High Blood Pressure
High blood pressure affects around 1 in 4 UK adults. So, if you’ve got the condition, you’re definitely not alone. Symptoms of high blood pressure include headaches, chest pain, anxiety, nausea and blurred vision. If it’s left untreated, it can cause severe long-term health problems, so it’s best to get on top of your blood pressure asap. The best way to manage high blood pressure is with lifestyle changes. Most importantly, drinking less alcohol, eating less salt and exercising more. If this doesn’t work, there are prescription medications available that can help. At The Independent Pharmacy, we're here to support you in managing your blood pressure healthily and effectively. Let's take proactive steps towards a healthier heart together.
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Advice for High Blood Pressure
What is High Blood Pressure?
High blood pressure, also known as hypertension, affects at least 1 in 4 adults in England alone. It is a condition that relates to the body’s circulatory system, specifically the pressure exerted to pump blood around the body. If this pressure is too high then it is likely to cause extra stress on the heart and arteries (blood vessels), which can lead to more serious conditions such as stroke, kidney disease, heart attack and even heart failure.
The symptoms associated with hypertension can sometimes be hard to spot, which is why it is important for adults to have their blood pressure checked on a regular basis. It is recommended that adults have a check at least once every five years. A blood pressure check is a readily available test that can be performed by your GP, pharmacist or other healthcare professionals. It can also be carried out by yourself by using a home testing kit.
Blood pressure is measured in millimetres of mercury (mmHg) and is presented by two figures; systolic and diastolic pressure. For example, the ideal blood pressure in a healthy adult would be 120/80mmHg or 120 over 80. The systolic reading (120) relates to the pressure of the blood when your heart beats. The diastolic reading (80) shows the pressure of the blood as your heart rests between beats. The diastolic reading reveals how strongly the arteries are resisting the blood flow. If your resting blood pressure is 140/90 mmHg or over, then this will indicate hypertension or high blood pressure.
The risk of developing hypertension increases as we get older. Lifestyle choices can also strongly influence our risk of developing the condition. There isn’t always a clear cause but factors that increase the risk of developing hypertension include:
- Being overweight
- Being over 65 years of age
- Having a blood relative with hypertension
- Lack of exercise
- Eating a poor diet that is high in salt and lacking in fresh fruit and vegetables
- Drinking too much alcohol or coffee
- Smoking
- Being of African or Caribbean descent
What are the symptoms of High Blood Pressure?
Hypertension, in most cases rarely presents with any obvious symptoms. In severe cases where the blood pressure is very high, the symptoms can become more apparent. These can include;
- Blurred or double vision
- Persistent headache
- Nose bleeds
- Shortness of breath
Symptoms such as these only occur in rare cases, if you are experiencing any of the above it is strongly advised you see a doctor as soon as possible. Experiencing any of the above symptoms would class as a medical emergency.
How is High Blood Pressure diagnosed?
High blood pressure should always be diagnosed by a medical professional and not self-diagnosed based on home tests. Although a general idea of the blood pressure reading can be taken at home, deciding on the appropriate treatment (medicinal or lifestyle) should be carried out by a healthcare professional.
As stated above, hypertension rarely presents with any obvious symptoms. This highlights the importance of having your blood pressure checked regularly, especially if any of the risk factors for developing high blood pressure apply to you.
The diagnosis will be made using a blood pressure monitor. These devices are safe, quick and simple to use. A cuff is placed around the upper arm (in some cases the wrist) and is inflated, restricting the blood flow. The cuff will then slowly deflate, releasing pressure and allowing for a reading to be taken. This reading is based on how the pulse beats as the pressure from the cuff is relieved. To gain an accurate reading from a blood pressure test you should ensure that your bladder has been emptied and your body has been at rest for at least five minutes. As the test is being performed it is important to be sitting down with your legs uncrossed and your back supported. Also, it is important not to talk as the reading is being taken.
If during your first test the results come back as high it does not automatically mean that you suffer from hypertension. A person’s blood pressure will fluctuate throughout the day. Feeling stressed or nervous about visiting your GP can lead to raised blood pressure. This is known as ‘white coat syndrome’. If under these conditions a high reading has been taken then it is likely a home testing kit will be provided, allowing a second test to be performed in a more relaxed environment. Alternatively, a 24-hour heart rate monitor can be provided, allowing your blood pressure to be monitored throughout the day. These methods will help determine whether your blood pressure is consistently high and not merely the result of anxiety.
Other methods that can be used to help diagnose hypertension include blood and urine tests. These tests are designed to check for underlying conditions that are known to affect circulation and increase blood pressure, such as kidney disease.
Can I prevent myself from getting High Blood Pressure?
