Blood Pressure (high)

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Introduction

High Blood Pressure (Hypertension)

High blood pressure, or hypertension, rarely has noticeable symptoms. But if untreated, it increases your risk of serious problems such as heart attacks and strokes.

More than one in four adults in the UK have high blood pressure, although many won't realise it.

The only way to find out if your blood pressure is high is to have your blood pressure checked

This page covers:

What is high blood pressure?

Health risks

Checking your blood pressure

Causes

Reducing your blood pressure

Medication for high blood pressure

What is high blood pressure?

Blood pressure is recorded with two numbers. The systolic pressure (higher number) is the force at which your heart pumps blood around your body.

The diastolic pressure (lower number) is the resistance to the blood flow in the blood vessels. They're both measured in millimetres of mercury (mmHg).

As a general guide:

  • high blood pressure is considered to be 140/90mmHg or higher
  • ideal blood pressure is considered to be between 90/60mmHg and 120/80mmHg
  • low blood pressure is considered to be 90/60mmHg or lower

A blood pressure reading between 120/80mmHg and 140/90mmHg could mean you're at risk of developing high blood pressure if you don't take steps to keep your blood pressure under control.

Find out more about what your blood pressure result means.

Risks of high blood pressure

If your blood pressure is too high, it puts extra strain on your blood vessels, heart and other organs, such as the brain, kidneys and eyes.

Persistent high blood pressure can increase your risk of a number of serious and potentially life-threatening conditions, such as:

If you have high blood pressure, reducing it even a small amount can help lower your risk of these conditions.

Check your blood pressure

The only way of knowing whether you have high blood pressure is to have a blood pressure test.

All adults over 40 are advised to have their blood pressure checked at least every five years. Getting this done is easy and could save your life.

You can get your blood pressure tested at a number of places, including:

  • at your GP surgery
  • at some pharmacies
  • as part of your NHS Health Check
  • in some workplaces

You can also check your blood pressure yourself with a home blood pressure monitor.

Read more about getting a blood pressure test.

Causes of high blood pressure

It's not always clear what causes high blood pressure, but certain things can increase your risk.

You're at an increased risk of high blood pressure if you:

  • are over the age of 65
  • are overweight or obese
  • are of African or Caribbean descent
  • have a relative with high blood pressure
  • eat too much salt and don't eat enough fruit and vegetables
  • don't do enough exercise
  • drink too much alcohol or coffee (or other caffeine-based drinks)
  • smoke
  • don't get much sleep or have disturbed sleep

Making healthy lifestyle changes can help reduce your chances of getting high blood pressure and help lower your blood pressure if it's already high.

Read more about the causes of high blood pressure.

Reduce your blood pressure

The following lifestyle changes can help prevent and lower high blood pressure:

Some people with high blood pressure may also need to take one or more medicines to stop their blood pressure getting too high.

Read more about how to keep your blood pressure healthy.

Medicines for high blood pressure

If you're diagnosed with high blood pressure, your doctor may recommend taking one or more medicines to keep it under control.

These usually need to be taken once a day.

Common blood pressure medications include:

  • ACE inhibitors - such as enalapril, lisinopril, perindopril and ramipril
  • angiotensin-2 receptor blockers (ARBs) - such as candesartan, irbesartan, losartan, valsartan and olmesartan
  • calcium channel blockers - such as amlodipine, felodipine and nifedipine or diltiazem and verapamil.
  • diuretics - such as indapamide and bendroflumethiazide
  • beta-blockers - such as atenolol and bisoprolol
  • alpha-blockers - such as doxazosin
  • renin inhibitors - such as aliskiren
  • other diuretics - such as amiloride and spironolactone

The medication recommended for you will depend on things like how high your blood pressure is and your age.

Read more about how blood pressure is treated.


Causes

Causes

In most cases, it's not clear exactly what causes high blood pressure (hypertension). But there are several things that can increase your risk.

Who's at risk of high blood pressure?

