Blood Pressure - Know your numbers

Blood pressure can seem like a mysterious thing. Doctors check it all the time and many patients wonder why. 

Along with pulse rate, respiratory rate, temperature and oxygen levels, blood pressure is one of the ‘vital signs’ and can tell a healthcare professional a lot of information about someone’s immediate and long-term state of health, and yet changes in blood pressure – whether it is high or low – often cause absolutely no symptoms for the patient. 

Whilst blood pressure is important for assessing someone when they are acutely unwell, for example when suffering with sepsis or another life-threatening condition, we are usually interested in long-term trends in blood pressure. 

This is because raised blood pressure is a key risk factor for health problems such as stroke, heart attacks, and kidney disease. 

Because it usually causes no symptoms, people can have high blood pressure for many years and never know it, even though it is quietly doing damage to their body. It is for this reason that high blood pressure, otherwise known as hypertension, is sometimes called a ‘silent killer’.

High blood pressure sometimes runs in families, but it is also strongly linked to getting older, being overweight, a poor diet, and a sedentary lifestyle. 

Because of this, high blood pressure is extremely common, in fact about 1 in 3 adults in the UK will have it – many will be unaware.

When we measure blood pressure, we measure two numbers. 

The higher number is called the systolic blood pressure. The systolic blood pressure is the pressure in your arteries at the point where the heart is contracting and sending a surge of blood around the body. 

The lower number is called the diastolic blood pressure. This is the pressure in your arteries between heart beats. 

Both numbers are important. The pressure is given in ‘millimetres of mercury’ or mmHg. 

Hypertension is another word for high blood pressure. The different hypertension stages represent the severity.

Lower reading targets are used for people with diabetes, kidney disease and certain heart conditions. 

There is, however, a move away from monitoring blood pressure with single, spot readings. Your blood pressure changes moment to moment as your body responds to different things happening in your daily life – it varies according to your stress levels or activity levels for example. Because many people find a doctor’s surgery or hospital room slightly stressful, the readings taken there can be falsely raised leading to people being treated unnecessarily for raised blood pressure. 

It is now common practice in the UK to further assess a raised blood pressure reading in one of two ways. 

First is a 24 hour ‘ambulatory’ reading. For this, you wear a blood pressure monitor for 24 hours and it measures your blood pressure regularly throughout that period. 

The second way is with home monitoring. To do this, patients are asked to check their own blood pressure twice a day for 7 days at home. An average is then calculated of these readings. 

Both of these methods are more accurate than single clinic readings and many people find that they do not actually need treatment once it has been checked in these ways. For the same reason, people with high blood pressure are encouraged to check it periodically at home because this is more accurate than occasional appointments with the doctor.

If you are found to have high blood pressure, you should see this as a good thing – it is the chance to act before significant health problems have developed so that you can live a longer, healthier life in the future. 

How you manage your blood pressure will depend on a number of factors. First, of course, is your preference. You should be involved with any treatment decisions that are made because it is you that will have to live with them. You should make a decision after a discussion of your options with your doctor who will be more or less encouraging of you starting medication depending on your particular circumstances. 

If your blood pressure is very high, your doctor is likely to suggest medication straight away. The need for medication can always be reviewed in the future but it is safest to ensure that it is controlled quickly.

Even if it is only slightly raised, your doctor may suggest medication if you are already known to have other health problems that increase your cardiovascular risk such as diabetes or kidney disease, if you have a strong family history of heart disease or stroke, or if you have other lifestyle risk factors such as being a smoker.

If your blood pressure is only slightly out of range, then you may choose to manage this with lifestyle changes. You can actually achieve significant improvements in your blood pressure by making some simple changes and this may enable you to avoid medication. 

Diet is a big factor. Salt intake in the UK is major problem as excess salt raises the blood pressure. 

The average daily salt intake in the UK is 8.5g, the recommendation is for less than 5.8g. If everyone reduced their intake to the recommended limits, there would be 30,000 fewer heart attacks and strokes each year. 

A more comprehensive set of dietary changes are described as the ‘DASH’ diet (Dietary Approaches to Stop Hypertension). 

This diet is based on strong evidence and advocates a diet low in red meats, fatty foods, and added salt and sugar, and one that is high in fruit and vegetables, grains, seeds and nuts.

There is also a direct relationship between the amount of alcohol you drink and your risk of high blood pressure, particularly if you drink more than two drinks per day. Current public health advice in the UK is not to exceed more than 14 units of alcohol per week with a unit of alcohol being equivalent to a single shot of spirit, or half a pint of normal strength beer (about 4%).

As ever, you should stop smoking. Not only is smoking already a big risk factor for heart disease and stroke, but each cigarette actually causes a transient spike in your blood pressure too. 

Increasing your exercise levels and losing weight if you are overweight are also great ways to reduce your blood pressure and improve your overall state of health. A weight loss of 10kg is often enough to help people to stop medication. 

If medication does prove necessary, there are a wide range of options, and your doctor will help you choose which one is right for you based on current national guidelines. 

This article has focussed on high blood pressure but many people worry about low blood pressure. In general, low blood pressure is not a problem. Many people will naturally have low blood pressure, particularly young people or slim people. 

In these people it rarely causes any symptoms and is protective for them against developing cardiovascular disease. It can sometimes cause people to feel dizzy or lightheaded, particularly when going from sitting to standing. This often occurs if people are on blood pressure medication that is too strong, and it is usually a sign that the dose needs to be decreased or the medication changed.

Occasionally, low blood pressure occurs in someone who is seriously unwell, such as someone suffering sepsis but, in this context, there are usually numerous other signs and symptoms that something is wrong.

The aim of this article has been to de-mystify the issues around blood pressure. Checking your blood pressure is easy to do and can be done at home, or at the GPs surgery, your local pharmacy, and at many gyms. Finding out there is a problem early is the best wat to stop bigger problems arising in the future.

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