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High Blood Pressure

High Blood Pressure

Issue 9 Jan / Feb 2005

What is high blood pressure?

High blood pressure (hypertension) means that the pressure of the blood in your arteries is too high. Blood pressure is measured in millimetres of mercury (mmHg) and is recorded as two figures. For example, 140/85 mmHg. This is said as ‘140 over 85’.

What do the numbers mean? The top (first) number is the systolic pressure. This is the pressure in the arteries when the heart contracts. The bottom (second) number is the diastolic pressure. This is the pressure in the arteries when the heart rests between each heartbeat. The machine that measures blood pressure is called a sphygmomanometer. The cuff is placed around your arm and pumped up. The pressure in the cuff around your arm is then gradually reduced. A doctor or nurse listens with a stethoscope over an artery in the arm as the pressure in the cuff is lowered. They can hear typical noises when the pressure in the cuff equals your systolic and diastolic pressures. Modern electronic devices can also measure blood pressure.

 

What are normal and high blood pressure values?

Normal blood pressure is less than 140/90 mmHg. (However, if you have diabetes you should aim to have a level less than 140/80 mmHg.) Mildly high blood pressure is 140/90 mmHg or above, but below 160/100 mmHg. Treatment with tablets may be advised if it remains at this level, depending on whether you have other ‘risk factors’ (see below). Definitely high blood pressure is 160/100 mmHg or above. Treatment with tablets is usually advised if your blood pressure remains at this level. A one-off blood pressure reading which 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. You are said to have ‘high blood pressure’ (hypertension) if you have several blood pressure readings which are high, and which are taken on different occasions, and when you are relaxed.

 

Observation period

If one reading is found to be high, it is usual for your doctor or nurse to advise a time of observation. This means several blood  pressure checks at intervals over time. The length of the observation period varies depending on the initial reading, and if you have other health risk factors. For example, say a first reading was mildly high at 150/94. If you are otherwise well, then a period of several months ‘observation’ may be advised. A blood pressure reading may be taken every few weeks or so. The observation period is also a good time to address any lifestyle factors. If the blood pressure readings remain high after an ‘observation period’ then treatment with medication may be advised. However, if you have diabetes, or have recently had a heart attack, you may be advised to have blood pressure checks fairly often over the next week or so. Also, treatment with medication may be considered at an earlier stage if the readings remain high.

 

How common is high blood pressure?

In the UK, about half of people over 65, and about 1 in 4 middle aged adults, have high blood pressure. It is less common in younger adults. It is more common in people from African-Caribbean origin, and from the Indian subcontinent. Most cases are mildly high (between 140/90 and 160/100 mmHg). But, at least 1 in 20 adults have blood pressure of 160/100 mmHg or above.

 

Why is high blood pressure a problem?

High blood pressure usually causes no symptoms. This is why all adults should have their blood pressure checked every 3-5 years. However, over the years, high blood pressure may do some damage to the arteries and put a strain on your heart. In general, the higher your blood pressure above normal, the greater your health risk. High blood pressure is a ‘risk factor’ for developing heart disease (angina, heart attacks, heart failure), stroke, peripheral vascular disease, and kidney damage sometime in the future. Other risk factors which also increase the risk of developing these conditions are: a)smoking, b)lack of exercise, c an unhealthy diet, d)obesity, e)high cholesterol level, f)a strong family history of heart disease or stroke, g)being male, h) ethnic group (For example, South Asians in the UK have an increased risk.) i) diabetes. Some risk factors are more ‘risky’ than others. For example, smoking or high blood pressure pose a greater risk to health than an unhealthy diet. Also, risk factors interact. If you have two or more risk factors, your health risk is much more increased than if you just had one. For example, a male smoker who takes no exercise and has high blood pressure has quite a high risk of developing heart disease before the age of 60. The benefit of lowering a high blood pressure is a reduced risk of serious illness. For example, it is estimated that reducing a high diastolic blood pressure by 6 mmHg reduces your risk of stroke by nearly 40%, and reduces your risk of heart disease by about 15%. Larger reductions in blood pressure provide greater benefits.

 

What is the treatment for high blood pressure?
The usual ‘target’ is to reduce blood pressure to below 140/85 mmHg. The target level is lower if you have diabetes.

There are several medicines that can lower blood pressure. The one chosen depends on such things as: if you have other medical problems; if you take other medication; side-effects; etc. Some medicines work well in some people, and not so well in others. One or two may be tried before one is found to suit.

In most cases, treatment is for life. However, in some people whose blood pressure has been well controlled for 3 years or more, treatment may be able to be stopped. Your doctor can advise. If you stop treatment, you need regular blood pressure checks. In some cases the blood pressure remains normal, but in others it starts to rise again. Treatment can then be started again.

 

What can I do to lower blood pressure?

 

LOSE WEIGHT if you are overweight, Losing some weight can make a big difference. On average, blood pressure falls by about 2.5/1.5 mmHg for each excess kilogram which is lost. Losing weight has other health benefits apart from lowering blood pressure.

 

EXERCISE REGULARLY

You should aim to do some exercise on 5 or more days of the week, for at least 30 minutes. For example, brisk walking, swimming, cycling, dancing, gardening, etc. Regular exercise can lower blood pressure in addition to giving other health benefits.

 

EAT A HEALTHY DIET, which means AT LEAST five portions of a variety of fruit and vegetables per day.


THE BULK OF MOST MEALS should be starch-based foods (such as cereals, wholegrain bread, potatoes, rice, pasta), plus fruit and vegetables. NOT MUCH fatty food such as fatty meats, cheeses, full-cream milk, fried food, butter, etc. Use low fat, mono-, or poly-unsaturated spreads.

 

INCLUDE 2-3 portions of fish per week. At least one of which should be ‘oily’ (such as herring, mackerel, sardines, kippers, pilchards, salmon or fresh tuna). If you eat meat it is best to eat lean meat, or poultry such as chicken. If you do fry, choose a vegetable oil such as sunflower, rapeseed or olive oil. Try not to add salt to food, and limit foods which are salty. Use herbs and spices to flavour food rather than salt. Choose foods labelled ‘no added salt’ and try not to add salt to food at the table. Use fresh fish and meat rather than canned or processed.

A healthy diet provides health benefits in different ways. For example, it can lower cholesterol, help control your weight, and has plenty of vitamins, fibre, and other nutrients which help to prevent certain diseases. Some aspects of a healthy diet also directly affect blood pressure. For example: Increasing the number of portions of fruit and vegetables from 2 to 7 per day will, on average, reduce blood pressure by 7/3 mmHg. If this is combined with a low-fat diet, the effect on lowering blood pressure is greater If you also keep to a low-salt diet, then the blood pressure may become even lower. A diet which is low-fat, low-salt, and high in fruit and vegetables can lower systolic blood pressure by up to 11 mmHg.

 

SMOKING AND CHOLESTEROL

Smoking and a high cholesterol level do not directly affect the level of your blood pressure. But, they greatly add to your health risk if you already have high blood pressure. If you smoke, you should make every effort to stop. If your cholesterol level is high, then it can be treated.




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