Hypertension

What is hypertension?

Hypertension is a condition in which the blood pressure is persistently higher than normal. It is more common in men than women, especially from middle age onwards.

The pressure of the blood as it flows through the arteries and veins varies naturally. It is lower when the body is at rest and rises during physical exertion. It can also rise temporarily in response to stress. However, if your blood pressure is persistently higher than normal, even when you are resting or relaxed, you are suffering from hypertension.

High blood pressure puts extra strain on the heart and the circulatory system. It poses a serious risk to health by increasing the likelihood of coronary artery disease, heart attack, stroke and kidney disease. Occasionally, it can give rise to other serious complications. The increased risk relates not only to how high your blood pressure is but for how long it has remained raised.

What causes hypertension and who is at risk?

There is very often no single direct cause of hypertension. For many people, high blood pressure is a natural consequence of getting older; this is known as 'essential hypertension'. There is some evidence that essential hypertension is genetically linked.

The arteries harden and become narrower as a result of ageing or a high fat diet. This restricts the circulation of blood through the body making the heart work harder to keep the blood flowing. This increases blood pressure.

A number of factors can increase the risk of hypertension or make the problem worse. These include:

• Lack of exercise
• Stress
• Smoking
• Obesity
• Excess alcohol consumption

Sometimes, however, there are specific causes. These include:

• Kidney problems
• Some heart conditions
• Complications during pregnancy
• Certain hormone imbalances
• Side effects of drugs such as steroids or 'hair-restoring' creams

What are the common symptoms and complications of hypertension?

Essential hypertension produces few, if any, specific symptoms. It is usually diagnosed by chance when your blood pressure is measured as part of a routine health check or during an examination for another problem or after a stroke or heart attack.

When very severe, hypertension can produce:

• Breathlessness
• Headaches
• Dizziness

Symptoms of complications include:

• Kidney problems
• Eye problems
• Seizures ('fits')

How do doctors recognise hypertension?

The diagnostic test for high blood pressure is simply measuring blood pressure over a period of time to see if it consistently higher than normal. Other investigations that may be carried out if high blood pressure is thought to be a problem are an ECG (an electrocardiogram) which measures the electrical activity of the heart, a chest X-ray to see if the heart is enlarged, blood tests and possibly investigations of the kidneys.

What is the treatment for hypertension?

Self-care action plan

Most people have had their blood pressure measured at some time.

However, as you reach middle age (especially if you lead a sedentary life), it becomes more important to have your blood pressure checked as a matter of routine. It is a quick and simple procedure. The doctor places an inflatable band or 'cuff' around your upper arm about level with your heart and inflates it with a hand-held pump. A gauge indicates how much pressure the cuff is exerting. As it tightens around the upper arm, the cuff restricts the flow of blood. By allowing the cuff to deflate slowly, the doctor can tell at what pressure the blood starts to flow by feeling and listening with a stethoscope for your pulse.

When assessing whether your blood pressure is abnormally high, the doctor will consider your medical history, your general fitness, your lifestyle and your age (blood pressure tends to be higher the older you are). The doctor will also compare your current blood pressure with records of your previous tests. If you have not had your blood pressure measured before, you will probably have to make one or more return visits so that the doctor has a series of readings to confirm the diagnosis of hypertension.

Treating hypertension is very much a team effort between you and your doctor. If your blood pressure is only slightly raised or if there is no specific cause for hypertension, treatment usually centres around adopting a more healthy lifestyle. The doctor may advise you to:

• Give up smoking
• Lose weight
• Take more exercise
• Improve your diet
• Eat less fatty food
• Avoid stress
• Learn to relax

Medicines

In more serious cases or if the measures above are not effective, medication (usually in the form of tablets) may be prescribed. There are many different types of medicines for high blood pressure but some of the most common are known as beta blockers. By relaxing the muscle around the arteries and slowing the heart rate, these drugs tend to increase the flow of blood through the arteries which results in a drop in pressure. Other drugs called calcium channel blockers (such as nifedipine) are also commonly prescribed. Once these drugs have reduced your blood pressure, you must keep taking them. They are only a treatment not a cure.

Complementary therapy

A variety of complementary treatments are available for hypertension. However, there is no conclusive research evidence to prove that any complementary medicines (eg homeopathic medicines and herbal remedies) are beneficial and do not have harmful effects.

Therapies such as the Alexander technique, reflexology, relaxation and visualisation, yoga and tai chi may help promote a sense of well-being and reduce stress which exacerbates high blood pressure.

What is the outcome of hypertension?

You can greatly reduce your risk of developing hypertension by adopting a healthy lifestyle. If you already suffer from hypertension, you can reduce your risk of complications by following the lifestyle advice provided by your doctor.

Once you have been diagnosed as having hypertension, it is important to visit your doctor regularly to have your blood pressure measured. This enables a regular record to be built up and the progress of your hypertension to be monitored.

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