High Blood Pressure

High blood pressure, also known as hypertension, affects at least 1 in 4 adults in England alone. It is a condition that relates to the body’s circulatory system, specifically the pressure exerted to pump blood around the body. If this pressure is too high then it is likely to cause extra stress on the heart and arteries (blood vessels), which can lead to more serious conditions such as stroke, kidney disease, heart attack and even heart failure.

The symptoms associated with hypertension can sometimes be hard to spot, which is why it is important for adults to have their blood pressure checked on a regular basis. It is recommended that adults have a check at least once every five years. A blood pressure check is a readily available test that can be performed by your GP, pharmacist or other healthcare professionals. It can also be carried out by yourself by using a home testing kit.

Blood pressure is measured in millimetres of mercury (mmHg) and is presented by two figures; systolic and diastolic pressure. For example, the ideal blood pressure in a healthy adult would be 120/80mmHg or 120 over 80. The systolic reading (120) relates to the pressure of the blood when your heart beats. The diastolic reading (80) shows the pressure of the blood as your heart rests between beats. The diastolic reading reveals how strongly the arteries are resisting the blood flow. If your resting blood pressure is 140/90 mmHg or over, then this will indicate hypertension or high blood pressure.

The risk of developing hypertension increases as we get older. Lifestyle choices can also strongly influence our risk of developing the condition. There isn’t always a clear cause but factors that increase the risk of developing hypertension include:

• Being overweight
• Being over 65 years of age
• Having a blood relative with hypertension
• Lack of exercise
• Eating a poor diet that is high in salt and lacking in fresh fruit and vegetables
• Drinking too much alcohol or coffee
• Smoking
• Being of African or Caribbean descent

Hypertension, in most cases rarely presents with any obvious symptoms. In severe cases where the blood pressure is very high, the symptoms can become more apparent. These can include;

• Blurred or double vision
• Persistent headache
• Nose bleeds
• Shortness of breath

Symptoms such as these only occur in rare cases, if you are experiencing any of the above it is strongly advised you see a doctor as soon as possible. Experiencing any of the above symptoms would class as a medical emergency.

High blood pressure should always be diagnosed by a medical professional and not self-diagnosed based on home tests. Although a general idea of the blood pressure reading can be taken at home, deciding on the appropriate treatment (medicinal or lifestyle) should be carried out by a healthcare professional.

As stated above, hypertension rarely presents with any obvious symptoms. This highlights the importance of having your blood pressure checked regularly, especially if any of the risk factors for developing high blood pressure apply to you.

The diagnosis will be made using a blood pressure monitor. These devices are safe, quick and simple to use. A cuff is placed around the upper arm (in some cases the wrist) and is inflated, restricting the blood flow. The cuff will then slowly deflate, releasing pressure and allowing for a reading to be taken. This reading is based on how the pulse beats as the pressure from the cuff is relieved. To gain an accurate reading from a blood pressure test you should ensure that your bladder has been emptied and your body has been at rest for at least five minutes. As the test is being performed it is important to be sitting down with your legs uncrossed and your back supported. Also, it is important not to talk as the reading is being taken.

If during your first test the results come back as high it does not automatically mean that you suffer from hypertension. A person’s blood pressure will fluctuate throughout the day. Feeling stressed or nervous about visiting your GP can lead to raised blood pressure. This is known as ‘white coat syndrome’. If under these conditions a high reading has been taken then it is likely a home testing kit will be provided, allowing a second test to be performed in a more relaxed environment. Alternatively, a 24-hour heart rate monitor can be provided, allowing your blood pressure to be monitored throughout the day. These methods will help determine whether your blood pressure is consistently high and not merely the result of anxiety.

Other methods that can be used to help diagnose hypertension include blood and urine tests. These tests are designed to check for underlying conditions that are known to affect circulation and increase blood pressure, such as kidney disease.

High blood pressure can be reduced, or even prevented, by eating a healthy diet and maintaining a healthy weight. It is also important to take regular exercise and to only drink in moderation. Smoking is also a contributing factor in developing hypertension so cessation is recommended.

