1. Hypertension (high blood pressure) Dr. Fiona Gillan GP Registrar at Church End Medical Centre

2. Structure of talk  What is blood pressure and how do we measure it?  What is high blood pressure? -Causes, why does it need to be diagnosed? (cardiovascular risk), how is it diagnosed?  What can we do about it including how to prevent it  Conclusion  Questions

3. What is blood pressure?  Blood pressure is the pressure of blood in your blood vessels (arteries).  It is measured in millimetres of mercury (mm Hg).  There are two figures eg. 150/95 mm Hg. This is said as 150 over 95.  The top (first) number is the systolic pressure. This is the pressure in the arteries when the heart contracts.  The bottom (second) number is the diastolic pressure. This is the pressure in the arteries when the heart rests between each heartbeat.

4. How do we measure it?  Clinic/GP surgery blood pressure readings  Home blood pressure readings  Ambulatory (mobile) blood pressure readings  As a rule, an average of the ambulatory blood pressure readings gives the most true account of your usual blood pressure.

5. What is high blood pressure (hypertension)?  High blood pressure is a blood pressure that is 140/90 mm Hg or above each time it is taken at the GP surgery (or home or ambulatory readings always more than 135/85 mm Hg) i.e. it is sustained at this level.  Plus, can be either just a high systolic pressure – eg. 170/70 mm Hg.  Just a high diastolic pressure – eg. 120/104 mm Hg.  Or both – eg. 170/110 mm Hg.  However, depending on various factors, the level at which blood pressure is considered high enough to be treated with medication can vary from person to person.

6. What causes high blood pressure? The cause is not known in most cases (essential hypertension) The pressure in the blood vessels (arteries) depends on how hard the heart pumps, and how much resistance there is in the arteries. The cause of the slight narrowing of the arteries is not clear. Various factors probably contribute. Common in older people In some cases, high blood pressure is caused by other conditions (secondary hypertension) eg. certain kidney or hormone problems.

7. Why is high blood pressure a problem?  High blood pressure is a risk factor for developing a cardiovascular disease (such as a heart attack or stroke), and kidney damage, sometime in the future.  If you have high blood pressure, over the years it may do some damage to your blood vessels (arteries) and put a strain on your heart.  In the UK, cardiovascular diseases are a major cause of poor health and the biggest cause of death.

8. Cardiovascular risk Everybody has some risk of damaging their blood vessels, some at increased risk. Can change/prevent Treatable/partly treatable Fixed Smoking Lack of physical activity Obesity Unhealthy diet Excess alcohol High BP High cholesterol High fat blood levels Diabetes Kidney diseases that affect kidney function Strong family history Being male Early menopause in women Age Ethnic group

9. Why do we check blood pressure?  High blood pressure (hypertension) usually causes no symptoms.  Therefore you will not know if you have high blood pressure unless you have your blood pressure checked.  Everyone should have regular blood pressure checks at least every five years.  More frequent (annually) in people: -Who are older -Who have had a previous high reading -With diabetes

10. How is high blood pressure diagnosed?  A one-off blood pressure reading that is high does not mean that you have 'high blood pressure’.  Only diagnosed if you have high blood pressure recorded on several readings, which are taken on different occasions, when you are relaxed.  Therefore usually there is a period of observation where these several readings can be taken.  These results will then be reviewed by your GP and the results discussed with you.

11. How can we lower blood pressure?  Two ways: 1.Lifestyle changes 2.Medications

12. Lifestyle changes  Lose weight if you are overweight  Take more physical activity  Eat a healthy diet  Have a low salt intake  Limit your caffeine intake  Drink alcohol in moderation  Stop smoking

13. Medication Medication to lower blood pressure is usually advised for:  All people who have a blood pressure that remains at 160/100 mm Hg or above after a trial of any relevant lifestyle changes.  People with a blood pressure that remains at 140/90 mm Hg or above after a trial of any relevant lifestyle changes AND who have: -Diabetes; or -An existing cardiovascular disease; or -A 2 in 10 risk or more of developing a cardiovascular disease within the next 10 years.  People with a blood pressure of 130/80 mm Hg or more who have certain diseases.

14. Medication contd.  Some medicines work well in some people, and not so well in others.  It is common to need 2 or more different medicines to reduce high blood pressure to a target level. (Sometimes 3 or more are required).  Although reaching a target BP level is ideal, you will benefit from any reduction in blood pressure.  In most cases, medication is needed for life.

15. Key points about medication  Important to remember to take your medicine(s)  Better to take at the same time each day  Report any side effects you notice  Necessary to have at least annual blood tests to check other risk factors for cardiovascular disease eg. Diabetes, and to monitor effect of medicines on organs of the body  Although you are taking a medication for your blood pressure, important to also follow lifestyle advice

16. Conclusion  High blood pressure doesn’t usually present with symptoms, therefore the only way to tell whether you have high BP is to have it checked  High blood pressure is an important risk factor for developing more serious diseases of the heart and blood vessels, therefore by managing it well, it can reduce your risk of progression to these diseases.  There are a number of ways to lower blood pressure by altering your lifestyle, although sometimes medication is required.

17. Any questions?  References: -patient.co.uk ‘High blood pressure (hypertension)’ condition leaflet -‘Estimating cardiovascular risk’ article in InnovAiT Volume 7 Issue 6 June 2014 Thank you for listening