Factors that can raise your risk of developing high blood pressure include:

  • age - the risk of developing high blood pressure increases as you get older
  • a family history of high blood pressure
  • being of African or Caribbean origin
  • a high amount of salt in your food 
  • a lack of exercise
  • being overweight or obese
  • regularly drinking large amounts of alcohol
  • smoking
  • long-term sleep deprivation

Making healthy lifestyle changes can help keep your blood pressure at a normal level.

Read more about how to prevent high blood pressure.

Known causes of high blood pressure

In about 1 in 20 cases, high blood pressure occurs as the result of an underlying condition, medication or drug.

Conditions that can cause high blood pressure include:

Medicines and drugs that can increase your blood pressure include:

In these cases, your blood pressure may return to normal once you stop taking the medicine or drug.

Adrenaline
Adrenaline is a hormone produced at times of stress that affects heart rate, blood circulation and other functions of the body.
Genetic
Genetic is a term that refers to genes- the characteristics inherited from a family member.
Heart attacks
A heart attack happens when there is a blockage in one of the arteries in the heart.
Kidney
Kidneys are a pair of bean-shaped organs located at the back of the abdomen, which remove waste and extra fluid from the blood and pass them out of the body as urine.
Origin
The origin is the place where something begins.

Diagnosis

Diagnosis

High blood pressure (hypertension) doesn't usually have any symptoms, so the only way to find out if you have it is to get your blood pressure checked.

Healthy adults aged over 40 should have their blood pressure checked at least once every five years.

If you're at an increased risk of high blood pressure, you should have your blood pressure checked more often - ideally once a year.

Having this done is easy and could save your life.

This page covers:

Where to get tested

What the test involves

Ambulatory (24-hour) monitoring

Home testing

What your result means

Where to get a blood pressure test

You can ask for a blood pressure check - you don't have to wait to be offered one.

Blood pressure testing is available:

  • at your GP surgery - by a GP, practice nurse, healthcare assistant or self-service machine
  • at some pharmacies
  • at an NHS Health Check appointment offered to adults aged 40-74 in England
  • in some workplaces
  • at a health event

You can also test your blood pressure at home using a home testing kit.

The test

A stethoscope, arm cuff, pump and dial was normally used to measure your blood pressure, but automatic devices with sensors and digital displays are commonly used nowadays.

It's best to sit down with your back supported and legs uncrossed for at least five minutes before the test.

You'll usually need to roll up your sleeves or remove any long-sleeved clothing so the cuff can be placed around your upper arm. Try to relax and avoid talking while the test is carried out.

During the test:

  • you hold out one of your arms so it's at the same level as your heart, and the cuff is placed around it - your arm should be supported in this position with a cushion or the arm of a chair, for example 
  • the cuff is pumped up to restrict the blood flow in your arm - this squeezing may feel a bit uncomfortable, but only lasts a few seconds
  • the pressure in the cuff is slowly released and detectors sense vibrations in your arteries - a doctor will use a stethoscope to detect these if your blood pressure is measured manually
  • the pressure in the cuff is recorded at two points as the blood flow starts to return to your arm - these measurements are used to give your blood pressure reading

You can usually find out your result straight away, either from the healthcare professional carrying out the test or on the digital display.

If your blood pressure is high, you may be advised to record your blood pressure at home to confirm whether you have high blood pressure.

Ambulatory (24-hour) monitoring

Having a raised blood pressure reading in one test doesn't necessarily mean you have high blood pressure.

Blood pressure can fluctuate throughout the day. Feeling anxious or stressed when you visit your GP can also raise your blood pressure.

If you have a high reading, you may be asked to take some readings with a home blood pressure monitor or wear a 24-hour monitor that checks your blood pressure throughout the day. This will confirm whether you have consistently high blood pressure.

This is known as 24-hour or ambulatory blood pressure monitoring (ABPM). 

Home testing

Blood pressure tests can also be carried out at home using your own digital blood pressure monitor.

