What is it? What can I do about it?

Often high blood pressure (hypertension) is first found when visiting your doctor for some other reason. We try and routinely measure blood pressure for all our patients at least once every 3 years. We know that high blood pressure itself does not cause symptoms; it only causes symptoms when the body has already been affected by it for some time. A stroke or a heart attack may unfortunately be the first sign of high blood pressure. Heart failure with leg swelling and shortness of breath can occur purely as a result of high blood pressure. Kidney failure may also result from unrecognised (or untreated) high blood pressure.

In most people with high blood pressure, no cause can be found. This is called essential hypertension. It is commoner in older people and in black people though it can occur at any age and in any race. There are many different causes for the raised blood pressure in the remaining cases. Each of these is quite rare. They usually arise from a number of abnormalities of the kidney or the endocrine glands like the adrenal that sits on top of the kidney.

Why does it occur?

The tendency to high blood pressure often runs in families. There are also many things that can raise the blood pressure in some people. These include too much salt in the diet, a lot of alcohol, stress and the contraceptive pill.

What can you do?

Non-drug treatment of high blood pressure should be used by all hypertensive patients whether taking drugs or not. Such measures have produced reductions in blood pressure of approximately two thirds that produced by drugs, so the additional effect is very worthwhile. In mild hypertension they may make drug treatment unnecessary, whilst in more severe hypertension, lower doses and less combination drug therapy may be required.

Weight reduction

Weight reduction in those who are overweight reduces blood pressure and also lowers the risk of later cardiovascular disease. Dietary restriction reduces blood pressure by approximately 1-2 mm Hg for every kilogram lost.

Regular exercise

Regular exercise to improve overall fitness lowers blood pressure and cardiovascular risk. We suggest three training sessions, or jogging for 30 minutes three times a week in younger patients. The elderly should increase the distance they walk. Alternate day exercise is better than weekly exercise and everyone should aim for at least 30 minutes of exercise that leaves you feeling a little puffed three times each week. If you have pre-existing heart disease or develop chest pains when exercising consult your doctor.

Salt and alcohol

Reductions in dietary salt and alcohol intake are also encouraged. To reduce blood pressure, salt should be excluded at the table and reduced in cooking. Alcohol consumption should be kept below 21 units per week in men and 14 in women, including alcohol-free days each week. Alcohol is better spread throughout the week rather than taken in one or two binges weekly. A unit of alcohol is a half pint of beer or lager, a glass of wine or one measure of spirits. Blood pressure has a direct proportional relationship to alcohol consumption-the more you drink, the higher your blood pressure goes.

Cardiovascular disease risk reduction

For cardiovascular disease prevention, it is most important to stop smoking. Avoiding foods with a high saturated fat and cholesterol content will also help. These lifestyle modifications. whilst not reducing blood pressure, do reduce the risk of later coronary heart disease. Not smoking will be provide benefits to your health far greater than having perfect blood pressure control.