Hypertension: Managing High Blood Pressure in the UK

Hypertension is the medical term for high blood pressure. It is a chronic condition where the force of the blood against your artery walls is consistently too high. Over time, this extra pressure damages the arteries and puts significant strain on the heart and other vital organs, such as the kidneys and brain.

In the UK, hypertension is one of the most common preventable causes of death. Because it rarely presents with noticeable symptoms until a serious event occurs, such as a heart attack or stroke, regular screening is vital for adults, particularly those over the age of 40.

When you have your blood pressure checked, the result is given as two numbers, measured in millimetres of mercury (mmHg):

• Systolic pressure (the top number): The force at which your heart pumps blood around your body.
• Diastolic pressure (the bottom number): The resistance to the blood flow in the blood vessels between heartbeats.

According to NICE (National Institute for Health and Care Excellence) guidelines, blood pressure is categorised as follows:

• Ideal blood pressure: Between 90/60mmHg and 120/80mmHg.
• Pre-hypertension: Between 120/80mmHg and 140/90mmHg (indicating a risk of developing high blood pressure).
• High blood pressure (Hypertension): 140/90mmHg or higher when measured in a pharmacy or GP surgery, or 135/85mmHg when measured at home.

For many adults, there is no single identifiable cause of high blood pressure; this is known as primary (essential) hypertension. However, several factors significantly increase your risk:

• Age: The risk increases as you get older.
• Diet: Consuming too much salt (sodium) and not enough potassium.
• Lifestyle: Being overweight, lack of physical activity, and drinking too much alcohol.
• Ethnicity: People of Black African or Black Caribbean descent are at a higher risk.
• Genetics: A family history of hypertension or cardiovascular disease.

Secondary hypertension is less common and is caused by an underlying condition, such as kidney disease, diabetes, or obstructive sleep apnoea.

One of the most dangerous aspects of hypertension is that most people do not feel any different when their blood pressure is elevated. You could have high blood pressure for years without knowing it. In very rare cases of extremely high blood pressure (hypertensive crisis), an individual might experience headaches, blurred vision, chest pain, or nosebleeds.

Because symptoms are unreliable, the NHS recommends that all adults over 40 have their blood pressure checked at least every five years. This can be done at your local GP surgery, some pharmacies, or by using a certified home blood pressure monitor.

The first line of defence against hypertension in the UK involves lifestyle modifications. These changes can often lower blood pressure enough to avoid the need for medication:

• Reduce Salt Intake: Aim for less than 6g of salt per day (about one teaspoon). Avoid processed foods, which often contain hidden salt.
• Balanced Diet: Focus on the DASH (Dietary Approaches to Stop Hypertension) diet, which is rich in fruits, vegetables, and low-fat dairy.
• Exercise: Aim for at least 150 minutes of moderate-intensity aerobic activity, like brisk walking or cycling, every week.
• Weight Management: Losing even a small amount of weight can significantly impact blood pressure readings.
• Limit Alcohol and Caffeine: Reducing intake of both can help stabilise your heart rate and pressure.

If lifestyle changes alone are not sufficient, your doctor may prescribe medication. The type of medication recommended depends on your age, ethnicity, and other health conditions:

• ACE Inhibitors: Such as Ramipril or Lisinopril, which relax blood vessels.
• Angiotensin-2 Receptor Blockers (ARBs): Often used if ACE inhibitors cause side effects (like a persistent dry cough). Examples include Losartan.
• Calcium Channel Blockers: Such as Amlodipine, which widen the blood vessels.
• Thiazide-like Diuretics: These help the body flush out excess water and salt.

Most people will need to take blood pressure medication for the long term to maintain healthy levels and protect their organs.

If you have checked your blood pressure at home or at a pharmacy and the reading is consistently above 140/90mmHg, you should consult a healthcare professional. An online GP can review your readings, discuss your medical history, and advise on necessary lifestyle adjustments.

Regular reviews are essential if you are already on antihypertensives to ensure the dosage is correct and to monitor for any side effects. An online GP can also provide repeat prescriptions or provide sick notes if you are undergoing intensive diagnostic tests that require time off work.