High Blood Pressure

 


What is High Blood Pressure? 

You probably have high blood pressure (hypertension) if your blood pressure readings are consistently 140 over 90, or higher, over a number of weeks. You may also have high blood pressure if just one of the numbers is higher than it should be over a number of weeks.  If you have high blood pressure, this higher pressure puts extra strain on your heart and blood vessels. Over time, this extra strain increases your risk of a heart attack or stroke. High blood pressure can also cause heart and kidney disease, and is closely linked to some forms of dementia. A blood pressure reading between 120/80mmHg and 140/90mmHg could mean you're at risk of developing High Blood Pressure if you don't take steps to keep your blood pressure under control.

How is High Blood Pressure Measured?

Blood pressure is documented with two metrics.

1. The systolic pressure (higher number) is the velocity that heart pumps blood around your body and relates to the volume of pressure in your arteries amid contraction of your heart muscle. This is known as systolic pressure.

2. The diastolic pressure (bottom number) is the resistance to the blood flow in the blood vessels.

They're both measured in millimetres of mercury (mmHg). This refers to the pressure in the arteries when the heart rests between beats. It is at this point the heart fills with blood and receives oxygen. A normal diastolic blood pressure is lower than 80. 90 or higher is considered as high blood pressure.

As a general guide: 

  • High Blood Pressure is considered to be 140/90mmHg or higher
  • Ideal Blood Pressure is considered to be between 90/60mmHg and 120/80mmHg
  • Low Blood Pressure is considered to be 90/60mmHg or lower

However steps can be taken to lower the risk of the condition developing which are discussed further in this article. 


What are the health risks of high blood pressure? 

Consistent high blood pressure that is apparent for over a period of time can elevate your risk of various and potentially life-threatening conditions, such as:

• Heart disease

• Heart attacks

• Strokes

• Heart failure

• Peripheral arterial disease

• Aortic aneurysms

• Kidney disease

• Vascular dementia

You don't always have to go to your doctor's office to have your blood pressure checked; you can monitor your own blood pressure at home. This is especially important if your doctor recommends that you monitor your blood pressure on a regular basis.


What are the Symptoms of High Blood Pressure? 

  • Severe headache
  • Fatigue or confusion
  • Vision problems
  • Chest pain
  • Difficulty breathing
  • Irregular heartbeat
  • Blood in the urine
  • Pounding in your chest, neck, or ears


Who is at risk of High Blood Pressure and what are the Causes?

Factors that can raise your risk of developing high blood pressure include:

• Age – the risk of developing high blood pressure increases as you get older

• Hereditary – a history of high blood pressure in the family

• Being of African or Caribbean origin

• High amount of salt consumption through diet

• Not getting enough exercise or being too idle

• Being overweight or obese

• Regularly exceeding the recommended weekly alcohol in consumption

• Smoking

• Long-term insomnia

• Making healthy lifestyle changes can help keep your blood pressure at a normal level

• Diabetes


Tips for Checking Your Own Blood Pressure

There are some factors that can lead to blood pressure to rise in the short-term. For instance, blood pressure can increase as a result of:

• Stress

• Smoking

• Cold temperatures

• Exercise

• Caffeine

• Certain medicines

Try to avoid as many of these possible triggers as you can when planning to take your blood pressure. Plus, aim to measure your blood pressure at about the same time each day. Your doctor may want you to check your blood pressure several times during the day to detect any fluctuations.


How can you check your blood pressure?

Before Checking Your Blood Pressure Find a secluded place when checking your blood pressure where you are unlikely to be disturbed.

You will need to listen to the sound of your heartbeat. Ensure that you are comfortable and calm with a recently discharged bladder as a full bladder can impact upon your reading. Roll up the sleeve on your arm or remove any tight-sleeved clothing. Reside in a chair next to a level surface (ideally a table) for 5 to 10 minutes. Your arm should rest comfortably at heart level. Sit up straight with your back against the chair, legs uncrossed. Rest your forearm on the table with the palm of your hand facing up. Step-by-Step Blood Pressure Check If you purchase a manual or digital blood pressure monitor (sphygmomanometer), follow the instruction booklet carefully.


