Ask the doctor - variable blood pressure

See all of our magazine doctors' questions and answers, on 25 health topics

A COUPLE OF MONTHS AGO,
My doctor checked my blood pressure and told me it was high. It was re-checked recently and was still high, but my blood pressure is always fine when I check it myself at home. Do I need to worry?

You may have ‘white coat hypertension’. Many people fi nd their blood pressure goes through the roof when they have to have it tested. Interestingly, the National Institute of Clinical Excellence (NICE) now recognises many people may be labelled as having hypertension when their blood pressure is fine most of the time. It has recommended that, ideally, no one should be diagnosed with hypertension unless they’ve had their blood pressure monitored with a machine that tests it at intervals over a 24-hour period. Your reading will be in two figures, one ‘over’ the other, such as 140/80. The upper figure is the pressure inside your arteries while your heart is contracting, the lower is the pressure in your system while your heart is resting between beats. Both are important – if either one is repeatedly raised, it needs following up. The level at which tablets would be recommended depends on lots of factors – if you have diabetes, chronic kidney disease or a history of heart disease or stroke, your doctor would recommend tablets if your blood pressure is consistently above 140/90 (or 135/85 average at home). NICE also recommends you be treated at this level if your 10-year risk of a heart attack or stroke is more than 20% (your GP can advise about this). If you don’t have any of these risk factors, you would be advised to take tablets if your blood pressure stays above 160/100 (150/95 average at home). You definitely need to be followed up – take readings yourself at home twice a day for a week and show the results to your GP.
Dr Sarah Jarvis, Good Housekeeping (Jan 12)

I’m 30 and have been having palpitations. My GP tells me I have an abnormal heart rhythm called SVT. I’m waiting for an appointment with the specialist – what’s the best treatment for me to ask for?

Being diagnosed with SVT – supraventricular tachycardia – can be frightening, but the good news is that it doesn’t usually mean you have any underlying heart problem. It’s caused by a short circuit in the normal electrical impulses that keep your heart running smoothly, and can occur at any age. The episodes of rapid heart beats that you tend to get – typically about 150 beats a minute as opposed to the usual 60-90 – can be accompanied by shortness of breath, dizziness and occasionally chest pain. While most people don’t suffer any serious complications, these episodes can last from seconds to hours and be very distressing, but settle of their own accord. If your episodes are mild, you may not need drugs, but just to avoid smoking, stress, alcohol and excess caffeine, which can all trigger an episode. Otherwise, your doctor may advise that you take medication to control your heart rate, either regularly or when you have an episode. Your specialist will only recommend surgery if heart monitoring tests can pinpoint the source of the abnormal heart rhythm.
Dr Sarah Jarvis, Good Housekeeping (Dec 11)

I’ve read about taking bilberry for varicose veins or weak blood vessels. Can I take bilberry pills on a regular basis?

Bilberry extract is thought to strengthen the lining of veins and the connective tissues surrounding them, to provide extra support – rather like an internal elastic stocking. This is helpful for treating easy bruising, thread veins, phlebitis, varicose veins and haemorrhoids, and there are no toxic effects with normal doses. Try Solgar Bilberry extract (£19.09 for 50 capsules from www.nutricentre.com).
Dr Sarah Brewer, Prima (Aug 11)

My blood pressure is 140/95. My doctor wants to start me on drugs to bring it down. I don’t smoke and am not overweight. Surely it’s not that high?

Guidelines suggest offering antihypertensive drug treatment if your blood pressure is at least 160/100 or if it is persistently at a level of 140/90 or more and you also have a high risk of heart disease. If you are otherwise healthy, lifestyle advice can usually bring down your blood pressure quite quickly – within two weeks. Cut back on salt intake (to less than 3g per day if you can, and certainly less than 6g per day). By avoiding salty foods, not adding salt and checking labels for hidden salt. Follow a Mediterranean-style diet (fruit, veg, fish, wholegrains, low-fat dairy foods, nuts, seeds and olive oil), have a moderate alcohol intake, and exercise regularly – walk briskly for at least 60 minutes a day if you can (or aim for 10,000 steps sing a pedometer). Your GP should be happy to advise you on the Dietary Approaches to Stop Hypertension (DASH) diet.
Dr Sarah Brewer, Prima (Jul 11)

I had my blood pressure checked recently and it was high on two occasions. Now my GP wants me to wear a 24-hour blood pressure monitor at home. My sister, who also has high blood pressure, didn’t need this – why do I?

