What to know about high blood pressure: Diagnosis, treatment and lifestyle changes

Due to the numerous serious complications associated with high blood pressure (hypertension), routine blood pressure testing is key as many patients to do not experience any notable symptoms. In this informative guide for patients, highly esteemed consultant cardiologist Dr Winston Martin shares his expert insight on how high blood pressure is defined, diagnosed and treated, including the most impactful lifestyle changes patients can make when trying to improve their blood pressure level.

How is high blood pressure defined?

Over the years, since the relationship between the tension, or pressure, within the circulation and heart disease and stroke was first identified, the definition of high blood pressure has changed, and it also depends on where and how it is measured.

Normal blood pressure, using a standard doctor's device, a sphygmomanometer in a clinic, is generally considered to be around 120 / 80 or lower. Elevated blood pressure is over 120 / 80 up to 140 / 90 and high blood pressure or hypertension is 140 / 90 or higher.

If using an ambulatory blood pressure device or a set of home BP (blood pressure) readings, then high blood pressure is diagnosed if the daytime or home average is 135 / 85 or higher.

It is also worth stating that in patients with diabetes or kidney disease, lower thresholds are often used and targeted because these patients run a much higher risk of vascular disease and the associated complications such as heart attack, strokes, heart failure and kidney failure.

What causes high blood pressure?

For quite a long time, the reasons why people developed high blood pressure weren’t known and so we used the term ‘essential’ or ‘idiopathic hypertension’, as we didn’t then have the knowledge that we have now.

Through careful large scale research, starting back in the 1950s and 60s into the early 21st century, our understanding has developed enormously. We now know that generally as people get older, their blood pressure, especially the systolic or upper number, tends to increase, so age is definitely a factor. We also know that so-called ‘modern urban living’, generally what was described as Western type lifestyles, contribute to developing high blood pressure. The term ‘Western’ is rather old fashioned now as most of the larger and rapidly growing urban centres are actually in India, the Far East, Africa and South America, and hypertension is a major health issue in these countries where access to healthcare is more challenging for a lot of the population.

In the main, it's a combination of diet and weight gain, reduced levels of walking and exercise, being less active and more sedentary, both at work and at home, and increased work-life stresses. These all have an adverse impact on the body's complex physiology, resulting in high blood pressure, often in combination with the tendency towards glucose or sugar intolerance and diabetes.

In a small number of patients, generally young people with high blood pressure before the age of thirty, or those in whom the blood pressure is very difficult to control with medication, so-called resistant hypertension, we often find that secondary causes are at play. This may be due to kidney abnormalities such as polycystic kidney disease, narrowed arteries to the kidneys or renal artery stenosis, or due to excess hormone production, such as cortisol in Cushing’s syndrome, adrenaline in pheochromocytoma, or aldosterone in Conn’s syndrome.

There may be clues in the patient’s medical history, an examination, or in their blood test results which hint at these issues and it’s crucial that they to see someone experienced in investigating this, as not all cardiologists are very good at this.

What are the symptoms of high blood pressure?

Many patients will tell you that they know when their blood pressure is high or that they experience headaches due to high blood pressure. I'm not saying that they're necessarily wrong, but we know that the vast majority of people with high blood pressure have no symptoms at all, and the first time they're made aware of it is when they have it measured routinely when they visit their GP surgery, in a hospital clinic, or before having an operation, such as when they have a pre assessment.

The truly unlucky ones only find out when they suffer from acute complication, such as a heart attack or stroke. Therefore, knowing your blood pressure and having it checked intermittently every few years is one of the best preventative actions one can do, alongside being up to date with your vaccinations. Because most people don't feel unwell with hypertension, this can be quite a challenge when needing to treat the condition.

How is high blood pressure treated?

In the first instance, recognising that one has the condition is the first and most important step. Assuming the diagnosis has been confirmed, ideally using an ambulatory monitor or a set of home readings, then there are two main complementary strategies.

The first is to address the adverse modern urban living factors that we mentioned through what we call therapeutic lifestyle changes, the TLCS. These focus on dietary changes, cutting back on salt and salty processed foods, reducing the ingestion of processed red meats, increasing whole food, fruit and vegetables and more healthy varieties when eating. Next is weight reduction, reducing sugar and carbohydrate intake and switching to more plant based foods such as beans, pulses and lentils.

Additionally, getting regular exercise and being less sedentary is key. This can be achieved by standing at work or in the office next to the desk, holding standing meetings rather than seated, going for brisk walks, ideally on a daily basis, doing cardiac exercises like cross training and swimming, in addition to muscle toning and strengthening through exercise like yoga, Pilates and the use of dumbbells.

Following these particular lifestyle changes, there are a range of different medications which help to lower blood pressure and reproduce some of the effects that exercise or a good diet have on the body. These different medications range from things like ACE inhibitors, Sartans, calcium channel blockers, diuretics, beta blockers, and some of the more specific hormone blockers like aldosterone antagonists. In fact, there's a wide range of different medications that one can use, and often the trick is to find the right cocktail of medication for your particular needs.

Are there ways you can lower your blood pressure yourself?

In terms of lowering blood pressure yourself, one would undertake regular exercise. You will also want to lose weight and often losing a kilogramme or two can have dramatic benefits in terms of reducing blood pressure. Dietary changes, such as reducing the amount of salt in your diet, choosing non-salted products and also eating more fruit and vegetables all helps to lower blood pressure.

If you are concerned about high blood pressure or are seeking treatment and wish to schedule a consultation with Dr Martin, you can do so by visiting his Top Doctors profile.