Do you have BP ? -Dr. Akshay Mehta


Yes, of course, all of us have BP (i.e. blood pressure).
All of us who are alive and kicking and have blood flowing in our arteries have BP.

Simply put, BP or blood pressure is the pressure or force exerted by the flowing blood on the walls of the arteries- the tubes that carry blood to all parts of the body from the heart. Every heartbeat consists of contraction and relaxation of the heart pump which sends a pressure wave throughout the arteries, much like the rising and falling waves of the sea.
The pressure wave generated at the time of contraction of the heart is the systolic pressure (the first or higher number usually mentioned in BP readings) and the pressure generated during the relaxation phase is called the diastolic pressure (the second or lower number in BP readings). So we all have BP with two numbers or readings: a higher (systolic) and a lower (diastolic) eg 140/90 (recorded as mm of mercury column ie Hg). However, some of us have high BP or hypertension which is a problem that needs attention

What is normal BP ?
It is the level of BP which is associated with least likelihood of producing complications in the future. From observations made over the years it has been seen that when the BP is consistently below 130 systolic and 80 diastolic, one has less chances of having complications related to BP.


What is high BP or hypertension?
When BP readings consistently remain above these desirable levels, it is called high BP or hypertension. Roughly one can say there is hypertension if the BP of a person on repeated and accurate measurements is above 140 mmHg systolic and/or 90 mmHg diastolic (i.e. 140/90). For diabetics and people with kidney failure, the limits are lower (130/80). For elderly people of say 75 years and above, the limits are more relaxed : about 150/90.


What is low BP? Is it dangerous?
Some people habitually have their BP at lower limits of normal i.e. 90/60 mm of Hg. So it is not abnormal or dangerous if this has been one’s usual BP and if it is not due to illness like shock, blood loss, dehydration, etc. or due to over medication.


Who are most likely to have hypertension ?
The following person have greater than average chances of having hypertension : diabetics, obese, people with kidney disease and people whose family members (parents or siblings) are known to have hypertension.

Is hypertension due to mental tension?
There is no definite correlation between mental tension and hypertension although mental tension can precipitate hypertension in those who are predisposed to get it. There are many “tense” individuals who do not have hypertension and there are many “cool” guys who have hypertension.

What causes hypertension?
In more than 90% of hypertensives, the exact cause is not known. In the minority, the cause may be a kidney disorder, some hormonal disturbance or some other correctable disorder.

What are the symptoms of hypertension? How does one know one has hypertension?
In most people with hypertension, there are no symptoms. Some may have headache. The best way to know whether one is hypertensive is to get it checked repeatedly.

Why treat it if it does not produce any symptoms?
Untreated high BP can produce complications mainly due to abnormal changes in the arteries making them more susceptible to fat deposits and narrowing called atherosclerosis. This can lead to problems like coronary heart disease and brain stroke. Another complication is kidney failure. It is to prevent these complications that proper treatment and control of BP is required despite the fact that it does not cause symptoms or unusual sensations.

Are medicines the only treatment for high BP?
No. The first and most important treatment of hypertension is lifestyle modification, such as salt restricted diet, weight reduction, regular exercise, abstinence from smoking and alcohol etc. Then, if required, the doctor will prescribe medications over and above these lifestyle changes.

How long should one continue taking medicines? Can one stop them once the BP is under control?
Usually the BP rises again if medications are stopped, hence treatment should be continued as long as the doctor feels that reducing or stopping treatment will cause the BP to rise again. Which usually means life-long medications.
But of course there are exceptions. If the BP is only mildly elevated, and if one vigorously pursues changes in lifestyle as mentioned above, the BP may reduce and one may be able to avoid, reduce or even stop all medication.

Should one stop medications before going for a BP check up?
No. You should get your BP checked while you are taking the medicines. Only then will the doctor know the response and the need to modify the treatment

Should one stop medications if there are side effects?
Yes, but one must immediately inform the doctor who can adjust the medications without untoward harm.

What are the side effects of medicines? Can one take them for long time without harm? Will their effect wear off with time?
Most medicines for hypertension have negligible or benign side effects if prescribed and taken properly. One can take them for long term safely. However different people respond or react differently to different medicines. If any side effects are noticed, one should immediately report to the doctor. In almost all cases, a good alternative will be prescribed by the doctor.
Usually effectiveness of a drug does not wear off over time, but if it does, due to some cause, adjustment in medications will be done by the doctor.

What diet changes are required to control BP ?
The diet recommended for hypertension is one with low salt intake and an increase in fruits, green vegetables, cereals, pulses, and low fat dairy products.

What types of exercises are beneficial, and what types are harmful?
The exercises that are beneficial are the aerobic, isotonic type. Aerobic exercises are those in which the supply of oxygen and nutrients to the exercising muscles continuously meets the demands of the muscles. Isotonic exercises are those with more movement and less force. Examples of isotonic, aerobic exercise are brisk walking, slow running, swimming, cycling, etc.
Exercises that may be harmful are isometrics, requiring more force than movement. For example, weightlifting.

How frequently should BP be checked?
This depends on your age, your initial BP readings and your likelihood of having high BP in the future. Depending on these factors your doctor will guide you as to show how often you should get your BP checked. It may vary from once every week to once a year.

Should one measure BP at home? What is ambulatory BP measurement ?
In a few persons, BP is high only when taken in the doctor’s clinic or a hospital, but normal when taken at home. This is called “white coat hypertension” and is less of a risk than true hypertension. So, if accurately done, home BP is a good idea and is a true reflection of one’s BP and can be done at different times of the day. Ambulatory BP is automatic BP measurement at frequent intervals throughout 24 hours by an equipment tied to the patient’s arm. It gives an idea about BP levels also while asleep in the night. It can also reveal early morning rises in BP which are detrimental to health. Many times drug therapy can be better tailored to the BP levels by noting these variations throughout the day.


What other precautions should one take if one has hypertension?
Hypertension is one of the most important risk (causative) factors in the development of coronary artery diseases, and its harmful effect are magnified by the presence of other risk factors like smoking, diabetes, abnormal blood lipids (cholesterol), obesity and physical inactivity. Hence it is important to identify these other factors, with checkups if necessary, and reduce or eliminate them with proper lifestyle changes and medications. At the present time, proper lifestyle changes together with excellent medications available can almost totally prevent the complications of hypertension.