High blood pressure is very common, increasing your risk of heart attack and stroke, but rarely causing any symptoms. However, latest research suggests ‘white coat hypertension’ – blood pressure raised by a doctor or nurse coming towards us with a blood pressure cuff! – may mean that people are diagnosed with high blood pressure and treated unnecessarily. That’s why new draft guidance from the National Institute of Clinical Excellence recommends checking blood pressure using a device worn around the arm for 24 hours before making a diagnosis. The blood pressure cuff inflates automatically twice an hour during the day and hourly at night, automatically recording readings that can be used to work out if your blood pressure is always high. Doctors hope it could stop people being labelled incorrectly as having high blood pressure, which usually needs life-long treatment.
Dr Sarah Jarvis, Good Housekeeping (Jul 11)

I want to give blood, but was turned down because I’m anaemic. In the past few weeks, I’ve been feeling tired, but I put that down to work. What can I do to bump up my iron?

Iron deficiency affects around one in three menstruating women. Visit your doctor for a full assessment to see whether the iron deficiency is from a lack in your diet or excess blood loss (due to heavy periods or a peptic ulcer). If it is dietary, eating iron-rich foods will help. The best source of iron is the heme form found in red meat, shellfish, sardines, wholemeal bread, egg yolk, green vegetables and dried fruit. If you are vegetarian, you need extra vitamin C to increase absorption of the type of iron found in plants. If advised to take supplements, I suggest those containing ferrous fumarate or ferrous gluconate. Iron-rich spa water, such as Spatone Iron Sachets (£7.14 for 28 sachets from Boots) and iron-rich plant extracts, such as Floradix (£8.69 for 84 tablets from Holland & Barrett) are also good.
Dr Sarah Brewer, Prima (Mar 11) 

My Raynaud’s syndrome has been really bad this winter. Can you recommend any natural treatments?

Raynaud’s syndrome, a painful and unpleasant condition, occurs when small arteries in the fingers are overly sensitive to the cold. They go into spasm, cutting off blood flow so the fingers go white, numb and tingly. Toes can be affected, too. As blood flow returns, they go blue, then turn bright red. Self-help includes keeping hands and feet as warm as possible, stopping smoking and avoiding sudden changes in temperature. Eating oily fish or taking omega-3 fish oil supplements help to reduce blood stickiness, while garlic tablets and Ginkgo biloba extracts can improve blood fl ow to the peripheries. Ginger has a natural warming effect and is worth trying. All are widely available in health-food shops and chemists. For further information and advice on Raynaud’s syndrome, visit raynauds.org.uk.
Dr Sarah Brewer, Prima (Jan 11) 

Over the past few months, the skin on my upper legs has turned blotchy. Could this be a symptom of bad circulation?

Blotchiness can be caused by poor circulation, or a result of sitting too close to a source of heat. Sometimes, however, it can be a sign of inflamed blood vessels, high blood pressure, allergic reactions or other skin problems. So go and see your doctor for a check-up. Assuming all is well, try increasing the amount of exercise you take, to boost your circulation. Massage the area with body lotion and take evening primrose and omega-3 fish oil supplements.
Dr Sarah Brewer, Prima (Jul 10)   

I keep getting nosebleeds. I've had the problem on and off for years, but following a recent cold even gently blowing my nose can trigger a nosebleed.