High blood pressure can be reduced, or even prevented, by eating a healthy diet and maintaining a healthy weight. It is also important to take regular exercise and to only drink in moderation. Smoking is also a contributing factor in developing hypertension so cessation is recommended.
- Diet: Ensure you are eating plenty of fresh fruit and vegetables as well as cutting down on the amount of salt in your diet. Eating a low-fat diet that incorporates plenty of fibre, fruit and vegetables is proven to help lower blood pressure. Salt on the other hand is known to raise blood pressure. Ideally a person should aim to eat less than 6g of salt per day.
- Alcohol: Should only be consumed in moderation. Regularly drinking alcohol above the recommended levels (14 units for both men and women) will raise your blood pressure. Alcohol is also high in calories. Exceeding recommended levels will likely lead to weight gain, which will increase the risk of developing hypertension.
- Weight: The more overweight you are, the harder your heart will have to work. By maintaining a healthy weight you will help to reduce the risk of developing hypertension.
- Exercise: By exercising regularly you can help lower you blood pressure. Adults are recommended to do at least 150 minutes of moderate aerobic activity every week. Moderate-intensity aerobic activity should make you feel slightly out of breath, a brisk walk or cycling for example.
- Smoking: There is no direct link between smoking and hypertension. However, smoking increases the risk of heart disease and stroke, which will cause the arteries to narrow. If you have hypertension and continue to smoke then the rate of the arterial narrowing increases dramatically. This will substantially raise the chances of developing heart and lung disease in future.
- Caffeine: Drinking too much caffeine can increase your blood pressure. Tea and coffee are safe to drink in moderation and as part of a balanced diet.
How is High Blood Pressure treated?
The first line of treatment in all cases of high blood pressure will always be to make simple lifestyle changes. Whether these changes are supplemented with blood pressure medication will depend on how high your blood pressure is:
- Consistent readings above 140/90mmHg with a low risk of cardiovascular (heart) disease: This would be managed with simple lifestyle changes. Your blood pressure will likely be reviewed by a healthcare professional on an annual basis.
- Consistent readings above 140/90mmHg (but below 160/100mmHg) with an existing risk of cardiovascular disease: Medication should be initiated to help lower your blood pressure alongside lifestyle changes.
- Consistent readings above 160/100mmHg: One or more drugs will be strongly advised to help lower your blood pressure.
There is a wide range of medication that is proven successful in treating hypertension. The choice of medicine, or combination of medicines, will be determined by your prescriber. Your GP’s first line of treatment is usually influenced by your age and ethnicity. If a sufferer is under 55 years of age then an ACE inhibitor or an Angiotensin Receptor Blocker (ARB) will generally be offered. If a patient is over 55 years old, a Calcium Channel Blocker will be the usual choice. If you are of African or Caribbean descent then regardless of age a Calcium Channel Blocker is the preferred option.
Hypertension medication can sometimes be a lifelong commitment. However, if a person’s blood pressure stays under control for several years then your doctor may suggest reducing or even stopping your treatment. As with all medication, it is important to follow the directions as stated. By consistently missing doses you could lower the effectiveness of the medication, lowering your protection against future illness.
The mechanism of action for the different types of blood pressure medication varies:
- ACE Inhibitors (e.g. Ramipril & Perindopril) work by relaxing the blood vessels, causing them to widen and therefore reduce blood pressure.
- Calcium Channel Blockers (e.g. Amlodipine & Felodipine) prevent calcium from entering the muscle cells of the blood vessels and heart. This has the effect of widening the arteries, allowing for an increase of blood flow and a reduction of pressure.
- Beta-Blockers (e.g. Atenolol & Bisoprolol) work by reducing the speed and force in which the heart beats, thus reducing blood pressure. Beta-Blockers are generally considered less effective than ACE Inhibitors and Calcium Channel Blockers, which is why they tend to be used in conjunction with other medicines instead of the sole line of treatment.
- Diuretics (e.g. Bendroflumethiazide & Furosemide) are also a popular treatment for hypertension. They are sometimes referred to as ‘water pills’. They work by flushing any excess water and salt from the body through the urine. This reduction in fluid, in turn, reduces the blood pressure.
Alternatives
There are some Non-Prescription alternatives to help treat High Blood Pressure including;
- Eat more fruit, vegetables, and low fat foods
- Limit salt, sugary drinks and red meats
- Cut back on saturated and trans fats alongside cholesterol.
- Try to limit stress
- Consider alternative therapies such as Acupuncture and meditation.
High Blood Pressure FAQs
High blood pressure (hypertension) is when you consistently, over a number of weeks, produce readings of 140/90 or higher.
Hypertension can also be classified if just one of the numbers (systolic or diastolic) is consistently higher than it should be over a number of weeks.
