High blood pressure - worse as you get older
High blood pressure (hypertension) affects us more as we get older, says Dr Chris Browne.
About three in ten adults in the UK have high blood pressure. It's much more common in older people - seven out of ten people over 70 have high blood pressure.
People of Afro-Caribbean heritage are more likely to have high blood pressure than those of other backgrounds who live in this country.
Blood pressure is the force that the blood applies to the walls of the arteries as it flows through them. It increases during exercise and when you feel stressed or anxious.
If your blood pressure is consistently higher than the healthy level when at rest, this is high blood pressure (hypertension).
Two types of high blood pressure
There are two types of high blood pressure:
More than nine in ten people with high blood pressure have primary hypertension. This means that it has no single clear cause.
Primary hypertension is caused by many factors including:
- Hereditary factors – genetics;
- Walls of the larger arteries lose their elasticity and become rigid – smoking a major factor;
- Arteries narrowing because of ‘furring up’ – too much fatty food;
- Obesity – puts greater strain on cardiovascular system;
- Excessive drinking – increases anxiety;
- Lack of exercise – to be efficient cardiovascular system requires regular exercise.
Secondary hypertension, which only affects about one in 20 sufferers of high blood pressure, is linked to a recognised cause including:
- kidney disease;
- endocrine disease – a disorder preventing hormones working properly;
- a narrowing of the aorta or the arteries leading to the kidneys;
- the contraceptive pill;
- pregnancy, which can cause pre-eclampsia.
High blood pressure increases the risk of major illnesses including:
- cardiovascular disease such as angina, stroke, heart attack and irregular heart beat;
- kidney failure;
- impaired vision.
Very high blood pressure, or a rapid rise in blood pressure, can lead to headaches, deterioration of the sight, fits and black-outs.
However, most people with high blood pressure don't have any symptoms and it will only be discovered when they have blood pressure taken as part of a medical examination…why a regular check-up is a wise move.
What the measurements mean
Blood pressure is measured with a monitor linked to a cuff placed around the upper arm.
It is expressed as two numbers, such as 120/80, which is a healthy blood pressure.
The first figure - the systolic blood pressure - is a measure of the pressure when the heart muscle is contracted and pumping blood. This is the time of maximum pressure.
The second figure - the diastolic blood pressure - is the pressure when the heart is resting and filling with blood. This is the time of minimum pressure.
High blood pressure, or hypertension, is when systolic blood pressure is consistently 140 or over and/or diastolic blood pressure is 90 or over when the patient has not been doing any significant exercise.
For those with diabetes, blood pressure of more than 130/80 is considered hypertension.
If the reading is high
It is normal for your GP to ask you to return for repeat measurements and other tests.
These may include:
- a urine test - protein in the urine can detect a kidney problem;
- a blood test to check the condition of your kidneys; and cholesterol and blood sugar levels;
- an electrocardiogram (ECG) – to check the condition of the heart.
You may be given a 24-hour ambulatory monitoring to confirm the diagnosis.
A monitoring device will be strapped round your waist and attached to a cuff wrapped around your upper arm. The cuff will inflate and deflate automatically throughout the 24 hours and record your blood pressure.
Blood pressure monitors
Discuss with your GP the value of getting a domestic blood pressure monitor for use at home.
The Blood Pressure Association has a list of clinically validated blood pressure monitors.
Continue to have your blood pressure tested regularly by your GP even if you use a blood pressure monitor at home.
High blood pressure is not curable, but requires long-term treatment
If you have very high blood pressure, you may need to go to hospital for short term treatment.
More likely is treatment by your GP and/or a nurse. If appropriate they will advise you to:
- stop smoking;
- change your diet to a low-fat, low-salt diet;
- eat more fruit and vegetables;
- cut down on alcohol;
- cut down on caffeine drinks;
- take regular exercise;
- lose any excess weight;
- reduce stress in your life with relaxation techniques or meditation.
If your blood pressure remains high, your GP may prescribe one or more of the following antihypertensive medicines:
- ACE inhibitors (eg ramipril) or angiotensin II receptor antagonists (such as candesartan cilexetil eg Amias) - to relax and widen the walls of the blood vessels;
- Calcium-channel blockers (eg amlodipine) and Alpha blockers (eg doxazosin) - to widen the blood vessels;
- Diuretics (eg bendroflumethiazide) - these increase the amount of water removed by your kidneys from your blood which lowers the volume of your blood which reduces blood pressure;
- Beta-blockers (eg atenolol) - these reduce pulse rate at rest and when you exercise.
What your GP prescribes will depend on factors including age and ethnicity. It may take time to find the best treatment.
If medicines to treat hypertension are prescribed, you must take them according to the instructions, even if you don't have any symptoms of high blood pressure.
The Blood Pressure Association
This organisation is the UK's largest body that aims to prevent unnecessary death and disability from heart disease, heart attacks and stroke caused by high blood pressure.
It provides a wide range of information and support services, as well as funding research into the treatment and prevention of high blood pressure.