This high blood pressure (also known as Hypertension) information page is based on the Hypertension page from the brilliant patient information website www.patient.info.
We strongly encourage all patients with high blood pressure to purchase their own blood pressure machine to allow them to monitor their blood pressure at home. A reliable brand is “OMRON” and their machines can be purchased online, from pharmacies and from supermarkets. You can find their basic models for as little as £25-30. Please ensure you purchase an “upper arm” machine and not a wrist machine as the wrist machines are less accurate.
What is blood pressure?
Your blood pressure reading will have two figures, one ‘over’ the other – for example, 140/80. The higher figure (called the systolic level) is a measure of the pressure inside your arteries when your heart is pumping blood out. The lower figure (called the diastolic level) is a measure of the pressure inside your arteries when your heart is resting between heartbeats. Blood pressure is measured in millimetres of mercury (mm Hg).
A one-off blood pressure reading that is high does not mean that you have high blood pressure. Your blood pressure varies throughout the day. It may be high for a short time if you are anxious, stressed, or have just been exercising.
What are the symptoms of high blood pressure?
The vast majority of people with high blood pressure do not know they have it, until it causes a complication such as a stroke or heart attack. Usually high blood pressure is only picked up if blood pressure is checked routinely, or as part of checks for another medical problem.
Occasionally if blood pressure is very high, you can get headaches. Even more occasionally, some people feel a bit dizzy, or their vision can be affected by high blood pressure.
Other than the blood pressure reading being high, there isn’t usually anything for the doctor to find on examination either. If blood pressure has been high for some time, or very high, there can be changes in the blood vessels at the back of the eye.
How is high blood pressure diagnosed?
You have high blood pressure if you have several blood pressure readings that are high, taken on different occasions, and when you are relaxed.
High blood pressure (hypertension) is a blood pressure that is 140/90 mm Hg or above each time it is taken at the GP surgery, or home or ambulatory readings where the average is more than 135/85 mm Hg. That is, it is sustained at this level.
Unless a single level is extremely high, your doctor will not make a diagnosis of high blood pressure without an average of several readings, usually from home or ambulatory measurements. Blood pressure recording outside of the doctor’s surgery is recommended in most people who are suspected of having high blood pressure.
One reason for this is because some people become anxious in medical clinics. This can cause the blood pressure to rise. (This is often called white coat hypertension.) Home or ambulatory monitoring of blood pressure may show that the blood pressure is normal when you are relaxed.
However, if you have diabetes, or have recently had a heart attack or stroke, you may be advised to have blood pressure checks fairly often over the following week or so. Also, treatment with medication is usually considered at an earlier stage if the high blood pressure readings remain high.
Why is high blood pressure a problem?
High blood pressure (hypertension) is a risk factor for developing serious health problems sometime in the future. If you have high blood pressure, over the years it may do some damage to your blood vessels (arteries) and put a strain on your heart. In general, the higher your blood pressure, the greater the health risk.
Cardiovascular disease is the biggest risk from having high blood pressure. Cardiovascular diseases are diseases of the heart (cardiac muscle) or blood vessels (vasculature). This usually means diseases of the heart or blood vessels that are caused by atheroma. Patches of atheroma are like small fatty lumps that develop within the inside lining of blood vessels (arteries). Atheroma is also known as atherosclerosis and hardening of the arteries.
Cardiovascular diseases that can be caused by atheroma include:
- Angina.
- Heart attack.
- Stroke.
- Transient ischaemic attack (TIA).
- Peripheral arterial disease.
What causes high blood pressure?
It isn’t always clear what might be causing high blood pressure. However, high blood pressure is more common in people:
- With diabetes. This is the case for type 1 diabetes but it is even more common in those with type 2 diabetes.
- Of African-Caribbean origin.
- From the Indian subcontinent.
- With a family history of high blood pressure.
- With certain lifestyle factors. That is, those who:
- Are overweight.
