Dear Ask The Doctor: I have been anemic now for many years. Recently my iron levels have really been low.My vitamin-D levels are also low. My symptoms seem extreme: shortness of breathe, paleness, hair falling out, no energy,I even have cognitive issues when I am very tired. Recently two worrisome symptoms have started: my blood meds aren't working (BP is out of control) and my appetite is very large, especially when I feel tired. I have been given all of the necessary tests to determine that nothing else causing my bp to be so high. Does anemia have anything to do with non responsive blood pressure?
Dear Patient: Anaemia can be linked with high blood pressure (hypertension), with one study observing that poor blood pressure control was associated with lower haemoglobin concentration. You have resistant hypertension, because you are taking four different classes of blood pressure medications, with unsatisfactory BP control. Your persisting anaemia requires full investigation and may require referral to a Haematologist, which in turn may improve your BP. I advise you attend your family doctor for a full history and clinical examination. He may also perform a 24 hour ambulatory BP monitor, which will give a more accurate assessment of your blood pressure throughout the day. Referral to a cardiologist that specialises in hypertension or an endocrinologist may help to optimise your BP control. Lifestyle measures to control BP include: Weight reduction with a target Body Mass Index of <25; reduced sodium intake <100mmol/day = 2.4g sodium; increased daily physical activity minimum of 30 minutes/day, limit alcohol intake <2 units/day for women; smoking cessation; reduced saturated fat/cholesterol intake, adequate calcium and magnesium dietary intake and adequate intake of dietary potassium approx 90 mmol/d. The DASH diet (Dietary Approaches to Stop Hypertension) has been promoted by the National Heart, Lung and Blood Institute.