17649 Blood Pressure

Overview

Blood pressure is the force of your blood pushing against the walls of your arteries (the tubes that carry blood away from your heart). It is written as two numbers, like 120 over 80. The top number (systolic) is the pressure when your heart squeezes and pumps. The bottom number (diastolic) is the pressure when your heart relaxes between beats. Blood pressure that stays too high is called high blood pressure, or hypertension. Blood pressure that drops too low is called low blood pressure, or hypotension. High blood pressure usually causes no symptoms, so many people only find out when it is measured.

Yes. High blood pressure is very common — roughly one in three adults in the UK has it, and many do not know. Low blood pressure is much less common and only matters if it causes symptoms.

Anyone can have high blood pressure, but it becomes more common as we get older. It is more likely if it runs in your family, if you are of Black African or Black Caribbean heritage, or if you have kidney disease or diabetes. Lifestyle also plays a big part — being overweight, eating a lot of salt, drinking too much alcohol, smoking and not being active all raise the chance. Children can have high blood pressure too, usually because of another health condition, so it is checked as part of routine child health reviews.

Symptoms

Common symptoms

• Most people with high blood pressure feel completely well and have no symptoms at all.
• Headaches and nosebleeds are often blamed on blood pressure, but they are not reliable signs — only a measurement can tell you.
• Very high blood pressure can sometimes cause headaches, blurred vision, chest tightness or breathlessness.
• Low blood pressure can cause dizziness, feeling faint, blurred vision, tiredness or feeling sick, especially when standing up quickly.

Symptoms in children

• Children with high blood pressure usually have no symptoms and it is picked up on a routine check.
• It is often linked to another condition, such as a kidney or heart problem, or to being overweight.
• Headaches, poor growth, or tiredness can occasionally be a sign, so these should be checked by a doctor.

Symptoms in older adults

• In older adults the top number often rises while the bottom number stays normal — this is common and still worth treating.
• Dizziness or light-headedness when standing up (called postural hypotension) is more common with age and with some medicines.
• Blood pressure can drop too low if medicines are too strong, so regular reviews are important.

Causes

Main causes

• In most people there is no single cause — this is called primary or essential high blood pressure, and it develops slowly over years.
• Sometimes another condition is the cause, such as kidney disease, an overactive thyroid, sleep apnoea (loud snoring with pauses in breathing), or narrowing of the arteries to the kidneys.
• Some medicines, such as certain painkillers, decongestants and some hormonal treatments, can raise blood pressure.
• Low blood pressure can be caused by dehydration, standing up quickly, some medicines, hormonal conditions, or heart problems.

Risk factors

• Getting older
• Family history of high blood pressure
• Being of Black African, Black Caribbean or South Asian heritage
• Being overweight or carrying weight around the waist
• Eating a lot of salt
• Drinking too much alcohol
• Smoking
• Not being physically active
• Poor sleep, including sleep apnoea
• Long-term stress
• Having diabetes, kidney disease or high cholesterol
• Pregnancy (blood pressure is checked regularly for this reason)

When to see a doctor

See a doctor urgently if:

• You have chest pain, sudden weakness or numbness, trouble speaking, or sudden vision changes — call your local emergency number straight away
• A home reading of 180/120 or above, even without symptoms
• You feel faint, dizzy or have fallen more than once
• You have a very high reading and feel unwell

Book a routine appointment if:

• You have not had your blood pressure checked in the last few years, especially if you are over 40
• You have a home reading that is regularly above 135/85, or a clinic reading above 140/90
• You have a family history of high blood pressure, stroke or heart attack
• You have diabetes, kidney disease or are pregnant
• You have ongoing headaches, breathlessness or swollen ankles
• You are taking blood pressure medicine and want a review or have new side effects

Diagnosis

High blood pressure is found by measuring it. A cuff is wrapped around your upper arm and gently inflated. Usually your doctor will take more than one reading at more than one visit. Often they will ask you to use a home monitor, or lend you a device that records your blood pressure every half hour over 24 hours — this is called ambulatory monitoring and gives a very reliable picture.

Tests that may be done

• Repeated clinic blood pressure readings, taken while you are sitting and relaxed
• Home blood pressure readings, usually twice a day for about a week
• A 24-hour ambulatory monitor (a small cuff worn day and night)
• A urine test to check your kidneys
• Blood tests for kidney function, cholesterol and blood sugar
• An ECG (a heart tracing) if there is a reason to check your heart
• An eye check, because very high blood pressure can affect the small blood vessels at the back of the eye
• Occasionally a scan of the kidneys or hormone tests, if your doctor thinks another condition may be the cause
• Blood pressure checks at other stages, such as during pregnancy

What to expect at your appointment

A check takes a few minutes and is painless, though the cuff feels tight for a moment. You will be asked to sit quietly for five minutes first, with your feet flat and your arm supported. Try to avoid coffee, cigarettes and exercise for 30 minutes beforehand. If you are asked to monitor at home, your doctor or pharmacist can show you how to use the cuff and record the results. Results are usually discussed with you soon afterwards, and you will be told whether any treatment or further tests are needed.