- Eat a lot of salt.
- Aren’t physically active.
- Drink a lot of alcohol.
- Have a lot of stress.
What tests are done for high blood pressure?
If you are diagnosed as having high blood pressure (hypertension) then you are likely to be examined by your doctor and have some routine tests which include:
- A urine test to check if you have protein or blood in your urine.
- A blood test to check that your kidneys are working normally and to check your cholesterol level and sugar (glucose) level.
- A heart tracing, called an electrocardiogram (ECG).
If you haven’t been asked to arrange the blood test or ECG then please inform our reception team. The urine sample test form is attached to this letter, please collect a sample pot from our reception staff.
The purpose of the examination and tests is to:
- Rule out (or diagnose) a secondary cause of high blood pressure, such as kidney disease.
- Check to see if the high blood pressure has affected the heart.
- Check for other risk factors such as a high cholesterol level or diabetes.
How to reduce high blood pressure
Sometimes there is quite a bit you can do with lifestyle changes, and in some people this may help them to avoid medication. In particular, the following help:
- Losing weight if you are overweight.
- Maintaining alcohol intake to within recommended limits.
- Reducing the salt you have in your food.
- Taking regular exercise.
- Stopping smoking doesn’t reduce your blood pressure as such, but smoking and high blood pressure put you at risk of the same conditions. So if you can quit smoking, you’ll reduce your risk of strokes, heart attacks, etc.
Treatments for high blood pressure
It is recommended by the National Institute for Health and Care Excellence (NICE) that medication to help control high blood pressure should be used in addition to lifestyle advice for persistent stage 2 hypertension (clinic blood pressure measured as 160/100 mm Hg or higher but less than 180/120 mm Hg and home or ambulatory blood pressure average of 150/95 mm Hg or higher).
You might also be advised to still start taking medication if you are aged under 80 with persistent stage 1 hypertension (clinic blood pressure 140/90 – 159/99 mm Hg and/or home/ambulatory blood pressure average of 135/85 – 149/94 mm Hg) for any of the following reasons:
- It is found that the high blood pressure has caused any damage, such as to your eyes, heart or kidneys.
- If you have known cardiovascular disease, kidney disease, diabetes.
- If you have a 10 year risk of a heart attack or stroke of above 10% (your clinician will calculate this)
“Severe” high blood pressure is a blood pressure that is higher than 180/120. If you get a reading higher than this at home, sit down and repeat the reading after a few minutes. If it is still greater than 180/120 then you need to seek same day medical advice, particularly so if you have having symptoms of headaches, nausea, changes in vision or chest pains.
Please contact the GP/111/visit the Walk in Centre/attend A&E if you get persistent readings greater than 180/120 particularly if you have symptoms with it.
There are many different medicines for high blood pressure. They work in various different ways. Your doctor will advise on the best one for you. If it doesn’t work, or you have side-effects, there are plenty of other options. Your blood pressure will be checked regularly and medication adjusted if need be.
Take home messages/summary if you have been diagnosed with high blood pressure:
- High blood pressure is also known as“Hypertension”.
- Please try to increase your exercise and lose weight as this can help improve your blood pressure and may mean you can reduce or stop medication in future. It will also help reduce the risk of other conditions such as Diabetes.
- Please reduce salt in your diet and stick to a low salt diet. By sticking to a low salt diet you can reduce you can reduce your systolic (top number) reading by as much as 8 mmHg.
- If you have been prescribed medication, please make sure you continue taking it long term unless you are told otherwise by the clinician.
- You will require an annual blood test to monitor your kidney function, blood sugar and cholesterol readings. If you have high blood pressure and have not received a form from us each year then please let us know.
- Please purchase a blood pressure machine. This will be an investment in your future health and it really helps us to help you monitor and manage your blood pressure in the long term.
- If you are under 80 years old, your target blood pressure is 135/85 or less on home readings.