GETTING A READ ON A LOW DIASTOLIC NUMBER
What is considered "low" for the diastolic number in a blood pressure reading? What would a low reading mean? If the systolic number is within normal range, what can be done to alter the diastolic number?
A blood pressure reading has two numbers, given in millimeters of mercury. The first, or upper, number measures the pressure in your arteries when your heart beats. That's systolic pressure. The second, or lower, number measures the pressure in your arteries between beats. That's the diastolic pressure.
In general, diastolic blood pressure is considered to be low if it is 60 millimeters of mercury or less. Normal blood pressure varies from one person to another though. If your diastolic blood pressure is consistently below 60 millimeters of mercury, but you aren't experiencing any problems from it, you may not need to do anything. Noticeable symptoms of low blood pressure generally include dizziness, lightheadedness or fainting. If you're having these or other symptoms that could be related to low blood pressure, more investigation may be required to uncover the possible cause and provide appropriate treatment.
In some cases, medications can cause low diastolic blood pressure. In particular, medications intended to lower blood pressure, called antihypertensives, may go too far in the other direction, reducing blood pressure beyond a healthy level. These antihypertensives include diuretics (sometimes called water pills), alpha blockers and beta blockers. Other medications also may lead to low blood pressure, such as drugs for Parkinson's disease, certain types of antidepressants and the drug sildenafil, particularly in combination with heart medication (e.g., nitroglycerine).
An underlying medical condition could trigger low blood pressure, as well. For example, heart problems, such as extremely low heart rate, heart valve problems and heart failure, may cause low blood pressure because they prevent the body from being able to circulate enough blood. Endocrine disorders, such as adrenal insufficiency, also can trigger low blood pressure.
Other conditions, including dehydration, blood loss, severe infection and a severe allergic reaction, can lead to low blood pressure. But, these disorders usually cause a sudden, dramatic drop in pressure, rather than a sustained low blood pressure reading over time.
Another possible cause for low diastolic blood pressure is extremely stiff arteries. Very often, at around age 55 or 60, arteries begin to lose some of their flexibility. That can increase systolic blood pressure and cause discordantly low diastolic blood pressure. In some cases, stiff arteries could be a symptom of vascular disease.
When your diastolic blood pressure is consistently below normal, it may need to be evaluated. In young healthy people who do not take medications or have any symptoms, no treatment may be needed. But, it's still a good idea to talk to your doctor about it. If you do take medications, ask your doctor to review your current medication list to see if they could be contributing to low blood pressure.
If your doctor suspects that an underlying disorder could be the source of the problem, then additional tests may be necessary. It also would be worthwhile to talk with your doctor about managing any vascular risk factors you may have that can be changed, such as smoking, high cholesterol, diabetes and obesity. When a medical condition leads to low diastolic blood pressure, successfully treating that problem may eliminate the low blood pressure, too.
Sandra Herrmann, M.D., nephrology, Mayo Clinic, Rochester, Minn.
AN IUD ISN'T THE ONLY OPTION FOR TREATMENT OF HEAVY MENSES
After almost a year of having a period that is much heavier than normal, my gynecologist recommended an IUD as treatment. How does this work, and is it safe? I am 38, and I'm done having children.
Many types of intrauterine devices, or IUDs, are available. The specific kind that has been approved by the U.S. Food and Drug Administration for treatment of heavy menses releases the hormone progestin. This type of IUD is safe and highly effective for easing periods that are heavier than normal. IUDs are not the only option for treating this condition though. Before you move forward, consider talking with your doctor about the range of treatment choices available to you.
Hormonal IUDs are small, T-shaped plastic devices placed in the uterus that release progestin over time. Typically, IUDs are used to prevent pregnancy. But, research has shown hormonal IUDs to be useful for easing heavy periods, too. That's because they not only thicken cervical mucus to prevent sperm from reaching or fertilizing an egg, they also thin the lining of the uterus. That decreases menstrual blood flow and cramping.
One of the main benefits of using an IUD to reduce heavy periods is that, once placed, an IUD is effective for three to five years. The exact amount of time it can be left in place depends on the brand you choose. Little, if any, followup care is needed to manage the IUD during that time.
Side effects usually are minimal. Some women may notice headaches, acne, breast tenderness, mood changes and weight gain when they are using a hormonal IUD. There is a small risk of tearing the uterus when the IUD is placed. But, that's rare, particularly when the procedure is performed by an experienced physician.
If you prefer not to have an IUD, or if you would like to explore other possible treatment options, there are alternatives. Some women take birth control pills to manage heavy menstrual bleeding. This also can be an effective treatment. Keep in mind, however, that taking the pill is not a good choice if you smoke. Your doctor should review your medical and family history before you start taking birth control pills to make sure you're an appropriate candidate for them.
If, as in your situation, birth control is not needed, another option for controlling menstrual bleeding is to take a pill 10 to 12 times a month that contains only progestin. The medication reduces bleeding by correcting the hormone imbalance that usually contributes to heavy periods.
If treatment with an IUD or medication is not successful, a variety of surgical options also can be used to decrease menstrual blood flow. Most of these procedures can be done on an outpatient basis and do not require an overnight hospital stay.
Before you make a decision, it would be a good idea to take time to review all the possible treatment options with your doctor. Talk about your preferences, and discuss your medical and family background. Go over the risks and benefits of each option. That conversation can help you get a better idea of the treatment choice that's right for you and help you find the one that best fits your situation.
Bonnie Maffi, M.D., gynecology, Mayo Clinic, Scottsdale, Ariz.
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