Like 24-hour or ambulatory monitoring, this can give a better reflection of your blood pressure. It can also allow you to monitor your condition more easily in the long term.

You can buy a variety of low-cost monitors so you can test your blood pressure at home or while you're out and about.

It's important to make sure you use equipment that has been properly tested. The British Hypertension Society (BHS) has information about validated blood pressure monitors that are available to buy.

Understanding your blood pressure reading

Blood pressure is measured in millimetres of mercury (mmHg) and is given as two figures:

  • systolic pressure - the pressure when your heart pushes blood out
  • diastolic pressure - the pressure when your heart rests between beats

For example, if your blood pressure is "140 over 90", or 140/90mmHg, it means you have a systolic pressure of 140mmHg and a diastolic pressure of 90mmHg.

As a general guide:

  • high blood pressure is considered to be 140/90mmHg or higher (or an average of 135/85mmHg at home)
  • ideal blood pressure is considered to be between 90/60mmHg and 120/80mmHg
  • low blood pressure is considered to be 90/60mmHg or lower

A blood pressure reading between 120/80mmHg and 140/90mmHg could mean you're at risk of developing high blood pressure if you don't take steps to keep your blood pressure under control.

Find out more about what your blood pressure result means.


Treatment

Treatment

Simple lifestyle changes can often help reduce high blood pressure (hypertension), although some people may need to take medication as well.

Your GP can advise you about changes you can make to your lifestyle and discuss whether they think you would benefit from medication.

This page covers:

When treatment is recommended

Lifestyle changes

Medication

When treatment is recommended

Everyone with high blood pressure is advised to make the healthy lifestyle changes outlined below.

Whether medication is recommended depends on your blood pressure reading and your risk of developing problems such as heart attacks or strokes.

Your doctor will carry out some blood and urine tests, and ask questions about your health to determine your risk of other problems:

  • if your blood pressure is consistently above 140/90mmHg (or 135/85mmHg at home) but your risk of other problems is low - you'll be advised to make some changes to your lifestyle
  • if your blood pressure is consistently above 140/90mmHg (or 135/85mmHg at home) and your risk of other problems is high - you'll be offered medication to lower your blood pressure, in addition to lifestyle changes
  • if your blood pressure is consistently above 160/100mmHg - you'll be offered medication to lower your blood pressure, in addition to lifestyle changes

The various treatments for high blood pressure are outlined below. You can also read a summary of the pros and cons of the treatments for high blood pressure, allowing you to compare your treatment options.

Lifestyle changes

Below are some changes you could make to your lifestyle to reduce high blood pressure. Some of these will lower your blood pressure in a matter of weeks, while others may take longer.

These include:

You can take these steps today, regardless of whether or not you're taking blood pressure medication. In fact, by making these changes early on you may be able to avoid needing medication.

Read more advice about lifestyle changes to prevent and reduce high blood pressure.

Medication for high blood pressure

Several medications can be used to help control high blood pressure. Many people need to take a combination of different medicines.

The medication recommended for you at first will depend on your age and ethnicity:

  • if you're under 55 years of age - you'll usually be offered an ACE inhibitor or an angiotensin-2 receptor blocker (ARB)
  • if you're aged 55 or older, or you're any age and of African or Caribbean origin - you'll usually be offered a calcium channel blocker

You may need to take blood pressure medication for the rest of your life. But your doctor might be able to reduce or stop your treatment if your blood pressure stays under control for several years.

It's really important to take your medications as directed. If you miss doses, it won't work as effectively. The medication won't necessarily make you feel any different, but this doesn't mean it's not working.

Medications used to treat high blood pressure can have side effects, but most people don't experience any. If you do, changing medication will often help.

Common blood pressure medications are described below.

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by relaxing your blood vessels.

Common examples are enalapril, lisinopril, perindopril and ramipril.

The most common side effect is a persistent dry cough. Other possible side effects include headachesdizziness and a rash.

Find out more about ACE inhibitors.

