I’m Richard Lehman, a GP, who has been treating blood pressure as part of normal general practice for the last 30 years. High blood pressure is different from most of the other things that doctor’s treat in that it’s not an illness as such. It’s something that we detect that doesn’t usually cause any symptoms but that requires lifelong control if we are to avoid the long-term consequences of having high blood pressure over many years.

 

I think this is an important point to get over because the other word for high blood pressure is hypertension and a lot of people feel that once they’ve been labelled with hypertension they have been labelled as somebody who is abnormally tense or who’s got something wrong with them. High blood pressure is not an illness. It is one of the things that can cause problems like heart attacks and strokes and kidney trouble and so we treat it as a matter of control over years, over decades, over the rest of a person’s life.

 

In all of us blood pressure varies from moment to moment from day to day and tends to rise as we get older. So that over the age of 65, for instance, a large proportion of the population need treatment for blood pressure. They don’t need it because it’s an abnormal state but because we want to keep them alive and well as long as possible.

 

So the definition of high blood pressure is an individual matter. There are overall guides to when to treat and when simply to monitor and when to simply advise lifestyle changes. But beyond a certain level treatment has to be with one or more of a range of different drugs that lower blood pressure and they have to be taken on a daily basis indefinitely. In some cases where there are other illnesses such as diabetes or a history of having had a stroke or a mini stroke we like to control blood pressure even more tightly than we do in people who haven’t had those conditions. So that again is an individual matter of tailoring treatment to the particular person.

 

Everybody should have their blood pressure checked regularly. In a person who is otherwise well that can be as seldom as every five years. In somebody who has got other conditions or in whom it’s borderline or who have many other risk factors in their lives then it’s probably better checked every year or more. And once you’re on treatment we tend to check blood pressure every six months or so once it’s stable. Of course it may need checking a lot more than that when we start treatment.

People are often alarmed when they are told that they have high blood pressure and wonder why on earth that’s the case. And it’s still a very common thing for people to go for an ordinary check, a routine check with the practice nurse or pre-operatively when they’re feeling a bit tense and they come back to see a doctor within a day or two highly alarmed that they’ve got this condition called hypertension and they wonder why it hasn’t been spotted before and why they in particular have been singled out to have it.

 

Now as I’ve explained already a large proportion of the general public are on treatment for blood pressure because we check it regularly in most people these days. And quite a proportion of people have it without knowing it because it doesn’t cause symptoms. However once we’ve detected it we have to keep an eye on it to see what the natural variation of it is. And that’s why we do repeat testing at a doctor’s surgery or often in people’s homes these days to get an idea of what the overall level is. But once we’ve done that and established that it is high and that it needs treatment we don’t really go looking very far for causes because it’s usually something that’s simply innate in people. Therefore if you’ve got a family member who’s got high blood pressure you’re just that little bit more likely to develop it later in life.

 

There are a few causes which we can identify and that’s why we usually run off a few basic tests in people whose blood pressure has been found to be high. One of those is a hormone produced near the kidneys and so we check kidney function with one or two chemical tests. We also make sure that we’re not causing high blood pressure in any sense by, for instance, using the oral contraceptive pill or one of the few medications, other medications that can cause raised blood pressure. But having done these basic screens we then tend to label blood pressure as what they used to call essential. Now that’s a silly word really because it’s not essential in any normal sense but it simply means that it’s it the essence of people and that we don’t know the cause.

 

Having said that once we’ve established blood pressure as being slightly too high we can look at factors in the lifestyle which can help to reduce it. What everybody tends to think of with this label of hypertension is that you’re a hypertense person and therefore you’ve got to relax more. Well that’s a nice thought and if you can do it good luck. But it’s not likely to have a huge effect on your blood pressure. Probably more important are factors such as exercise and salt intake and in people who drink heavily that can also be a factor. So those are things that people can address right from the start of the diagnosis. Being overweight also tends to be associated with a higher blood pressure and so once you’ve had this warning shot as it were of your blood pressure being discovered to be high it’s a kind of prompt to you to look at all of your lifestyle and make these changes because they’re all going to be good for you whether they reduce your blood pressure or not.