Having high blood pressure puts extra strain on the heart and blood vessels, which over time can increase your risk of suffering a heart attack or stroke.
- For the majority of cases (90%) of high blood pressure, the causes are unknown. The remaining cases are usually the result of an underlying cause or condition, such as:
- Diabetes.
- Kidney disease.
- Narrowing of the arteries that supply the kidneys.
- Hormonal conditions, such as Cushing's syndrome.
- Recreational drug use, specifically Cocaine, Crystal Methamphetamine and Amphetamines.
- Herbal medicines and supplements.
- The oral contraceptive pill.
- NSAIDs (Nonsteroidal-Anti-Inflammatory Drugs), such as Aspirin and Ibuprofen.
- Conditions that affect tissue in the body, such as Lupus disease.
- Blood pressure is measured in millimeters of mercury (mmHg).It consists of two separate readings, a higher pressure (systolic) and a lower pressure (diastolic). An example of a blood pressure reading will look like; 120/70 mmHg or 120 over 70.
- Hypertension can have no obvious symptoms and many people with the condition are not even aware of it. The best way to find out is to have you blood pressure measured by a GP or other healthcare professional. It is recommended that all adults have their blood pressure checked at least once every five years. In some rare cases, hypertension can present with symptoms. This usually only occurs when the blood pressure is extremely high.These symptoms include:
- Persistent headaches.
- Double or blurred vision.
- Shortness of breath.
- Nosebleeds.
- High blood pressure can be managed through simple lifestyle changes, some of which can lower your blood pressure in a matter of weeks. A list of recommended lifestyle changes are listed below:
- Reduce your salt intake. It is advised to eat less than 6g (0.2oz) of salt per day.
- Eat a balanced, healthy diet that is low in fat and rich in fresh fruit and vegetables.
- Maintain an active lifestyle. Being physically active is one of the most effective ways of preventing and controlling hypertension.
- Reduce the amount of alcohol you drink.
- Reduce the amount of caffeine you drink. As little as four or more cups of coffee per day can increase your blood pressure.
- Maintain a healthy weight.
- Stopping smoking. Smoking has significant links with developing heart and lung disease.
The steps above are recommended regardless of whether you have high blood pressure or not. A healthy diet and physical lifestyle can greater reduce the risk of developing a plethora of diseases. With regards to blood pressure sufferers, the healthier the lifestyle, the greater the benefits will be. In fact, many people who stick to a healthy regime do no need to take hypertension medication at all. - Everybody is different when it comes to medication. What works well for a friend or relative may not work as well for you. The same principle applies with hypertension medication. For a lot of people, one hypertension medicine is not enough to effectively lower blood pressure.Each group of hypertension medication works in a different way, hence taking a combination of hypertension medicines will usually have a greater effect. Your doctor will have guidelines regarding which combination of medicines are most suitable for you. Your first line of treatment will depend on your age.Under 55 years of age: The usual choice will be an ACE inhibitor or an Angiotensin Receptor Blocker (ARB).55 years and over: The usual choice will be a Calcium Channel Blocker.If you are from African or Caribbean heritage then a Calcium Channel Blocker is the preferred choice regardless of age.This first line of treatment may be enough to control and stabilise your blood pressure. If this initial treatment helps to reduce your blood pressure but doesn't fully control it then other hypertension medications can be used in conjunction with it.These medicines can include; Diuretics and Beta-Blockers.
An ACE Inhibitor works to reduce the amount of water in the blood whilst widening the arteries. Examples of ACE Inhibitors include; Captopril, Enalapril, Fosinopril, Perindopril and Ramipril.
These medicines are most effective in people under fifty-five years of age. ACE Inhibitors are less effective in black people and those over the age of fifty-five. They are also not suitable during pregnancy or breastfeeding.
The most common side-effects associated with ACE Inhibitors are; dizziness, headaches, fatigue and a persistent dry cough. Most ACE Inhibitor names end in 'pril'
ARB is an acronym for Angiotensin Receptor Blocker.
These medicines work to lower your blood pressure by blocking the actions of angiotensin II. This has the effect of relaxing the blood vessels, causing them to dilate (widen). This allows for blood to flow with greater ease through the body. ARB's also work to reduce the amount of water retained in the body, which results in a reduction in pressure.
The most common side-effects associated with ARB's are dizziness, headaches and cold and flu-like symptoms. In most cases, these side-effects are usually very mild. Examples of ARB's include; Candesartan, Irbesartan, Losartan and Valsartan. Most ARB names end in 'artan'
Diuretics are designed to reduce the amount of water in the blood and to widen the arteries.
Examples of Diuretics include; Bendroflumethiazide, Hydrochlorothiazide and Indapamide.