Angiotensin-2 receptor blockers (ARBs)

ARBs work in a similar way to ACE inhibitors. They're often recommended if ACE inhibitors cause troublesome side effects.

Common examples are candesartan, irbesartan, losartan, valsartan and olmesartan.

Possible side effects include dizziness, headaches, and cold or flu-like symptoms.

Find out more about ARBs.

Calcium channel blockers

Calcium channel blockers reduce blood pressure by widening your blood vessels.

Common examples are amlodipine, felodipine and nifedipine. Other medicines such as diltiazem and verapamil are also available.

Possible side effects include headaches, swollen ankles and constipation.

Drinking grapefruit juice while taking some calcium channel blockers can increase your risk of side effects.

Find out more about calcium channel blockers.

Diuretics

Sometimes known as water pills, diuretics work by flushing excess water and salt from the body through urine. They're often used if calcium channel blockers cause troublesome side effects.

Common examples are indapamide and bendroflumethiazide.

Possible side effects include dizziness when standing up, increased thirst, needing to go to the toilet frequently, and a rash.

Low potassium level (hypokalaemia) and low sodium level (hyponatraemia) may also be seen after long-term use.

Find out more about thiazide diuretics.

Beta-blockers

Beta-blockers can reduce blood pressure by making your heart beat more slowly and with less force.

They used to be a popular treatment for high blood pressure, but now only tend to be used when other treatments haven't worked.

This is because beta-blockers are considered less effective than other blood pressure medications.

Common examples are atenolol and bisoprolol.

Possible side effects include dizziness, headaches, tiredness, and cold hands and feet.

Find out more about beta-blockers.

Angina
Angina is chest pain caused by a reduced flow of blood to the heart, typically resulting from heart disease.
Antihypertensive
Antihypertensive medicine reduce high blood pressure (hypertension).
Artery
Arteries are blood vessels that carry blood from the heart to the rest of the body. .
Cholesterol
Cholesterol is a fatty substance made by the body that lives in blood and tissue. It is used to make bile acid, hormones and vitamin D.
Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.
Heart attack
A heart attack happens when there is a blockage in one of the arteries in the heart.
Platelets
Platelets are cells in the blood that control bleeding by plugging the broken blood vessel and helping the blood to clot.

Prevention

Prevention

High blood pressure can often be prevented or reduced by eating healthily, maintaining a healthy weight, taking regular exercise, drinking alcohol in moderation and not smoking.

Healthy diet

Cut down on the amount of salt in your food and eat plenty of fruit and vegetables. The Eatwell Guide highlights the different types of food that make up our diet, and shows the proportions we should eat them in to have a well-balanced and healthy diet.

Salt raises your blood pressure. The more salt you eat, the higher your blood pressure. Aim to eat less than 6g (0.2oz) of salt a day, which is about a teaspoonful.

Find out how to cut down on salt.

Eating a low-fat diet that includes lots of fibre - such as wholegrain rice, bread and pasta - and plenty of fruit and vegetables also helps lower blood pressure. Aim to eat five portions of fruit and vegetables every day.

Find out how to get your 5 A DAY.

Limit your alcohol intake

Regularly drinking alcohol above recommended limits can raise your blood pressure over time.

Staying within these recommended levels is the best way to reduce your risk of developing high blood pressure:

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over three days or more if you drink as much as 14 units a week

Find out how many units are in your favourite drink and get tips on cutting down.

Alcohol is also high in calories, which will make you gain weight and can further increase your blood pressure.

Find out how many calories are in popular drinks.

Lose weight

Being overweight forces your heart to work harder to pump blood around your body, which can raise your blood pressure.

Find out if you need to lose weight with the BMI healthy weight calculator.

If you do need to shed some weight, it's worth remembering that just losing a few pounds will make a big difference to your blood pressure and overall health.

Get tips on losing weight safely.

Get active

Being active and taking regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition.

Regular exercise can also help you lose weight, which will also help lower your blood pressure.

Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity such as cycling or fast walking every week.

