High blood pressure (hypertension)

What is hypertension?

Blood pressure is the force of blood against the walls of arteries. When this pressure is too high, it makes the heart work harder, and over time this can cause serious damage to the arteries, with a knock-on effect on the rest of your body.

How to understand your blood pressure

It can be confusing to see your blood pressure written down if you don’t know how to ‘read’ the numbers. A blood pressure reading has two numbers, which are both recorded in millimetres of mercury (mmHg):

1. Systolic pressure – This is the higher number that tells you the pressure in your arteries when your heart’s beating

2. Diastolic pressure – This lower number shows the pressure in your arteries in between beats

Ideally, blood pressure should be in the range of 90/60mmHg to 120/80mmHg. If it’s 140/90mmHg or over then, it’s considered to be high.

Causes of hypertension

The causes of hypertension aren’t always clear, but known causes include:

• Underlying health conditions, like obstructive sleep apnoea, kidney disease, thyroid problems, diabetes, lupus and scleroderma

• Specific medication, like steroids, the contraceptive pill and non-steroidal anti-inflammatory drugs (NSAIDs)

The following factors can put you at a higher risk of hypertension:

• Being overweight

• A diet that’s too high in salt

• Not eating enough fruit and vegetables

• Lack of exercise

• Drinking too much alcohol or caffeine

• Smoking

• Older age

• A family history of high blood pressure

• Ethnicity

Complications of hypertension

Hypertension is a serious risk factor for many other health conditions. Over time it can damage your arteries and put a strain on your heart and other organs, like the brain, kidneys and even the eyes.

Persistently high blood pressure can lead to several cardiovascular conditions, including:

• Heart attack

• Stroke

• Angina

• Transient ischaemic attack (TIA)

• Heart failure

• Aortic aneurysm

• Peripheral arterial disease

It can also increase your risk of other conditions like:

• Kidney disease

• Vascular dementia

• Blood vessel damage in the eyes leading to vision loss

Hypertension symptoms and diagnosis

Hypertension rarely has outward symptoms, so it’s essential to check it regularly with a blood pressure test. If you’re over 40, it’s a good idea to have a test every five years.

You can get your blood pressure checked at:

• A GP surgery

• Some pharmacies

• An NHS Health Check

• At home, if you’ve got a home blood pressure monitor

If you get a high blood pressure reading, it doesn’t necessarily mean you have hypertension. Many things can influence the reading, like natural fluctuations throughout the day or feeling anxious or stressed about the test.

To be sure, your doctor may recommend an ambulatory blood pressure monitor. This 24-hour monitor checks your blood pressure throughout the day to see if it’s consistently high. Alternatively, you may be given a home blood pressure monitor so you can regularly measure your blood pressure over a longer period.

Treatment for hypertension

There are many different types of medication to treat high blood pressure. You may need to combine different types depending on factors like your age, ethnicity, and blood pressure.

Some of the main types of medication include:

• ACE inhibitors – To relax and widen the blood vessels to reduce blood pressure within the blood vessels.

• Angiotensin-2 receptor blockers (ARBs) – These have a similar effect to ACE inhibitors.

• Calcium channel blockers – These change how calcium is used in the blood vessels and the heart to relax the blood vessels.

• Diuretics – Enable your kidneys to eliminate excess water and salts from your body to help to lower blood pressure by reducing fluid in the circulation.

• Beta blockers – Help to slow the heart rate and are often used in combination with another drug.

How to manage your blood pressure

It’s often possible to positively affect your blood pressure by making changes to your lifestyle. Factors that can help to lower your blood pressure include:

• Eating a healthy diet – It’s crucial to reduce salt intake and eat lots of fruit and vegetables.

• Limiting the amount of alcohol you drink – The best advice is to stay within the recommended guidelines of consuming no more than 14 units a week.

• Maintaining a healthy body weight – Being overweight affects your blood pressure as your heart has to work harder to pump blood around your body.

• Staying active – Regular exercise is good for losing weight and keeping the heart healthy.

• Stopping smoking – Smoking causes narrowing of the arteries and can put you at higher risk of a heart attack and stroke.

• Cutting down on caffeine – It’s best to drink less than four cups of coffee or tea a day or switch to caffeine-free alternatives.