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         Blood pressure

Why is high blood pressure harmful?
To put it very plainly, the higher your blood pressure, the shorter your life expectancy. People with high blood pressure run a higher risk of having a stroke (which damages the brain) or a heart attack. If left untreated for a long time, high blood pressure can lead to kidney failure and even damage your sight. It can also make the heart abnormally large and less efficient (a condition called ‘left ventricular hypertrophy’). This can lead to heart failure,which is when the pumping action of the heart becomes less effective. If you have high blood pressure, reducing your blood pressure can lower your risk of having all of these problems.

Why me?
You’re not alone.It’s more common in older people than in younger people. Among people in their 60s, about 6 out of 10 have high blood pressure, and among people in their 70s, 7 out of 10 people have it. But you are luckier than many because at least you know you have high blood pressure, and so you can take steps to try and reduce it. Nearly a third of people with high blood pressure are not being treated.

What is high blood pressure?
Blood pressure is the pressure of the blood in your arteries – the tubes that take the blood away from your heart to the rest of your body. You need a certain amount of pressure to keep the blood flowing. High blood pressure develops if the walls of the larger arteries lose their natural elasticity and become rigid, and the smaller blood vessels become narrower (constrict).

Your heart is a pump that beats by contracting and then relaxing. The pressure of blood flowing
through the arteries varies at different times in the heartbeat cycle.

• the highest pressure, known as systolic pressure, is the pressure when the beat or contraction of your heart forces blood round your body

• the lowest pressure, diastolic pressure, is the pressure between heartbeats when the heart
is resting.

Blood pressure is measured in millimetres of mercury (shortened to ‘mmHg’). A blood-pressure reading gives two numbers. The first number is the systolic pressure and the second is the diastolic pressure. Your target is to have a blood pressure below 140/85mmHg (140 systolic and 85 diastolic). If you have diabetes, kidney disease, or disease of the heart and circulation, your target is below 130/80mmHg. There is no fixed dividing line between normal blood pressure and slightly raised blood pressure.

What causes high blood pressure?
In over 9 out of every 10 people there is no definite cause of high blood pressure. This condition is known as ‘essential hypertension’. The following can all play a part:

• not doing enough physical activity

• being overweight

• having too much salt in your diet

• drinking too much alcohol, and

• not eating enough fruit and vegetables.

Genes are another factor. So, if one or both of your parents have (or had) hypertension, you have a greater chance of developing it too. In a very small number of people, a single cause is found, such as narrowing of the artery to a kidney or abnormal production of hormones from the adrenal glands. Severe kidney disease can also cause high blood pressure. Occasionally, some medicines used to treat ulcers, arthritis or depression may cause a rise in blood pressure.

What tests will I have?
Your doctor will probably examine your chest and generally look for signs that show whether your circulation is healthy. This includes looking at your eyes with an ophthalmoscope to see whether the high blood pressure has affected the blood vessels at the back of your eye. If you have hypertension, your doctor may also do simple blood and urine tests to find out more about the health of your heart and circulation. The main tests are:

• an electrocardiogram (ECG) – a test to record the rhythm and electrical activity of your heart

• blood tests to find out your cholesterol levels and blood sugar levels, and whether your high
blood pressure has caused any damage to your kidneys, and

• a urine test to look for signs of blood or protein in the urine.

What about low blood pressure?
People with low blood pressure tend to live longer than people with high or even ‘normal’ blood pressure. Low blood pressure is sometimes discovered during a routine examination. Most people with low blood pressure don’t have any noticeable symptoms. However, in some people who have blood pressure below 90/60mmHg, it can cause dizziness or even fainting when they get up after bending over or lying down, especially in older people.

If you have low blood pressure, simple measures may help, such as making sure you are taking enough fluid and possibly using well-fitting support stockings. Some people with low blood pressure may be encouraged to add more salt to their diet as this may help improve their blood pressure. (However, it is important to remember that having too much salt in the diet can lead to high blood pressure.) Low blood pressure can also be a side effect of drug treatment for high blood pressure, heart disease or depression. If so, your doctor may need to adjust the dose of the drugs you are taking, or give you a different drug.

Sometimes low blood pressure can be the result of another illness or condition. So if you are having symptoms of dizziness, it is important that you see your doctor. If your blood-pressure reading is unusually low, your doctor should check to make sure there is not a medical cause.

There is usually no need to treat low blood pressure. Only a very small number of people need
to take medication for it.

