Dr D A Ware · Dr G V Price · Dr J A Crane · Dr G A Preest· Dr O Thomas

High blood pressure is a symptomless disease. Although patients often report feeling that their "blood pressure is up", there are no reliable symptoms. In fact, you are more likely to feel unwell if your blood pressure is low! The medical name for high blood pressure is "Hypertension"

What do you mean by "High blood pressure"?
People with greatly elevated blood pressure are at risk of numerous diseases and the life insurance companies (who hold morbidity data) tell us that your life expectancy drops as your blood pressure goes up. We know, therefore, that very high blood pressure carries a risk, but who do you treat and where do you draw the line between normal and abnormal? Doctors have been debating this issue for years. The current consensus of opinion is that a consistently elevated blood pressure greater than 160/100 would benefit from treatment. This is for non Diabetics. The data from a large study called the "UKPDS" study showed that Diabetics are particularly sensitive to increases in blood pressure. It seems that Diabetics are damaged by levels of blood pressure previously thought to be safe. As a result, we aim to keep blood pressure below 140/80 in Diabetics. A diagnosis is made when a patient shows consistently elevated levels of blood pressure. It is quite normal for blood pressure to go up and down. It does not stay the same and blood pressure readings taken at different times will give different results. Therefore, unless the initial reading is exceptionally high, we would normally want to take at least 3 readings before establishing a diagnosis. We have even bought a special machine called a "24hour blood pressure monitor" that we use if we need additional readings. This machine looks like a Walkman, but costs many thousands of pounds! It is fitted by our nurse and you would normally wear it for 24 hours then return for us to analyse the results. It is NOT routinely used, but reserved for cases of borderline hypertension where we want further clarification. Patients often ask us "What is the correct blood pressure?". There is no single figure for correct blood pressure. This would be like saying that 5' 10" is the correct height and all others are abnormal! It's probably better to say that there is a normal range and above a threshold of 160/100 (or 140/80 for diabetics) you would benefit from treatment to bring your blood pressure down.

How did I get high blood pressure?
Most cases of hypertension (>95%) are of "unknown" origin. We call these cases "Essential Hypertension". Blood pressure levels are determined by many different factors - pulse rate, heart pumping volume ("stroke volume"), hormones, blood vessel elasticity and diameter, salt and fluid levels etc. Your blood pressure is a result of controlling these many different factors. Hypertension is probably not due to one single factor and probably a combination of different things. Some people have hypertension due to a definite underlying illness ("Secondary Hypertension") and the underlying illness is usually relating to the kidneys - however, these cases are very much in the minority. There tends to be a familial tendency to get hypertension and many factors can theoretically contribute to you developing this illness - lack of exercise, poor diet, obesity or just plain bad luck.

What investigations are necessary?
When you have been first diagnosed, you will need several routine investigations. We will need to test your urine for protein. This is done by putting a special dipstick into a sample of urine. You may need an ECG to see if your heart is enlarged. An enlarged heart can indicate that you have had your hypertension for a long time. You will also need a few blood tests for U&E, Thyroid function, Lipids and possibly LFT. We do these tests as part of our investigations or they may need to be done prior to starting certain treatments. These are the routine tests.
(If hypertension occurs in a young (<35yrs) individual, we may need to do additional tests such as an ultrasound scan of the kidneys or even refer to a specialist - but this is the exception rather than the rule, and these tests are NOT done on everyone.)

Treatment
Our goal is to get your blood pressure below 150/90 for non diabetics or 140/80 in Diabetics. Treatment is in a stepwise approach. Our aim is to control your blood pressure and reduce any other risk factors, WITHOUT leaving you with side effects. Remember that high blood pressure is symptom less. If you walk into the surgery with a dangerously high blood pressure, but feeling great, it is likely that you will not take your tablets if they give you side effects! We are aware of this problem and try to tailor treatment to each individual.

