Dr Rial & Partners
RED&GREEN PRACTICE
Waterside & Blackfield Health Centres
High Blood Pressure
“Blood pressure” is the measurement of the pressure of blood in your arteries. It is expressed as two numbers eg. 150/90.
The top number is the pressure when the heart is contracting (systolic) and the bottom number is the pressure when the heart is relaxing (diastolic).
High blood pressure is, in the vast majority of cases without any symptoms, but it is the major risk factor for having a stroke, as well as a major risk factor for heart disease (eg heart attack and angina).
High blood pressure is tricky to define, as what a doctor will consider as high blood pressure will vary from patient to patient depending on their individual circumstances (age, sex, weight, other medical problems, smoking status, cholesterol levels, family history etc) .
As a rule of thumb however a blood pressure of more than 160/100 is always considered high and less than 130/80 is always normal.
It is currently recommended that all adults have their blood pressure measured at least every five years, (unless you have had a previous reading over 130/80 in which case we recommend annual testing). In the surgery this can be done easily by using the automated machines – no appointment is needed and the receptionists will be glad to advise on how to use them. If this seems daunting then the nurses would be happy to oblige – or why not ask your doctor the next time you are in? Alternatively if you have an automatic home BP machine and you are worried about the readings you are getting – why not drop some readings into your doctor so they can review them (three readings a day, three days week (make them different days), for three weeks is ideal)?
If the first reading is high – don’t panic! It is very unusual for a doctor to recommend treatment based on one reading. It is much more likely that instead a period of ‘monitoring’ will follow. This will probably consist of a few readings over a 2 to 12 week period, as well as some blood tests to check cholesterol, blood sugar and kidneys, a urine check and possibly an ECG (tracing of your heart). It might also be recommended that you visit your optician if you have not been recently as the eye is literally a window onto your blood vessels – and it might be possible to see if there is any damage being done.
If you are diagnosed with high blood pressure it is most likely that there will be no identifiable cause for it. This is the case in 95% of people, and it is this type of high blood pressure that is referred to as “essential” hypertension.
In a small minority of cases the cause is due to problems such as kidney disease or sometimes hormone imbalances.
Assuming that there is no cause found then a range of treatments can and will be offered.
Lifestyle change is important to address where a problem is identified. Without this, even if medication is used – it is possible that the results will not be as good.
So what do you do?
Weight loss, if you are overweight (Body Mass index > 25kg/m2) can help, and you
might be able to reduce your blood pressure by 5%-
If you do some regular steady aerobic exercise for 5 days a week lasting 30 minutes you can get up to 5% off your blood pressure. You don’t need to go to the gym to do this either. Walking the dog counts!
Reduce salt intake as much as possible (and certainly no more than 5grms / day for an adult) by using herbs to flavour food, not adding salt while or after cooking and avoiding processed foods.
Eat 5 (and if possible 9) portions of fruit and veg’. Try to make this a variety of different colored items.
Avoid fatty foods like cheese, butter and fried foods. If you do have to use fats
– make them ‘low-
Eat fish. 2-
Eat plenty of fibre.
Limit the amount of alcohol you drink. Although small amounts of alcohol (about 1 unit a day – 1 unit being one pub measure of weak wine /spirit, or half a pint of weak beer) can be good for you, amounts in excess of 21 units for a man and 14 units for a woman will have a detrimental effect on many aspects of your health, including blood pressure.
So, you have done all that and your blood pressure is still high – what does the doctor do?
After discussion with you medication may be recommended. There are several groups of tablets that are currently used commonly.
These are the Angiotensin Converting Enzyme Inhibitors (‘ACEs’) eg Ramipril, Diuretics eg Bendroflumethiazide, Calcium Channel antagonists eg amlodipine, and Beta blockers eg Atenolol.
The exact one that you will be started on is likely to depend on your age, ethnicity and any other medical problems you might have.
You will of course be monitored (and should look out yourself) for side effects, and this might take the form of blood tests etc.
Your blood pressure will also be monitored to check the drug is working.
Unfortunately our bodies are very good at resisting a doctors initial effort to lower blood pressure and in as many of 75% (that is 3 out of every 4 cases) a second or third drug will need to be added.
Treatment more often than not is for life, and will require regular blood pressure readings (every 6 to 9 months once stable) and possibly blood tests.
To further reduce the risk of heart disease and stroke it is possible that additionally treatment for cholesterol as well as the addition of aspirin may be recommended – though we strongly advise against the daily use of aspirin for these purposes unless it is recommended by a doctor.
Although being diagnosed with high blood pressure is probably not what you would want, the worst kind of blood pressure to have is the kind you don’t know about and that isn’t treated, so go on – if you haven’t had your blood pressure done in a while – go get it checked!