Looking after your Hypertension
Blood pressure is measured by electronic machine (but we use the old mm of mercury units of pressure).
The top number (systolic) is the maximum pressure produced by the heart contracting and the lower number is the ‘pressure in the system’ when the heart relaxes. Both numbers are important.
Normal blood pressure (BP) is below 140/90 (we allow it to be a bit higher if you are over 80 – 150/90). An ideal BP is 120/80 or less (but if too low – under 90/60 can make you feel a bit faint or giddy).
Persistent blood pressure over 140/90 is ‘hypertension’.
You cannot tell if you have high blood pressure and so it is important to get it checked (at the medical centre, pharmacy or with your own machine) -everyone age 40 -74y is eligible for a free NHS Health Check where your overall Cardiac Risk score can be calculated.
It is recommended all people over the age of 40y should have a BP check every 5 years. Both men and women can suffer from hypertension.
Why worry about high blood pressure?
Over time it will cause damage to the walls of the arteries. They will become less elastic and will be damaged, leading to fatty deposits which causes narrowing and other changes in the vessel walls. This leads to decreased oxygen being transported to the tissues supplied by the arteries and in turn those become damaged.
So we see problems in the kidneys, brain, heart, eyes and most other areas of the body. Heart attacks, strokes and kidney failure are among the most common effects. Other conditions related include angina, aortic aneurysm, heart failure, peripheral arterial disease and vascular dementia.
With good blood pressure control we can reduce the incidence of these conditions and that’s why it’s important to know what your BP is and to treat it if high.
How do we measure blood pressure?
We use validated BP monitors and you can buy similar ones at reasonable cost – check this list. Upper arm cuffs are usually the most reliable. Check it twice a day whilst sitting down and take two readings one minute apart. Write them down and come and see us if your readings are over 130/80.
Readings at home are usually lower than ours in the medical centre. If there is a significant difference you might have ‘White Coat Hypertension’ (even though we don’t wear white coats). In that case we might use one of our Ambulatory BP monitors which you carry around with you and wear at night to produce a 24hr reading.
Preventing high blood pressure
All the usual healthy living recommendations help prevent high blood pressure:
- Cut down on salt – there is salt already in a lot of the food we eat (especially if processed) and the total daily amount should be less than 6g – a teaspoon. So no added salt to cooking or at the table – it’s surprising how quickly your taste adapts. More salt reduction advice here.
- Eat a low fat, high fibre diet; plenty of fruit and vegetables
- Lose weight – even a few pounds makes a difference to your BP. Check your Body Mass Index (BMI) here.
- Limit your alcohol – to a maximum of 14 units a weeks (men and women). Alcohol makes you put on weight – see how many calories are in your drinks.
- Get active Being active and taking regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. Regular exercise can also help you lose weight, which will also help lower your blood pressure. Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking, every week. Physical activity can include anything from sport to walking and gardening. See below for more details.
- Cut down on caffeine. If you drink a lot of coffee, tea or other caffeine-rich drinks, such as cola and some energy drinks, consider cutting down. Drinking more than 4 cups of coffee a day may increase your blood pressure.
- Stop smoking – of course! It may not cause blood pressure but the combination of blood pressure and smoking is bad news for your heart and cardiovascular system.
- Reduce stress – mediation and yoga are helpful and organising your life to be more balanced if you can.
Treating high blood pressure
Lifestyle changes such as those above may be enough to control very mild hypertension but most people will need medication eventually.
The reason to treat hypertension is to reduce the risk of this complications listed above. To help check your treatment options see this decision aid from NICE (National Centre for Clinical Excellence).
We shall also need to consider other risk factors such as high cholesterol or diabetes, family history and other factors and we’ll conduct a cardiac risk score called QRisk3 – you can complete it for yourself if you know all the details.
Commonly used medication includes:
- ACE Inhibitors (used first for under 55y) such as ramipril, perindopril or enalapril
- Angiotensin-2 receptor blocker – ARB (similar to ACE Inhibitors, useful if side effects from those) such as losartan or irbesartan
- Calcium Channel Blockers (used first for over 55y and African-Caribbean origin) such as amlodipine or felodipine
- Beta Blockers such as bisoprolol or atenolol.
- Diuretics (‘water tablets’) – sometimes added to this above, such as indapamide or bendroflumethazide.
You might also be offered a statin to reduce your cholesterol such as atorvastatin.
Excercise for Blood Pressure control
Excercise is very important to help control blood pressure and prevent it starting. You should be physically active each day – anything is better than nothing.
Aged 19 – 64 it is recommended do at least 150 min moderate exercise each week or 75 min vigorous activity exercise each week.
- Moderate means raising your heart rate and making you breathe faster and feel warm – eg brisk walking, dancing, riding a bike.
- Vigorous means breathing hard and fast and can include swimming fast, running or jogging, walking up the stairs, cycling fast or up hills etc.
- Very vigorous exercise HIIT – High Intensity Interval Training) is short bursts of intense activity such as circuits, running up stairs, interval running, lifting heavy weights. Read about the scientific evidence for this.
Muscle-strengthening exercises on at least 2 days a week
- Muscle-strengthening exercises include: carrying heavy shopping, yoga, Pilates, Tai Chi, lifting weights, working with resistance bands, heavy gardening, push-up and sit-downs.
You can start looking for something which might appeal here
If you need to begin improving fitness, this Strength and Flexibility programme can be an easy, equipment-free start.
No time for exercise – try these 10 minute workouts.
The BBC site also has an overview of all the types of exercise and sport
Older age group recommendations and suggestions:
There is a wide range of good articles on exercise for health on Patient.Info