failure and kidney failure.

The benefit of treatment of high BP far outweighs any risk of medication. As he is overweight, weight loss through exercise and diet will also help to keep the BP under control but he will still need to continue his medicine.

Question by chantakkin

Dr,

I bought a blood pressure monitor a month ago and did measurement from time to time. The systolic readings were eratic: ranging between 110 and 165....most of the time between 125 and 140; while diastolic readings were between 70 to 80. Do I need to consider taking medication? I understand all blood pressure medicines have some unfavourable side effects.

Thanks!

Answered by Dr. Goh Ping Ping, Chief, Senior Consultant, Cardiology, Changi General Hospital

Most of the readings are not in the high BP range. There appears to be some fluctuations in the systolic BP perhaps due to mood changes but on the whole, medicine is not required at this point and you should try to control your BP by diet, regular exercise and stress management.

Question by jacklhk1

Hi doctor, I have been taking medicines for high blood pressure for about a year plus. My questions are

1. What are the side effects?
2. Can I stop or reduce medicines in future?
3. Is mild giddiness a side effect?

Thanks

Answered by Dr. Goh Ping Ping, Chief, Senior Consultant, Cardiology, Changi General Hospital

1. There are many different classes of medicine, with different types of side effects. Hence it really depends on the actual medicine that you take. In general, newer medicines that combine low does of 2 medicines in a single pill tend to have lower side effect compared to taking either component in the full dosage.
2. BP Medicine is usually for long term. Please consult your doctor before stopping any medicine.
3. It is a possible side effect. Monitoring home BP and noting the BP during the giddy episode will help your doctor to manage your problem.

Question by joanne_ywc

I am 55 years, a regular blood donor.

Have been going for medical check-up few years ago and been told of my high blood pressure and advise to watch my diet and exercise. Tried to change my diet - eating more fruits and vegetables and continue to donate blood.

Will donating blood have any effect on my blood pressure?

I rejected medication cos i still wanted to continue my blood donation.

Answered by Dr. Goh Ping Ping, Chief, Senior Consultant, Cardiology, Changi General Hospital

Blood donation is safe. There is no adverse effect on high blood pressure that has been stable on treatment.

Ref: U11