Nosebleeds (epistaxis) can be an annoying problem. If you also have heavy periods, it's possible that you have a common, inherited bleeding disorder, such as lack of clotting factor XI or abnormal blood platelets. These bleeding disorders can be diagnosed with a blood test via your GP. Otherwise, the most usual cause is a fragile, superficial blood vessel in the nose that is easily damaged when blowing. This is best treated with cauterisation (sealing with heat) via an ENT clinic (your GP can refer you). Also, make sure you have a good intake of vitamin K, which is essential for normal blood clotting. Dietary sources include cauliflower, broccoli and dark green leafy vegetables such as spinach.
Useful amounts are also found in yogurt (produced by the bacteria present).
Dr Sarah Brewer, Prima (May 10)  

My cholesterol is high at 8.1 and I'm taking a statin to lower it, but I've started to suffer from muscle aches. Is this related?

Your cholesterol is certainly high and at that level it does need to be treated. Muscle ache is a common side effect of statins and, as you'll probably have to take them for life, ask your GP if you can switch to a different one. Some people find that Coenzyme Q10 supplements reduce muscle ache. Q10 is made by your body - but small studies have shown that people taking statins have reduced levels, so a supplement might help.
Dr Louise Selby, SHE (Apr 10)

I recently had a blood test because I'm taking blood pressure medication, and my doctor has told me I have chronic kidney disease. He seems very relaxed about it, but it sounds terrifying. What does it mean?

Actually, it's not nearly as worrying as the name might suggest. Using the measurements we take in the UK to define Chronic Kidney Disease (or CKD) up to one in 10 people is affected. The older you are, the more likely it is - about half of people over 75 have it. It just means that your kidneys don't filter waste products from your bloodstream quite as well as they used to. As long as we can slow down this process, most people with CKD never run into serious problems. The key is to control your blood pressure tightly - by taking medicine called an ACE inhibitor or an angiotensin II receptor blocker (ARB) - monitor your kidneys at least once a year, and reduce your risk factors for heart disease and stroke, which are linked to CKD. As you're on blood pressure medication and had a blood test, it's likely you've already been treated with an ACE inhibitor or ARB - but do talk to your GP to make sure all these safeguards are in place.
Dr Sarah Jarvis, Good Housekeeping (Apr 10)  

My blood pressure is 140/90 mmHg and my doctor wants to check it again in one month. Is this high?

Your blood pressure should ideally be less than 130/85mmHg. Levels between 130/85 and 139/89 are classed as ‘prehypertension' and levels
that are persistently 140/90 or higher are classed as hypertension. Your doctor will check your BP several times before deciding whether or not to prescribe any treatment. Blood pressure can go up for a number of reasons. Diet and lifestyle changes can help to bring it down. Cut back on salt and alcohol, try not to get stressed out and take regular exercise. Hypertension can lead to kidney failure, impaired eyesight, heart attack and stroke.
Dr Sarah Brewer, Prima (Mar 10) 

My fingers keep turning blue under my nails for no obvious reason. Could it be poor circulation?

Blueness at the end of the fingers is a sign of poor oxygenation - possibly because of poor circulation, although it can also be linked with exposure to cold. Sometimes the ends of the fingers can go blue, then white as a result of spasm of blood vessels in a condition known as Raynaud's. It's important to see your GP to have your blood pressure and limb circulation checked, allowing any possible underlying causes to be investigated.
Dr Sarah Brewer, Prima (Feb 10)

I've developed painful chilblains. How can I best treat them, and prevent them from happening again?

Chilblains occur when small arteries in your fingers, toes and even ears go into spasm when exposed to the cold. This reduces blood supply to tissues, causing skin to become purple-red, inflamed, itchy and intensely painful. Keep chilblains at bay by regularly massaging hands and feet with a moisturising skin cream, and exercising to boost your circulation. Wrap up warm in cold weather (gloves, thick socks, scarf and hat) and avoid tight, constricting clothes. Supplements that improve circulation, such as garlic, ginger, ginkgo biloba or omega-3 fish oils, can help, too. Try treating them with Nelsons Chilblains Cream (£4.35 for 30g). Visit nelsonsnaturalworld.com for details of this herbal remedy.
Dr Sarah Brewer, Prima (Jan 10) 

See all of our magazine doctors' questions and answers, on 25 health topics

The answers to specific problems may not apply to everyone. If you're worried, see your GP. For more information, visit netdoctor.co.uk