Treatment

Treatment aims to bring your blood pressure into a healthier range and so lower your long-term risk of heart attack, stroke and kidney problems. For some people, healthy changes alone are enough. Others also need medicine. If your blood pressure is only slightly raised, your doctor may suggest lifestyle changes first and check again in a few months. For low blood pressure, treatment focuses on the cause — for example, drinking more fluids, changing a medicine, or standing up more slowly.

Self-care at home

• Check your blood pressure regularly at home if you have a monitor, and keep a simple record
• Take any prescribed medicine every day, even when you feel well — high blood pressure has no symptoms
• Cut down on salt — aim for no more than about a teaspoon a day, and check labels for hidden salt
• Eat plenty of fruit, vegetables, whole grains, beans and low-fat dairy
• Be active — aim for about 150 minutes a week of moderate activity such as brisk walking
• Keep to a healthy weight, and ask your doctor or pharmacist for support if you want to lose weight
• Limit alcohol to no more than 14 units a week, spread over several days
• Stop smoking — your pharmacist or GP can help with free support
• Get enough sleep and manage stress where you can
• If you feel dizzy when standing, get up slowly and drink enough water

Medical treatments

If lifestyle changes are not enough, your doctor may prescribe medicine to lower your blood pressure. There are several different types, and they work in different ways — some help your body get rid of extra salt and water, some relax your blood vessels, and others slow your heart. Your doctor will choose based on your age, your background, other conditions you have, and any other medicines you take. You may need more than one medicine, and the dose may be adjusted over time. Never stop or change medicine on your own — speak to your doctor or pharmacist first, especially if you have side effects, because there is usually another option to try. If your blood pressure is too low and causing symptoms, your doctor may review your medicines, ask you to drink more fluids, or suggest other changes.

When is surgery considered?

Surgery is rarely used for ordinary high blood pressure. It may be considered if a specific cause is found — for example, a narrowed artery to a kidney or a hormone-producing growth. Your doctor would discuss this with you and refer you to a specialist if needed.

Living with this condition

Living with high blood pressure is mostly about steady habits rather than big sacrifices. Many people find it helps to build a routine: take your medicine at the same time each day, keep a home monitor and note your readings, and go for regular check-ups. Blood pressure can change with illness, hot weather, travel and stress, so occasional odd readings are normal. Keep a record and bring it to your appointments. If you have low blood pressure, plan ahead for hot days, stand up slowly, and drink plenty of water.

Lifestyle tips

• Plan meals around vegetables, beans and whole grains, and cook more at home so you control the salt
• Find an activity you enjoy and do it regularly — walking, swimming, cycling or dancing all count
• Keep a home blood pressure log and bring it to appointments
• Use a pill organiser or phone reminder if you find it hard to remember your medicine
• Cut back on very salty foods such as processed meats, ready meals, stock cubes and some breads and sauces
• Keep alcohol within recommended limits and have several drink-free days a week
• Get support to stop smoking — it is one of the biggest things you can do for your heart
• Weigh yourself occasionally rather than every day, and focus on trends, not single numbers

Diet and exercise

A heart-friendly eating pattern — sometimes called a Mediterranean-style diet — is rich in vegetables, fruit, beans, nuts, olive oil, fish and whole grains, and low in salt and processed food. Reading food labels for salt and choosing fresh over packaged makes a big difference. For activity, aim for about 150 minutes of moderate exercise a week, such as brisk walking, plus some gentle strength work twice a week. Start where you are and build up. If you have other health conditions, ask your doctor what is safe for you.

Mental health and emotional wellbeing

Being told you have high blood pressure can feel worrying, and checking your numbers can become stressful. That is very common. Stress itself can raise blood pressure for a while, so it is worth finding ways to unwind — breathing exercises, time outdoors, talking to friends, or a hobby you enjoy. If you feel anxious or low for weeks, tell your doctor. Support is available, and talking about it helps.

Prevention

Often, yes — or at least delayed. High blood pressure is not always preventable, especially as we get older or if it runs in the family, but healthy habits lower your risk a lot and help keep your numbers in a safer range. The same habits protect your heart, brain and kidneys.

Vaccines

There is no vaccine for blood pressure. Keeping up with routine vaccinations, such as flu and other recommended jabs, is still worthwhile because infections can be harder on your heart and body.

Screening programmes

In the UK, adults aged 40 to 74 are usually offered a free NHS Health Check every five years, which includes blood pressure. Many pharmacies also offer free blood pressure checks without an appointment. Blood pressure is checked at most GP appointments, during pregnancy, and as part of reviews for diabetes, kidney disease and heart disease. If you have not been checked recently, it is worth asking.

Complications

If left untreated

• Heart attack and heart failure, because the heart has to work harder
• Stroke, from damage to the blood vessels in the brain
• Kidney damage and kidney disease over time
• Damage to the small blood vessels in the eyes, which can affect sight
• Narrowing and stiffening of the arteries, which can affect circulation to the legs
• Vascular dementia, linked to reduced blood flow to the brain
• For low blood pressure, falls and injuries from fainting, especially in older adults

Long-term outlook

The outlook is genuinely good. Blood pressure is one of the most treatable things in medicine. Many people bring their numbers into a healthy range with a few steady changes, and medicines work well when they are needed. Regular checks mean problems are spotted early, when they are easiest to manage. Small steps — less salt, more walking, taking your medicine — add up to a real difference over the years.

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