Hypertension, or high blood pressure (BP), is a concept some patients struggle with. You’re told you have a health condition, and yet you feel well, it doesn’t give you any symptoms, and you don’t feel any different once treatment is started.
You’re buying into the concept that looking after yourself (with lifestyle modifications and medication) will protect you from serious illness such as kidney disease, strokes or heart attacks in many years to come. Perhaps it’s best viewed as paying into your pension – you won’t ever feel like you’re reaping the rewards, but you’d kick yourself if you hadn’t invested.
Yes! Lots! If you’re leading a sedentary lifestyle, get active. Start gently, building up gradually to 30 minutes of exercise where you feel a bit out of breath, at least five times per week. Swap takeaways and processed foods for fruit and veg – keep your eye on foods that are high in fat, sugar or salt and avoid them.
Both exercise and following a healthy diet may also help lose any extra weight you’re carrying – this can have a big impact on your hypertension. Alcohol can add unnecessary calories and is a risk factor for hypertension in itself, alongside smoking. Your doctor can help with quitting services to increase your chance of success.
If you’re working long hours, missing out on sleep, and feel perpetually stressed, you should look to address these, as they take a toll on your BP. Look for ways to take time out to relax and try to build up a healthier sleep routine to ensure you’re getting a quality night’s sleep.
If your hypertension is borderline, you and your doctor may decide together to try lifestyle modifications alone. If this isn’t enough once reviewed, or your BP is fairly high, they may start medication in the form of tablets.
Your kidney function will be checked on a blood test before medication. Your doctor will check for other risk factors for heart disease, including cholesterol and diabetes, and you may need to provide a urine sample for an additional kidney check. An eye test will be arranged to check the back of your eyes and you may be sent for an ECG (electrocardiogram) to check the electrics of your heart.
If started on medication, your surgery will offer to re-check your BP six to eight weeks later. Your kidney function will be checked again, too, in case the medication has affected this.
Your BP will then be checked every three months until it has reached a satisfactory level. Your doctor may tweak medication in terms of doses, or swapping over a medication if you experience side effects. They may add another tablet in to reach your target BP.
Once you have achieved good hypertension control, you will be recalled on a yearly basis, unless there’s reason to see you sooner, such as related conditions like kidney disease or diabetes.
If you want to keep an eye on your blood pressure, you can purchase a machine to have at home and take it every month or two.
If you’re under 80 years old and have no related conditions like diabetes, you should aim for less than 140/90 mmHg from the doctor’s machine, or less than 135/85 mmHg on home readings. Your target will be lower if you have other conditions.
If you are 80 years old or over, you may be more at risk of dizziness and falls, so your BP target is less than 150/95 mmHg in the clinic (or 145/85 mmHg at home).
Most times, we don’t know, and this is called essential hypertension. Some factors put you at higher risk: age is the biggest of these, especially those over 65.
Other groups high risk groups include those who are black African or black Caribbean, or those with a close family member diagnosed at an early age. Other factors include if you live in a deprived area, if you smoke, drink excess alcohol, or lots of coffee or other caffeinated drinks, if you are overweight, eat a diet high in salt, fats and sugars and low in fruit and vegetables, or if you lead a high-stress lifestyle.
Up to 1 in 10 people with high blood pressure are diagnosed with secondary hypertension – it occurs as a cause of another condition or certain medications. These include problems with your kidneys, adrenal glands, thyroid, a connective tissue disorder or obstructive sleep apnoea. Medications that can provoke a high BP include long-term high-dose steroids, the combined contraceptive pill, non-steroidal anti-inflammatories like ibuprofen or naproxen, and drugs of misuse such as cocaine or excess alcohol.
Your doctor or hospital specialist will keep a close eye on your blood pressure if you have one of these conditions or are prescribed certain medications, and treat early if needed.
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