Physical activity can include anything from sport to walking and gardening. Get more ideas on how to get active.

Cut down on caffeine

Drinking more than four cups of coffee a day may increase your blood pressure. 

If you're a big fan of coffee, tea or other caffeine-rich drinks, such as cola and some energy drinks, consider cutting down.

It's fine to drink tea and coffee as part of a balanced diet, but it's important that these drinks are not your main or only source of fluid.

Stop smoking

Smoking doesn't directly cause high blood pressure, but it puts you at much higher risk of a heart attack and stroke.

Smoking, like high blood pressure, will cause your arteries to narrow. If you smoke and have high blood pressure, your arteries will narrow much more quickly, and your risk of heart or lung disease in the future is dramatically increased.

Get help to stop smoking.

Get a good night's sleep

Long-term sleep deprivation is associated with a rise in blood pressure and an increased risk of hypertension. It's a good idea to try to get at least six hours of sleep a night if you can.

Read some tips for getting to sleep if you find yourself struggling to get enough sleep.


'My diet and lack of exercise contributed greatly to my stroke'

'My diet and lack of exercise contributed greatly to my stroke'

Andy Jones liked to eat a lot of salt with his food. Whatever he ate, whether it was a Chinese takeaway or fish and chips, Andy would always add plenty of seasoning.

Although he didn't consider himself to be unhealthy, Andy didn't exercise and was overweight, which earned him the nickname Chunky.

The excessive salt Andy was adding to his food had raised his blood pressure to dangerous levels.

High blood pressure caused his arteries to fur up and put extra strain on his heart. 

Most people with high blood pressure don't have any symptoms, but the condition sharply increases the risk of having a stroke.

In December 2003, Andy, who ran a courier business in Warwick, collapsed on someone's doorstep during a delivery.

"I had a feeling like vertigo and I felt dizzy," he says. "I knocked on the door and I told the person who answered that I was feeling unwell. I collapsed moments later."

He had lost the use of his right side and his speech was slurred. Hospital tests confirmed he had had a stroke caused by a blood clot.

Cholesterol control

Andy was in hospital for a week, where he was given physiotherapy and speech therapy. He took medication to control his blood pressure and cholesterol.

"I was home for Christmas Eve," he says. "I was walking again by then, but it took me three months to regain the use of my hand and arm.

"My speech and my ability to swallow came back within 24 hours. However, even now I struggle with tying shoelaces and using keys."

He says his family were crucial in his recovery. "They helped with my determination to get better," he says. "My mother walked with me every day."

Having a stroke at 40 was a big shock for Andy. "I thought strokes didn't happen to people my age," he says.

In fact, out of the 150,000 people who have a stroke in the UK each year, 31,000 are under 60.

"It took me a long time to come to terms with my stroke," Andy says. "I still suffer bouts of anxiety and depression."

Returning to work

Andy says the stroke has left few traces, but its less obvious effects include moments of extreme tiredness.

"It's a hidden disability that's hard to explain," he says. "It's a fatigue I've never experienced before, and it's quite debilitating."

He lost his business soon after the stroke, but was keen to get back to work as soon as possible to rebuild his self-esteem. After working as a driver in the voluntary sector, Andy now works part-time in a betting shop.

Cutting out salt

He is now a lot more careful about what he eats, has cut down on takeaways, and greatly reduced the amount of salt in his diet.

"I don't add salt to my food," he says. "If I feel like a snack, I'll have fruit."

He says he eats his meals more slowly, which leaves him more satisfied. "I always aim to be the last to finish," he says. "It means I eat less but feel fuller."

Andy believes his excessive consumption of salt helped lead to his stroke. "My diet and lack of exercise contributed greatly to my stroke," he says.

"I wish I had known I had high blood pressure. I would have done something about it, and would probably have prevented the stroke."

Some good has come out of Andy's experience, though: he may have saved his younger brother from a stroke.

"After my stroke, he went to have his blood pressure checked and found it was too high. Now he's addressing that."