High pressure tactics

    20 October 2016

    If I were to ask you to name a health problem that affects around seven million people in the UK right now which almost all of them are unaware of, what would you say? Diabetes? Cancer? In fact, the answer is high blood pressure, or hypertension. Like every GP, I measure blood pressure a dozen times or more every working day. The reason this is so important is that, if left untreated, high blood pressure is a massive risk factor for heart disease, stroke and-kidney problems.

    Our heart is a small but powerful pump that moves about five litres of blood around our body every minute of the day and night. There has to be a certain degree of pressure in our circulation to keep it flowing, and this is expressed by two figures: one is the pressure-exerted when our heart contracts or squeezes (systolic), the other is the pressure when the heart relaxes (diastolic). The-figures used are in millimetres of mercury, and a typical reading might be 140/80, where 140 is the systolic pressure and 80 the diastolic. Blood pressure varies naturally through the day, increasing with exercise and stress and falling at rest or when asleep.

    High blood pressure is more common as we get older. This is usually because our arteries become less elastic with age and if that’s the case it is known as ‘essential’ or ‘primary’ hypertension. In about 10 per cent of cases there is an underlying medical cause for raised blood pressure, and this is called ‘secondary’ hypertension. Typical causes include chronic kidney diseases, problems with the blood supply to the kidneys,-chronic alcohol abuse and some hormonal disturbances that affect the kidneys. The main factors I see in my own surgery include a family history of high blood pressure, obesity, smoking, too much salt in the diet, lack of exercise, diabetes and kidney diseases.

    A major problem with hypertension is that it causes very few symptoms in most people. Even apparently very fit people can have it without knowing, but in severe cases there may be nosebleeds, headaches, confusion and sleeping or breathing difficulties.

    If treated successfully, a patient with hypertension has a reasonable expectation of a normal life span. But if it is left-untreated then the chances of a heart attack or stroke are greatly increased. Other effects can include heart failure as the heart-gradually loses its ability to pump blood, kidney failure, eye damage and the weakening and expansion of the aorta in the chest or abdomen. This can cause sudden rupture with possible fatal consequences.

    Luckily, there are many ways you can help yourself if you are diagnosed with hypertension. In at least a quarter of cases simple lifestyle changes are enough to bring your blood pressure down to normal. You should:

    Stop smoking

    It’s the most effective single thing you can do to cut your blood pressure and improve your health in general. Smoking doubles your risk of heart disease and trebles your chance of dying before retirement age. If you find it too difficult to stop, ask your doctor about treatments.

    Reduce your weight

    Every kilogram of weight lost will help to reduce your blood pressure, and the simple advice is to avoid foods rich in saturated fats and eat more white meat, oily fish, fresh fruit and vegetables, as well as increasing your fibre intake.

    Drink less alcohol

    Too much will push up your blood pressure, so aim to stay below the recommended limits of three units a day for men and two for women (one unit is equivalent to half a pint of beer, a small glass of wine or a single measure of spirits).

    Do more exercise

    This need not be strenuous or involve joining a gym. Just walking briskly for 20 to 30 minutes three to four times a week will help.

    Eat less salt

    Don’t add it to your food and avoid eating salty processed foods.

    Even if these measures do not bring your blood pressure down to normal, they can reduce the number of tablets you need to take. Modern drugs to treat hypertension are highly effective and can be used in low doses with few, if any, side effects. Treatment is tailored to each person’s condition, and the most commonest types are-diuretics (water tablets), beta-blockers, ACE inhibitors and calcium antagonists. If you are pregnant, or trying for a baby, your GP needs to know because some drugs are less suitable in such cases and the doctor will want to keep a closer eye on you.

    Undiagnosed high blood pressure really is a silent killer. So if you don’t know what your reading is, get it checked. It takes only 30 seconds and might just save your life.