• Diet: Ensure you are eating plenty of fresh fruit and vegetables as well as cutting down on the amount of salt in your diet. Eating a low-fat diet that incorporates plenty of fibre, fruit and vegetables is proven to help lower blood pressure. Salt on the other hand is known to raise blood pressure. Ideally a person should aim to eat less than 6g of salt per day.
• Alcohol: Should only be consumed in moderation. Regularly drinking alcohol above the recommended levels (14 units for both men and women) will raise your blood pressure. Alcohol is also high in calories. Exceeding recommended levels will likely lead to weight gain, which will increase the risk of developing hypertension.
• Weight: The more overweight you are, the harder your heart will have to work. By maintaining a healthy weight you will help to reduce the risk of developing hypertension.
• Exercise: By exercising regularly you can help lower you blood pressure. Adults are recommended to do at least 150 minutes of moderate aerobic activity every week. Moderate-intensity aerobic activity should make you feel slightly out of breath, a brisk walk or cycling for example.
• Smoking: There is no direct link between smoking and hypertension. However, smoking increases the risk of heart disease and stroke, which will cause the arteries to narrow. If you have hypertension and continue to smoke then the rate of the arterial narrowing increases dramatically. This will substantially raise the chances of developing heart and lung disease in future.
• Caffeine: Drinking too much caffeine can increase your blood pressure. Tea and coffee are safe to drink in moderation and as part of a balanced diet.

The first line of treatment in all cases of high blood pressure will always be to make simple lifestyle changes. Whether these changes are supplemented with blood pressure medication will depend on how high your blood pressure is:

• Consistent readings above 140/90mmHg with a low risk of cardiovascular (heart) disease: This would be managed with simple lifestyle changes. Your blood pressure will likely be reviewed by a healthcare professional on an annual basis.
• Consistent readings above 140/90mmHg (but below 160/100mmHg) with an existing risk of cardiovascular disease: Medication should be initiated to help lower your blood pressure alongside lifestyle changes.
• Consistent readings above 160/100mmHg: One or more drugs will be strongly advised to help lower your blood pressure.

There is a wide range of medication that is proven successful in treating hypertension. The choice of medicine, or combination of medicines, will be determined by your prescriber. Your GP’s first line of treatment is usually influenced by your age and ethnicity. If a sufferer is under 55 years of age then an ACE inhibitor or an Angiotensin Receptor Blocker (ARB) will generally be offered. If a patient is over 55 years old, a Calcium Channel Blocker will be the usual choice. If you are of African or Caribbean descent then regardless of age a Calcium Channel Blocker is the preferred option.

Hypertension medication can sometimes be a lifelong commitment. However, if a person’s blood pressure stays under control for several years then your doctor may suggest reducing or even stopping your treatment. As with all medication, it is important to follow the directions as stated. By consistently missing doses you could lower the effectiveness of the medication, lowering your protection against future illness.

The mechanism of action for the different types of blood pressure medication varies:

• ACE Inhibitors (e.g. Ramipril & Perindopril) work by relaxing the blood vessels, causing them to widen and therefore reduce blood pressure.
• Calcium Channel Blockers (e.g. Amlodipine & Felodipine) prevent calcium from entering the muscle cells of the blood vessels and heart. This has the effect of widening the arteries, allowing for an increase of blood flow and a reduction of pressure.
• Beta-Blockers (e.g. Atenolol & Bisoprolol) work by reducing the speed and force in which the heart beats, thus reducing blood pressure. Beta-Blockers are generally considered less effective than ACE Inhibitors and Calcium Channel Blockers, which is why they tend to be used in conjunction with other medicines instead of the sole line of treatment.
• Diuretics (e.g. Bendroflumethiazide & Furosemide) are also a popular treatment for hypertension. They are sometimes referred to as ‘water pills’. They work by flushing any excess water and salt from the body through the urine. This reduction in fluid, in turn, reduces the blood pressure.

There are some Non-Prescription alternatives to help treat High Blood Pressure including;

• Eat more fruit, vegetables, and low fat foods
• Limit salt, sugary drinks and red meats
• Cut back on saturated and trans fats alongside cholesterol.
• Try to limit stress
• Consider alternative therapies such as Acupuncture and meditation.