How Low Should My Blood Pressure Be?

Recently, news outlets reported on a recent medical study (the so-called SPRINT trial) suggesting a goal blood pressure of under 120/80.

While not a bad idea, the question of just what is a good blood pressure is a bit more nuanced.

The first, higher pressure is the systolic blood pressure (SBP).  This is the pressure in your arteries when your heart is actually pumping.  The second, lower number is the diastolic blood pressure (DBP).  This is the "standing pressure" when your heart is filling with blood.

Generally, a high SBP can cause problems involving larger arteries: cardiac arrest, heart attack and stroke.  A high DBP (even if the SBP is okay) can cause problem involving smaller arteries: retinal problems, kidney disease, circulation problems to the feet.  Also, elevated blood pressure is associated with erectile dysfunction and Alzheimer's disease.

The goal of treating blood pressure is to reduce the risk of any of these things from happening to you, while also avoiding negative consequences of treatment or over-treatment.  Something the recent SPRINT trial noted was fewer heart attacks with blood pressures of 120/80 compared to 140/90.  However, there was also a significant occurrence at blood pressures of 120/80 or less of side-effects of blood pressure drugs such as abnormal electrolyte levels, abnormal kidney function, dizziness and fainting.

Medical studies that look more closely at both upside and downside risks are referred to by doctors as the Eighth Joint National Committee (JNC 8).

Goal blood pressure in patients 60 years old or older is 150/90 or less.  In patients with diabetes or chronic kidney disease, the goal is 140/90 or less.  Mind, if you are on medication and your blood pressure is 120/80 and you are not having any problems with it that's okay.  We simply are careful to avoid over-treating blood pressure as well as under-treating it.

Also, this should not detract from methods of lowering your blood pressure that don't involve medications: smoking cessation, weight loss, exercise and avoiding salty foods!

Treating and Preventing Constipation

Constipation occurs when your bowel movements (BM's) tend to be hard, dry, pebbly and require straining.  Sometimes, if the blockage is large enough, the only bowel contents that can make it around the blockage have to be liquidy.  This appearance of constipation plus diarrhea is called obstipation.  If this is the case, do not use medicines that treat diarrhea because they make the underlying constipation even worse!

Normally, your food is broken up by your stomach.  Nutrients are digested and absorbed by the small intestine.  The large bowel, or colon, serves to reabsorb water and important electrolytes such as sodium and potassium.  What's left by this point is mostly indigestible fibers from fruits and vegetables (also known as roughage or dietary fiber) and also bacteria from your bowels.  This fecal material is stored in the rectum which is at the very end of the colon.  When the rectum becomes full and stretched out, you feel the urge to go to the bathroom to have a BM.

If you do not eat enough roughage, then feces will stay in your rectum for longer than usual and become dehydrated.  This is how constipation is caused, and why the constipated BM's are dry, hard and pebbled looking.

Preventing constipation is mainly through eating enough fruits and vegetables to have normal, daily, formed BM's.  Eating more fruits and vegetables also helps to lower your risk of heart attack, stroke, diabetes, obesity and colon cancer.

On the other hand, folks who are long-standing "meat and potatoes" types can develop constipation to the point where their rectums no longer even feel fullness and they don't feel a need to go to the bathroom until they haven't had a BM for days. At this point they may even become dependent on fairly powerful laxatives or enemas to be able to have a BM at all.

Please note; it's the chronic constipation that results in a need for medications.  Laxatives and the like are not "addictive" in the strict sense.

At this point, over-the-counter (OTC) medications are available to help to establish a more normal and healthy pattern of BM's. There are a lot of them, so it helps to understand how they work so you can use them effectively.

First, add more fiber. Using Metamucil, Citrucel, flax seeds or bran every day can help to have more normal BM's.

Also, keep your BM's soft by using a daily stool softener such as DSS, or Colace.

It is also OK to use a plant-based mild stimulant (a cathartic) such as Senakot once or twice a day to be able to have daily soft BM's.

If you are using fiber, a stool softener and a cathartic once or twice every day and still have not had a BM in 2-3 days, then you should use a series of increasingly strong laxatives to help clear the blockage.  Try these one at a time a half day apart, to allow each one a chance to work:

1. Milk of Magnesia, 30 cc/1 fluid ounce
2. Magnesium Citrate
3. Dulcolax suppository