Steps towards checking your blood pressure

1. Locate your pulse. Locate your pulse by lightly pressing your index and middle fingers slightly to the inside centre of the bend of your elbow (where the brachial artery is). If you cannot locate your pulse, place the head of the stethoscope (on a manual monitor) or the arm cuff (on a digital monitor) in the same general area.

2. Secure the cuff. Slide the cuff onto your arm, making sure that the stethoscope head is over the artery (when using a manual monitor.) The cuff might be indicated with an arrow pointing to the location of the stethoscope head. The lower edge of the cuff should be roughly 2cm – 3cm’s above the bend of your elbow. Use the fabric fastener to make the cuff secure, but not too tight. Then place the stethoscope in your ears. Slant the ear pieces a little forward to hear the best sound.

3. Inflate and deflate the cuff. If you are using a manual monitor: Hold the pressure gauge in your left hand and the bulb in your right and shut the airflow valve on the bulb by turning the screw clockwise. Inflate the cuff by squeezing the bulb with your right hand. You could sense your pulse through the stethoscope here. Watch the gauge. Keep inflating the cuff until the gauge reads about 30 points (mm Hg) above your expected systolic pressure and you should cease to hear your pulse through the stethoscope. Keeping your eyes on the gauge, gently release the pressure in the cuff by opening the airflow valve anti-clockwise. The gauge should drop slowly at 2 to 3 points with each heartbeat. (You may need to practice turning the valve slowly). Listen carefully for the first pulse beat. As soon as you hear it, note the reading on the gauge. This reading is your systolic pressure (the force of the blood against the artery walls as your heart beats). Continue to slowly deflate the cuff. Listen carefully until the sound disintegrates.

As soon as you can’t hear your pulse any longer, note the reading on the gauge. This reading is your diastolic pressure (the blood pressure between heartbeats). Allow the cuff to completely deflate. Remember you'll achieve the most accurate recording if your arm is held straight. If you release the pressure too quickly or could not hear your pulse, DO NOT inflate the cuff again right away. Wait one minute before repeating the measurement. Start by reapplying the cuff.


Additional Tests for High Blood Pressure

The doctor may further request the following tests to assist in the diagnosis of high blood pressure: Urine and blood tests - underlying causes might be due to cholesterol, high potassium levels, blood sugar, infection, kidney malfunction, etc. Protein or blood in urine may indicate kidney damage. High glucose in the blood may indicate diabetes.

Exercise stress test - often utilised for patients with borderline hypertension. This commonly involves peddling a stationary bicycle or walking on a treadmill. The stress test assesses how the body's cardiovascular system reacts when physical activity is upped. If the patient has hypertension this data is vital to be aware of prior the exercise test starts. The test monitors the electrical activity of the heart, in addition to the patient's blood pressure during exercise.

An exercise stress test can unravel health issues that are not triggered when the body is at rest. Imaging scans of the heart's blood supply might be taken simultaneously.

ECG (electrocardiogram) - this tests the heart's electrical activity. This test is more commonly used for patients at high risk of heart problems, such as hypertension and increased cholesterol levels. The initial ECG is known as a baseline.

Subsequent ECGs may be comparative with the baseline to expose changes which may point towards coronary artery disease or thickening of the heart wall.

Holter monitoring - the patient carries an ECG mobile device that is attached to electrodes on their chest for about 24 hours.

Echocardiogram - this device uses ultrasound waves which display the heart in motion.

This will allow the doctor to detect and distinguish problems, such as thickening of the heart wall, defective heart valves, blood clots, and excessive fluid around the heart.


How can High Blood Pressure be managed without medication?

By making these 10 lifestyle changes, you can lower your blood pressure and reduce your risk of heart disease. If you've been diagnosed with high blood pressure, you might be worried about taking medication to aid blood pressure reduction. Lifestyle plays an important role in treating your high blood pressure. If you successfully control your blood pressure with a healthy lifestyle, you might avoid, delay or reduce the need for medication.

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Lifestyle Changes to lower your blood pressure

1. Lose extra pounds and watch your waistline. Blood pressure usually increases as those ponds pile on. Being overweight also can cause disrupted breathing when sleeping (sleep apnea), which pushes blood pressure even higher. Losing weight is one of the key lifestyle alterations for reducing blood pressure. Losing just between 8 - 10 pounds can have a noticeable positive impact on your blood pressure. Besides shedding pounds, generally keeping an eye on the stretch of that waist line is good lifestyle practice. Carrying too much weight around your waist can put you at greater risk of high blood pressure. Gender wise, men are at risk if their waist measurement is over 40 inches (102 centimetres). Women are at risk if their waist measurement is greater than 35 inches (89 centimetres). However, these figures vary throughout different ethnic groups. Ask your doctor about a healthy waist measurement for you.