So let’s look now at some of the treatments that doctors recommend to patients for high blood pressure because these are important. These are treatments that you have to be comfortable with taking for the rest of your life and that’s a very vital point here because if they’re causing you side effects then we have to address those and keep changing the medication until: a) it works at reducing your blood pressure and b) you are perfectly happy to take it as part of your daily routine indefinitely.

 

There are many classes of drugs which lower blood pressure and fortunately we can usually find among them treatments which are successful and side effect free for most people. I won’t go through them in detail but I think by the same token as it’s important that they work it’s also important for you if you are taking blood pressure medication to be aware that these effects can exist and to mention them to your doctor. For instance, one of the drug classes that’s widely used for blood pressure and actually has an excellent reputation for reducing the risk of stroke in particular is a weak water tablet usually the one called bendroflumathiazide. Now that can cause sexual difficulties in men and most men don’t like coming to doctors anyway, coming along every six months to have their blood pressure taken, they may well not want to mention to the doctor that they are having difficulties in sustaining an erection, for instance. But if you are experiencing those difficulties there’s absolutely no reason for you to suffer in silence. Your doctor may forget to ask you but do volunteer these effects which can include headache, for instance. You may put down your headache to high blood pressure but headache actually doesn’t usually co-exist with high blood pressure. It’s much more commonly an effect of some of the drug classes used to treat high blood pressure. Similarly tiredness, well we all feel tired some of the time but if you feel tired most of the time then it could possibly be an effect of one of the blood pressure medications that you’re taking. So by all means raise these not necessarily waiting for your next blood pressure appointment but if you have any suspicion that that may be the case.

 

Most blood pressure tablets have the effect initially of making you feel slightly giddy on getting up quickly, for instance. That may wear off but if things like that persist then please do let your doctor know.

Living with high blood pressure is like living, full stop. The fact that you’ve had high blood pressure diagnosed doesn’t have to change your life radically if you’ve already got a healthy lifestyle and that’s entirely possible. High blood pressure is not your fault. It’s something that happens within you. You can do things which will help to lower it a little bit particularly avoiding salt, particularly controlling weight and to some extent keeping to a healthy diet which is something I’ll come on to in a moment. But by and large your high blood pressure is only one of several risk factors. And it’s also worth you looking at the other ones that there may be in your life.

 

The biggest one of all is smoking and anyone who has high blood pressure, anyone full stop, should stop smoking because it’s such a high risk factor for heart disease as well as lung cancer, lung damage and stroke and all the other things.

 

Now if you happen to be over weight as well it will help your blood pressure if you reduce your weight but it will also help you generally to stay healthy if you can get your body mass index down to the usual target level of 30 or under, ideally around 25. And diet will play a part in that as well. And again you’ve got to be living with the lifestyle that you can maintain and that gives you good enjoyment in your life. And fortunately the diets which help to keep blood pressure under control are not difficult ones to follow. The classic one is called DASH from a low salt study but it also included a low fat component. Now you may want to look that up and follow it but equally if you simply want to follow a Mediterranean style diet, the kind of food that you may have on holiday then that’s absolutely fine provided that you try to avoid excessive salt. The problem of fat in the diet is often brought up but there’s no specific link between fat in the diet and high blood pressure and in fact if you want to follow a low glycaemic diet like the Atkin’s Diet that will also help to lower your blood pressure and control your weight. So you’ve got a large range of options there.

 

Cholesterol is a factor that like blood pressure you won’t be aware of and that’s largely not under your control but genetically determined. So don’t feel that simply because you’re keeping to a good diet you don’t need to have your cholesterol checked. You do if you’re having treatment for blood pressure. You do anyway if you’ve reached the middle of life, say around 50 because that’s one of the risk factors that you can know about and then take control over usually again by the use of tablets. So what I’m emphasising here is that high blood pressure is not a disease. It’s not a condition that’s going to shorten your life if you take the right precautions, if you keep taking your tablets and if you address the things that you yourself can address within your lifestyle.