Diuretics are a good alternative for patients who cannot tolerate Calcium Channel Blockers. However, they are not suitable during pregnancy or for those whose suffer from Gout. Thiazide Diuretics can also raise the potassium and sugar levels in the blood so regular blood and urine tests are required. In some cases, Diuretics have been known to cause impotence. Most Diuretic medicine names end in 'ide'
Calcium Channel Blockers work to widen the arteries. They are found to be most effective in black people and those over the age of 55.
Examples of Calcium Channel Blockers include; Amlodipine, Felodipine, Lercanidipine, Nifedipine and Verapamil.
These medicines are not suitable for people with a history of heart or liver disease or for those with poor circulation. The most common side-effects associated with Calcium Channel Blockers are; dizziness, headaches, fatigue, swollen ankles and skin rashes (usually only temporary). Most Calcium Channel Blocker names end in 'pine'
- Hypertension medication tends to be well tolerated. If you are finding that one particular medicine isn't working well for you then it is advised to consult your doctor, who can prescribe a more effective alternative.The most common side-effects associated with Hypertension medicines are:
- ACE Inhibitors only: Persistent dry cough.
- ARB only: Nasal congestion, diarrhoea, back and leg pain.
- Calcium Channel Blockers only: Facial flushing, headaches, swollen ankles.
- Thiazide Diuretics: Raises potassium and blood sugar levels, impotence.
- Beta Blockers: Sleep disturbances, nightmares and impotence (uncommon)
The only way to know for certain whether your blood pressure is high is to have it measured. This is normally done at your doctor's surgery, after an initial assessment. Once complete, your GP can then decide what course of action is best for you. Usually, this will involve monitoring your blood pressure, to ensure your readings are consistently higher than normal. The frequency of this monitoring and whether medication is required will depend on upon your initial readings.
At The Independent Pharmacy, we only provide blood pressure tablets for patients who have already been prescribed medication from their doctor.
- The largest age group to suffer from hypertension is the over 65s. However, it is important to note that approximately five million people in The UK are currently unaware that they suffer from the condition. The only way of knowing for sure is to have your blood pressure tested.It is recommended that all adults have their blood pressure checked at regular intervals (at least every 5 years). The process is quick, easy and painless and could potentially save your life. Your odds of suffering with hypertension increase with age. However, there isn't always an obvious cause, though you are thought to be more at risk if:
- You are overweight.
- You are over 65 years old.
- You have a blood relative with the condition.
- You are of African or Caribbean descent.
- Your diet contains too much salt.
- You don't eat enough fresh fruit and vegetables.
- You drink too much alcohol or caffeine.
- You don't exercise regularly.
- You smoke.
- There is currently no cure for hypertension but simple lifestyle changes can significantly improve the condition.Certain lifestyle changes are proven to lower blood pressure fairly quickly, while others can take up to several weeks before the effects are apparent. For some, a combination of medication and lifestyle choices will be required.
- If left untreated, hypertension can potentially lead to a number of cardiovascular health complaints (diseases of the heart and blood vessels). These include:
- Stoke: Where the blood supply to part of the brain is restricted or cut off.
- Heart attack: Where the blood supply to the heart is suddenly blocked.
- Embolism: Where a blood clot or air bubble restricts the flow of blood within a vessel.
- Aneurysm: Where the wall of a blood vessel bursts, causing an internal bleed.
- Vascular Dementia: Where a reduction in blood flow to the brain causes damage to parts of the brain.
Hypertension can also lead to kidney disease. Small blood vessels contained within the kidneys can become damaged as a result of high blood pressure, resulting in the kidneys not functioning properly. Mild to moderate kidney disease rarely presents with any obvious symptoms. When diagnosed, kidney disease will need to be treated using a combination of medication and dietary changes. Kidney Dialysis or transplant may be required for more serious cases. - High blood pressure affects approximately 10-15% of all pregnancies. This can present in two ways during pregnancy.These are:Chronic Hypertension: This is where high blood pressure was already present prior to pregnancy.Gestational Hypertension: This form of hypertension is related to the pregnancy.The types of treatments you can receive will depend on the cause of the hypertension. The key to a healthy pregnancy is to ensure your blood pressure is controlled. Regular checkups with your antenatal team are the best way of monitoring your condition. An additional antenatal appointment will be offered if it is required to meet the needs of your baby.
Dr Don Grant is The Independent Pharmacy's original online prescriber and has advanced in his role to become the Clinical Advisor, using his wealth of experience to advise on our clinical polices and prescribing guidelines.
Dan is an experienced pharmacist having spent time working in both primary and secondary care. He currently supports our clinical team by providing robust clinical governance review of our internal processes and information.