2. Exercise regularly. Regular physical activity — at minimum 30 minutes most days of the week — can reduce blood pressure by 4 to 9 millimetres of mercury (mm Hg). Try to be consistent because if you stop exercising, your blood pressure can rise again as well as losing any fitness you build up. The more you do, the more you can do! The most beneficial types of exercise for lowering blood pressure are predominantly cardiovascular exercises like walking, jogging, cycling, swimming or dancing. Strength and muscle training can also help. Talk to your doctor about developing an exercise program.

3. Eat a healthy diet. Eating a diet that is rich in whole grains, fruits, vegetables and low-fat dairy products and skimps on saturated fat and cholesterol can lower your blood pressure by up to 14 mm Hg. This eating plan is known as the Dietary Approaches to Stop Hypertension (DASH) diet. If you haven’t been eating as healthy as you could for a long period of time, it can be difficult to implement new dietary changes your eating habits, but with these tips, you can adopt a healthy diet:

  • Keep a food diary. Writing down what you eat, even for just a week, can shed surprising light on your true eating habits. Monitor what you eat, how much, when and why. 
  • Consider boosting potassium. Potassium can lessen the effects of sodium on blood pressure. The best source of potassium is food, such as fruits and vegetables, rather than supplements. Talk to your doctor about the potassium level that's best for you. 
  • Be a smart shopper. Read food labels when you shop and stick to your healthy-eating plan when you're dining out, too.

4. Reduce sodium in your diet. A minimal reduction in Sodium intake can reduce blood pressure by 2 to 8 mm Hg. The effect of sodium on blood pressure varies among groups of people. In general, limit sodium to less than 2,300 milligrams (mg) a day or less. However, a lower sodium intake — 1,500 mg a day or less — is appropriate for people with greater salt sensitivity, including:

• African-Americans

• Anyone age 51 or older

• Anyone diagnosed with high blood pressure, diabetes or chronic kidney disease

To decrease sodium in your diet, consider these tips:

• Read food labels. If possible, choose low-sodium alternatives of the foods and beverages you normally buy.

• Eat fewer processed foods. Only a small amount of sodium occurs naturally in foods. Most sodium is added during processing.

• Don't add salt. Just 1 level teaspoon of salt has 2,300 mg of sodium. Use herbs or spices to add flavor to your food.

• Ease into it. If you don't feel you can drastically reduce the sodium in your diet over night, cut back little by little. Your palate will adjust over time.

5. Cap the amount of alcohol you drink. Alcohol can be both good and bad for your health. In small amounts, it can potentially lower your blood pressure by 2 to 4 mm Hg. But this positive effect is reversed if you consume too much alcohol — generally more than one drink a day for women and for men older than age 65, or more than two a day for men age 65 and younger Drinking over moderate volumes of alcohol can lead to a raise in blood pressure by 3 or 4 points. It can also neutralise the effect of blood pressure medications.

6. Quit smoking. Each cigarette you smoke increases your blood pressure instantly after you finished your cigarette. Stopping smoking completely allows your blood pressure to begin to head to normal levels. People who quit smoking, regardless of age, have substantial increases in life expectancy.

7. Cut back on caffeine. The part caffeine plays and how it impacts blood pressure is still relatively inconclusive. Caffeine can elevate blood pressure by as much as 10 mm Hg in people who hardly consume it, but there is little to no strong effect on blood pressure in regular caffeine indulgers. Although the effects of chronic caffeine ingestion on blood pressure aren't clear, the possibility of a slight increase in blood pressure exists. To assess if caffeine raises your blood pressure, check your pressure within 30 minutes of drinking a caffeinated beverage. If your blood pressure increases by 5 to 10 mm Hg, you may be sensitive to the blood pressure raising effects of caffeine. Talk to your doctor about the effects of caffeine on your blood pressure.

