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How to manage high BP during pregnancy?

Q: I am 7 months pregnant and at the last examination my BP was 140mm which was considered high by my doctor. I am already taking 1 tablet a day of Ecosprin and the doctor asked me to take 2 if my BP goes beyond 140mm. Also, I have swollen legs and have been advised to rest and stop eating foods containing salt. I am a working lady (7.00 A.M. to 3.30 P.M.) and reach home at 4.00 P.M. I take some breakfast and sleep for 1 and 1/2 hr. Please suggest some exercises and diet to reduce my BP? My weight is now 71kg which was 62kg at the beginning of my pregnancy.

A:At the outset I would like to reassure you that 140mm systolic blood pressure is not alarming. (you have not mentioned the diastolic blood pressure). You certainly need to check the blood pressure frequently but at this stage there is no need for any active treatment. It is not advisable to take any medicines for the blood pressure. You need to check the blood pressure every week and if it goes up you need to see your doctor. I am not quite sure why your doctor has prescribed aspirin because the role of low dose aspirin in this kind of situation is extremely limited. Since the CLASP trials have been published, we are less enthusiastic about giving aspirin to pregnant women than we were about ten years ago. In fact it is not considered completely safe in pregnancy now. Please ask your doctor to specify why you have been given aspirin and how it is likely to help you or your baby. I am not quite sure why it has been prescribed. Pregnancy associated hypertension is more harmful if it occurs with passage of protein in the urine so please get your urine checked every two weeks or so for the presence of proteins. Swelling of feet can be completely normal, is a part of pregnancy and you do not have to worry on that account. Salt restriction in pregnancy to prevent or treat hypertension has no scientific basis and has been abandoned long ago as a standard clinical practice. It also has no role in the treatment of swelling feet. If you have no renal disease and if there is no anaemia or protein deficiency, swelling of the feet in pregnancy is considered physiological (normal) and is a part of the body's compensation mechanism to put the extra fluid which it accumulates during mid- and late-pregnancy in a buffer compartment. It should not be interfered with. Bed rest is not of required at all. Work during pregnancy is good and it is good to be moderately active throughout pregnancy. In your case, and infact in most cases in pregnancy, bed rest does not improve the chances of having a healthy baby and it is very bad for self esteem and quality of life during pregnancy. In your case whatever you can do without getting tired or exhausted can be and should be done. This includes all routine household work and work at office. Did you develop raised blood pressure during pregnancy or you always had it is not clear from your letter. As long as it has been within normal limits you do not have to worry on that account. I think you are trying too hard to lower it by diet (mainly restrictions) and exercise. There is no evidence that any special diet or exercise or bed rest for that matter prevent or treat high blood pressure during pregnancy. From the account you have given it seems that you are carrying a normal pregnancy with a slight tendency to develop hypertension which is common in pregnancy and would be dealt with appropriately once high blood pressure is recorded. In the meantime, please continue normal activities and diet. You will have to talk to your treating physician and figure out why you are being given aspirin and advised salt restriction. In case the doctors answers do not satisfy you, please take a second opinion. As things stand today there is nothing to suggest that you are carrying an abnormal pregnancy and hence any restrictions or special diet or precautions are not required. I wish you all the best for the rest of the pregnancy.


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