High blood pressure

High blood pressure or hypertension is one of the most common and important cardiovascular risk factors. It is sometimes labelled a “silent killer” because hypertension normally does not cause any alarming symptoms, but over time can lead to significant damage. In England, 30% of people suffer from high blood pressure, and many are unaware of any problem. Patients with hypertension are at high risk of heart attack or stroke if left untreated. Therefore, everybody should get their blood pressure checked at least every five years or during any GP consultation.

Some people have high blood pressure readings only in hospital or GP surgery due to stress and anxiety. Their blood pressure taken at home is perfectly within limits; this is called 'white-coat hypertension (even if not many doctors wear white coats nowadays!) Therefore, the gold standard diagnostic test is 24-hour blood pressure monitoring or home blood pressure monitoring, which eliminates the stress due to the medical environment.

Basics of hypertension

If blood pressure is high, the heart has to pump harder to overcome the resistance, leading to thickening of the heart muscle (LVH, left ventricular hypertrophy) that can be diagnosed with an ECG echocardiogram. Arteries in the body often develop atherosclerosis, contributing to the elevated risk of heart attack, stroke, kidney disease, and many other conditions.

Blood pressure measurements are given as two figures: systolic blood pressure and diastolic blood pressure. Systolic blood pressure indicates the pressure when the heart contracts to pump the blood into the arteries, and diastolic blood pressure indicates the pressure when the heart relaxes. Blood pressure is measured in millimetres of mercury (mmHg). When you hear from your doctor that your blood pressure is, e.g. 130/80 mmHg, your systolic blood pressure is 130 mmHg, and the diastolic blood pressure is 80 mmHg. High blood pressure refers to the reading 140/90 mmHg or above.

Who is at risk?

The risk of high blood pressure increases with the advancing age, obesity, smoking, stress, African or Caribbean descent, family history of hypertension, a diet high in salt and poor in fruits and vegetables, alcohol excess, lack of physical activity and diabetes mellitus. If you have one or more of the above conditions, try to modify your lifestyle to prevent the development of high blood pressure. It would be best to get your blood pressure checked more often than the standard 5-year interval.

Prevention and treatment

There are many things you can do to prevent the onset of high blood pressure:

  • Lose some weight if you are obese
  • Exercise regularly
  • Stop smoking
  • Reduce alcohol intake if you drink above the recommended limits (14 units a week)
  • Eat a healthy diet including fruits and vegetables
  • Cut down on salt in your diet
  • Control your sugar level at an optimum level if you are diabetic

If you have been diagnosed with hypertension, your GP or consultant will advise you to modify your lifestyle and to take medicines if appropriate. The most common classes of antihypertensives are ACE inhibitors (lisinopril, perindopril, ramipril), calcium channel blockers (amlodipine, felodipine, diltiazem) and diuretics (indapamide, bendroflumethiazide).

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