8. Reduce your stress. Chronic stress is an important contributor to high blood pressure. Occasional stress also can contribute to high blood pressure if you react to stress by eating unhealthy food, drinking alcohol or smoking. Consider what makes you to feel stressed, such as work, family, finances or illness. Once you know what's causing your stress, think about how you can eliminate or reduce stress. If you can't eliminate all of your stressors, you can at least cope with them in a healthier way. Try to: Change your expectations. Give yourself time to get things done. Learn to say no and to live within manageable limits. Try to learn to accept things you can't change. Think about problems within your control and make a plan to solve them. You could talk to your boss about difficulties at work or to family members about problems at home. Know your stress triggers. Avoid whatever triggers you can. For example, spend less time with people who bother you or avoid driving in rush-hour traffic. Make time to relax and to do activities you enjoy. Take 15 to 20 minutes a day to sit peacefully and breathe deeply. Try to intentionally enjoy what you do rather than hurrying through your "relaxing activities" at a stressful pace.

9. Monitor your blood pressure at home and see your doctor regularly. Home monitoring can help you keep a finger pulse on your blood pressure, make certain your lifestyle changes are working, and alert you and your doctor to potential health complications because of it. Blood pressure monitors are available widely and without a prescription. Talk to your doctor about home monitoring before you get started. Regular visits with your doctor are also important to monitoring your blood pressure. If your blood pressure is under control, you might need to visit your doctor only every six to 12 months, depending on other conditions you might have. If your blood pressure isn't well-controlled, your doctor will likely want to see you more frequently.

10. Seek out support Supportive family and friends can help improve your health. They may encourage you to take care of yourself, drive (or even walk) you to the doctor's office or begin an exercise program with you to keep your blood pressure low. If you find you need support aside your family and friends, look into joining a support group. This may put you in touch with people who can give you an emotional or morale boost and who can offer practical tips to cope with your condition.


What Treatments are Available for High Blood Pressure?

Several medications can be used to help control high blood pressure. Many people need to take a combination of different medicines.

The medication recommended for you at first will depend on your age and ethnicity: if you're under 55 years of age – you'll usually be offered an ACE inhibitor or an angiotensin-2 receptor blocker (ARB) if you're aged 55 or older, or you're any age and of African or Caribbean origin – you'll usually be offered a calcium channel blocker You may need to take blood pressure medication for the rest of your life. But your doctor might be able to reduce or stop your treatment if your blood pressure stays under control for several years. It's really important to take your medications as directed. If you miss doses, it won't work as effectively.

The medication won't necessarily make you feel any different, but this doesn't mean it's not working. Medications used to treat high blood pressure can have side effects, but most people don't experience any. If you do, changing medication will often help. Common blood pressure medications are described below. ACE inhibitors Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by relaxing your blood vessels. Common examples are enalapril, lisinopril, perindopril and ramipril.

The most common side effect is a persistent dry cough. Other possible side effects include headaches, dizziness and a rash.

Angiotensin-2 receptor blockers (ARBs)

ARBs work in a similar way to ACE inhibitors. They're often recommended if ACE inhibitors cause troublesome side effects. Common examples are candesartan, irbesartan, losartan, valsartan and olmesartan. Possible side effects include dizziness, headaches, and cold or flu-like symptoms.

Calcium channel blockers

Calcium channel blockers reduce blood pressure by widening your blood vessels. Common examples are amlodipine, felodipine and nifedipine. Other medicines such as diltiazem and verapamil are also available. Possible side effects include headaches, swollen ankles and constipation. Drinking grapefruit juice while taking some calcium channel blockers can increase your risk of side effects.

Diuretics Sometimes known as water pills, diuretics work by flushing excess water and salt from the body through urine. They're often used if calcium channel blockers cause troublesome side effects. Common examples are indapamide and bendroflumethiazide. Possible side effects include dizziness when standing up, increased thirst, needing to go to the toilet frequently, and a rash. Low potassium level (hypokalaemia) and low sodium level (hyponatraemia) may also be seen after long-term use.  

Beta-blockers

Beta-blockers can reduce blood pressure by making your heart beat more slowly and with less force. They used to be a popular treatment for high blood pressure, but now only tend to be used when other treatments haven't worked. This is because beta-blockers are considered less effective than other blood pressure medications. Common examples are atenolol and bisoprolol. Possible side effects include dizziness, headaches, tiredness, and cold hands and feet.