24 May 2018
In this article Dr Vinay Bhatia, Consultant Cardiologist, wants to explain the importance of diagnosing and treating this condition.
High blood pressure (hypertension) is one of the most important preventable causes of premature disease and death in the UK. Hypertension is a major risk factor for stroke, heart attack, heart failure, kidney failure and brain disease. The condition is remarkably common and accounts for a significant proportion of the annual NHS drugs costs. However, it is a condition that is underdiagnosed and patients often initially feel well and so cannot understand why they need to take
regular medication (with potential side effects) on a long-term basis.
What causes the blood pressure to rise?
Blood pressure is commonly measured with a sphygmomanometer at your GP practice, but it is a parameter that is always changing depending upon what you are doing and your state of mind. The condition can run in the family (genetics) but it is also strongly influenced by the way we lead our lives (lifestyle factors).
Are there any symptoms that I should be looking out for?
Often patients do not have any symptoms, they appear to be ‘healthy’ and it is diagnosed incidentally at a routine check-up. However, patients may experience breathing difficulties, chest discomfort, palpitations, visual disturbance, headaches, urinary problems or even feeling generally unwell.
How do we diagnose the condition?
There are well published guidelines on how blood pressure should be measured and the accepted cut-off to establish the diagnosis, but often a 24 hour blood pressure monitor or home monitoring is advised. Your doctor will need to examine you, carry out blood and urine tests and request an electrical recording of your heart rhythm. Other tests that are generally advised include a cardiac ultrasound (echocardiogram).
Hypertension becomes more common with increasing age, but in younger patients there may be rarer potentially curable causes and therefore these patients are further investigated.
The importance of adverse lifestyle factors
An unhealthy lifestyle can promote and lead to the progression of hypertension. This includes a poor diet (including too much salt); heavy alcohol drinking; lack of regular exercise; being overweight and smoking. Doctors will calculate your risk of developing a heart attack and stroke and these risk factors (including also having diabetes and high blood cholesterol) will multiply your total risk. Stress at work is also being increasingly recognised as an important contributory factor.
What are the treatment options?
The treatment of hypertension invariably involves taking long-term tablets to lower the blood pressure. The good news is that there are many different drugs to choose from, but the not so good news is that they can all have potential side effects. Doctors will aim to try one well tested drug and then increase the dose steadily (with monitoring) until they either achieve control or the top dose is reached. Then they will add another well tried and tested combination and so on until control is eventually established. Most patients can be controlled on one or two drugs, but a small proportion are still struggling after three or more drugs (resistant hypertension).
Other emerging treatment modalities under review
It is known that the nerves supplying the kidneys play a role in blood pressure regulation and there is a procedure that deactivates this process (renal denervation therapy). Although this treatment is available it is also still undergoing re-evaluation in carefully controlled trials in order to see if there is a definite and sustained improvement in blood pressure control.
What happens if I do not take my tablets regularly and change my lifestyle?
These compliance issues can be the root cause of why blood pressure remains out of control. Failure to control high blood pressure in the long-term can lead to heart, kidney and brain disease and eventually premature death. I often tell my patients that religiously taking the tablets now is their investment into securing a healthier future for themselves.