Lifestyle measures

Sometimes, hypertension may be controlled by giving one type of tablet, but more often patients need several different tablets with different modes of action. There is some evidence that several tablets at a low dose are tolerated better than one tablet at high dose. Patients over 50yrs with certain risk factors may be advised to take aspirin. If you cholesterol is high enough, you may be advised treatment with a tablet called a "statin" (e.g. Fluvastatin, Atorvastatin, Simvastatin, etc). If you are taking a statin, we will need to keep an eye on a chemical called "creatine kinase" in the blood. We do this by taking an "LFT" blood test (see above). You will also need to modify any other risk factors (see below).
We usually start treatment in a stepwise approach, starting with a "diuretic" or "water tablet" e.g. Bendroflurazide or Frusemide. These tablets act primarily by reducing the circulating volume of fluid (a bit like bleeding fluid from a radiator to reduce the pressure!). Diuretics may aggravate or trigger an attack of gout. The next tablet added is often a "beta-blocker" e.g. Atenolol and this acts by slowing the pulse (slowing the pump to reduce the pressure). Asthmatics cannot take beta-blockers. The next treatment would be a "calcium antagonist" e.g. Nifedipine or Adipine. These tablets act by relaxing the vessel walls so that the pressure within them drops. When vessels dilate, there may be numerous effects. The blood pressure within drops but if the vessels are in your cheeks, you may notice flushing. If the vessels are in the legs, the dilatation may produce a little ankle swelling. One of the most useful blood pressure tablets are called "ACE inhibitors" e.g. Ramipril (Tritace) or Perindopril. These tablets have a number of additional benefits besides lowering blood pressure (especially in Diabetics). They act by reducing the levels of a potent vasoconstrictor (a vasoconstrictor is a hormone that makes blood vessels narrow down, thus increasing the pressure within). These are just a few examples of the more common medicines used.

"How often do I need to see the Doctor?"
As soon as your blood pressure is under control you may be able to see the Health Care Assistant once every 6 months for routine blood pressure check. Any problems detected during routine surveillance will be brought to the Doctor's attention. If your blood pressure is poorly controlled or if there are problems, we may need to see you more often. If you are taking "water tablets" (e.g. Bendroflurazide, co-amilofruse, frusemide etc) or an "ACE inhibitor" (e.g. Ramipril, Lisinopril or Perindopril), you will need an annual U&E blood test. This will usually be indicated when you have run out of repeat prescriptions. If your blood lipids (e.g. cholesterol) is raised to a level that requires treatment, this will also need to be tested annually.

What are "Risk Factors"?
Hypertension is one risk factor amongst many for developing disease of the blood vessels ("Atherosclerosis"). This puts you at a higher risk of heart attacks, angina, strokes etc. These diseases are some of the biggest killers in the Bridgend area.
Other risk factors include smoking, inactivity, poor diet, family history, cholesterol levels, obesity etc. You should modify your lifestyle to reduce your risk factors if you can. Our section on "Heart Attacks" gives more details about this and includes a downloadable version of our low cholesterol diet for you to print out if you wish.

"I don't think that I have high blood pressure, but I just want it checked. Who should I see?"
The Health Care Assistant! You do not have to see the Doctor just to have your blood pressure checked. Our nurses no longer see patients for routine blood pressure check (we have employed Health Care Assistants to do this to free up more nurse time), but you could see a nurse at work or even at some Chemists! Don't think that it should be normal just because you feel "well". Hypertension is a silent disease. You will probably not have symptoms if it is high.

"You haven't told me anything that I don't know already! Where can I learn more?"
There are many leaflets available at the surgery. If you are looking elsewhere on the Internet, be careful. There is a lot of unverified rubbish out there. Stick with reputable sources of information such as the British Heart Foundation - www.bhf.org.uk - but remember that we are not responsible for the validity of any information obtained via external links from this site.

British Hypertension Society - Information service
Blood pressure Unit, Dept. of Physiological Medicine, St George's Hospital Medical School, Cranmer Tce, London SW17 0RE  02087252959
bhsis@sghms.ac.uk
www.hyp.ac.uk/bhs/home.htm

Blood Pressure Association
60 Cranmer Tce, London SW17 0QS 02087724994 Membership: 02087744983
www.bpassoc.org.uk

Cardiac Risk Assessment Clinic
Family History of heart disease? Worried about your heart? Aged over 40? There is a special clinic available to all at the Princess of Wales Hospital Bridgend.
Contact Delyth Townsend at the Coronary Heart Disease Risk Clinic at the Princess of Wales Hospital on 01656 752759 for an appointment. You do not need to see your GP to be referred to this clinic.

If you are a patient with our practice and would like us to include any further information on this page we would welcome your comments. You can contact us by using the "Feedback" button on the homepage. We regret that we are unable to comment on any personal or individual cases. For this reason, we ask that you do not send any requests for medication, personal questions for Doctors, etc.

We will add to this page, depending on feedback from our patients. We regret that we cannot answer individual or personal questions online.

The information contained on this site is general information which is not in any way intended to replace the specific advice that patients may obtain from their own doctor about individual care.

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