How is blood pressure measured?
Your doctor or nurse will measure your blood pressure using a sphygmomanometer (pronounced ‘svig-mo-man-ometer’). This is usually a digital blood-pressure monitor, which is made up of a box with a tube leading to a cuff. The cuff is wrapped round your upper arm. At the press of a button, the cuff inflates to a certain level and then automatically deflates. While it is inflated, the cuff will feel slightly uncomfortable as no blood can get through to your lower arm. In the cuff there is a sensor which detects your pulse and changes the information into blood-pressure readings which appear on a display screen. The size of the cuff is important. If a cuff is too large, it can give an artificially low reading. Fat arms will need larger cuffs – otherwise the blood-pressure measurement will be higher than it actually is.

Before you have your blood pressure taken, you should have rested for at least five minutes. You should be sitting down when you have the measurement taken. Some doctors or nurses may use a mercury sphygmomanometer instead of the digital blood-pressure monitor described above.

The doctor or nurse wraps the cuff round your arm and pumps up the cuff to a pressure above your likely systolic pressure. The doctor or nurse will then use a stethoscope to listen to the artery at the bend of your arm, and will then gradually release the pressure in the cuff. At systolic pressure, the blood will start to flow again. The doctor or nurse will hear this through the stethoscope as a thumping noise. As the pressure falls, the sound becomes muffled and then disappears when your blood pressure is at diastolic pressure and the blood is no longer obstructed.

24-hour monitoring
Some doctors use ‘24-hour ambulatory monitoring’ to measure your blood pressure. This involves strapping a recording device – about the size of a large personal stereo – round your waist. The monitor is connected by a narrow tube to a cuff which is wrapped round your upper arm. The cuff inflates and deflates regularly throughout the day and night to take, and record, your blood pressure.

While you are wearing the monitor you can carry on with all your regular daily activities apart from having a bath or shower, or swimming. 24-hour monitoring is used for several reasons, including measuring blood pressure in borderline cases, and closely monitoring the effect of drug treatment for high blood pressure.

The readings from 24-hour monitoring tend to be quite a bit lower than the measurements taken in a clinic.

Changes in blood pressure
Everyone’s blood pressure varies during the day. It tends to be highest in the morning and lowest at night. Blood pressure may also become high if you are anxious or under stress. Some people get worried about seeing their doctor, and having their blood pressure taken can make it go up. Nearly everyone is nervous on the first visit and their blood pressure is usually higher than at later appointments. That is why your doctor will probably want to take two or three separate measurements, or suggest 24-hour monitoring, before deciding whether you really do have consistently high blood pressure.

Home blood-pressure monitors
Some people have their blood pressure assessed by using a blood-pressure monitor at home. This provides a number of readings to assess, in much the same way as 24-hour monitoring. It might be helpful for you to measure your own blood pressure if your doctor thinks it is much higher when it is measured at the clinic than at other times (the ‘white coat effect’). Also, some people like to monitor their own blood pressure as it makes them feel more in charge of their care. However, home blood-pressure monitors are not a good idea for everyone as some people feel more anxious taking their own blood pressure than having it taken by someone else. Most home blood-pressure monitors are digital. They display a digital reading of your blood pressure. They are becoming more popular but some are not very reliable.

Will I have to start taking medicines straight away?
In many cases your doctor will monitor your blood pressure for a few weeks or months before deciding whether to treat it with medicines. In the meantime you can do a lot to help your own health by looking at your lifestyle and making changes where necessary.

What can I do to help control my blood reassure?
It’s helpful to look at the areas of your lifestyle that an cause high blood pressure. For example:
• not doing enough physical activity

• being overweight

• too much salt in your diet

• drinking too much alcohol, and

• not eating enough fruit and vegetables.

It’s also important to look at the areas of your lifestyle that cause extra risk to your heart, such as smoking or having a diet that is high in fat.

Be more physically active
The type of activity recommended for the heart is moderate, rhythmic (aerobic) activity such as brisk walking, cycling or dancing. Walking and cycling re particularly good as you can often build them into your daily routine.

If you play a sport or enjoy gardening, there is no reason to stop. However, blood pressure tends to rise during ‘isometric’ exercises such as weightlifting or weight training. So, if you have high blood pressure, it is best to avoid this type of activity.

      Doctor Tips
Angina is an uncomfortable feeling or pain in the chest.
It usually feels like a heaviness or tightness.
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