Periodically we have to check to ascertain that all patients on our hypertension register have had a blood pressure reading in the last 6-9 months and usually we have to chase up more than half the patients and 10% do not respond after 3 requests; many are found to be uncontrolled due to poor compliance of medication putting their cardiovascular disease risk at stake.
High blood pressure (hypertension) is the major risk factor for cardiovascular disease. Hence, in 2002, it was named ‘the number one killer’ by the World Health Organization (WHO) in The World Health Report.
Every year, 17 May is dedicated to World Hypertension Day (WHD).
The theme for 2013 is Healthy Heart Beat-Healthy Blood Pressure.
This was inaugurated in May 2005 and has become an annual event: the purpose of the WHD is to promote public awareness of hypertension and to encourage citizens of all countries to prevent and control this silent killer, the modern epidemic.
In the UK the incidence is more than 12 million in adults aged 16- 75years.
In the Department of Health’s 2010 ‘Health Survey for England’ the prevalence of hypertension in adults of 16 years or older was 31.5% in men and 29.0% in women. After the age of 70 years 40-50% are affected.
The full data are available on their website http://www.dh.gov.uk/ or directly at: http://www.ic.nhs.uk/webfiles/publications/003_Health_Lifestyles/HSE2010_REPORT/HSE2010_Trends_commentary.pdf
Prevalence of hypertension is also collected by General Practices nationally and published via the Quality and Outcomes Framework: http://www.qof.ic.nhs.uk/
In our practice we have 300 patients with high blood pressure and we participate in Quality Outcomes Framework (QOF) where we are committed to recording a blood pressure at a minimum of 9 month intervals and then treating to control the blood pressure at the recommended level by medical treatment and lifestyle advice.
You can view how well the practice is doing on the website http://www.qof.ic.nhs.uk/ and we are shown to be above the expected targets thanks to our hard-working staff and co-operation of patients.
Moreover, this achievement will significantly reduce the incidence of stroke and heart attack.
If you are over 40 yrs of age or have a family history and have not had your blood pressure taken in the past 5 years please call in to have this done.
1) What is Hypertension (high blood pressure)
Blood pressure is simply the physical pressure of blood in the blood vessels. It is similar to the concept of air pressure in a car tyre.
The pressure in the arteries depends on how hard the heart pumps, and how much resistance there is in the arteries.
It is thought that slight narrowing of the arteries increases the resistance to blood flow, which increases the blood pressure.
The cause of the slight narrowing of the arteries is not clear. Various factors probably contribute.
2) How is it measured?
A common blood pressure might be 120/80 (said as ‘120 over 80’). These values are quoted in units known as millimeters of mercury (mmHg).
There are 2 numbers because the blood pressure varies with the heartbeat. The higher pressure (120) represents the pressure in the arteries when the heart beats, pumping blood into the arteries.
This pressure is called systolic pressure.
The lower pressure (80) represents the pressure in the arteries when the heart is relaxed between beats.
This pressure is called diastolic pressure.
3) Does it vary in an individual ?
Blood pressure can be quite variable, even in the same person.
4) what makes the blood pressure vary?
Blood pressure goes up and down with different normal daily activities. For example, exercise, changes in posture and even talking changes blood pressure.
Blood pressure tends to be higher during the day than at night and higher in the winter than in the summer.
Blood pressure also rises when we grow older, particularly systolic blood pressure. Before adulthood, blood pressure rises in parallel with height.
In adult years, weight and blood pressure are closely related. When weight goes up, blood pressure tends to go up and we can lower blood pressure by losing weight.
5) Does it vary in individuals?
Blood pressures differ between individuals. Some people have low, some average and some high blood pressure levels.
6) What is the definition of high blood pressure?
There are various definitions of high blood pressure, which is also known as hypertension, but most doctors consider blood pressures of 140/90 and greater to be high.
The precise values that doctors might interpret as high blood pressure depend to an extent on individual circumstances. For example, in patients with diabetes, the definition of hypertension is considered by some to be pressures greater than 130/80.
The definition of hypertension is used by doctors to help decide which patients would benefit from medical (lifestyle and drug) treatment to lower pressure.
The definitions depend on the balance of risk of not lowering blood pressure (heart attack and stroke, etc) versus the risks of treatment (drug side effects, etc).
This explains why hypertension is defined at lower blood pressure levels in diabetic subjects. For the same blood pressure, cardiovascular complications (that is damage to the heart, blood vessels and brain) are more likely in diabetics and blood pressure reduction offers benefit even when a diabetic’s blood pressure is not as high as regular definitions of hypertension.
7) Why is blood pressure important?
Blood pressure is important because it is the driving force for blood to travel around the body to deliver fresh blood with oxygen and nutrients to the organs of the body.
However, high blood pressure is important because it leads to increased risk of serious cardiovascular disease, with complications such as heart attack, heart failure, stroke, kidney failure and blindness.
8) What is the cause of high blood pressure ?
For the vast majority of people with high blood pressure no precise explanation is ever found. For this reason, such cases are said to have ‘essential’ hypertension.
These cases are likely to result from a range of factors that could be broadly grouped into genetic and environmental (lifestyle) factors that work together to raise blood pressure.
Because genes and environmental are shared within families, it is not uncommon for people with high blood pressure to know of relatives with the same condition.
In a minority of cases of hypertension (less than about 5%) a precise cause can be identified. These include hormonal imbalances and kidney diseases that can result from genetic problems, occasionally tumors (usually benign) and blood vessel narrowing. Doctors are trained to look for signs of these specific conditions, as they are often curable.
High blood pressure is more common is older age groups and in people with a family history of hypertension. It is also more frequent in those who are overweight. However, high blood pressure can affect young thin people with no family history, so no one should consider himself or herself immune from high blood pressure.
9) Why is it important to control blood pressure ?
It is the goal of good clinical practice to reduce high levels of pressure wherever possible in order to reduce the risk of complications such as heart attack and stroke.
10) How is high blood pressure controlled?
Changes to lifestyle such as weight loss, reduced salt intake, reduced alcohol consumption or exercise are often the first line of treatment. If these approaches don’t return blood pressure to acceptable levels then drug treatment is usually required.
11) How do you know if you have high blood pressure?
The truth is you cannot know your blood pressure unless you have it measured and every adult should know his or her blood pressure.
Although headaches and nose bleeds can be the result of very high blood pressure, there are many more innocent causes for these common ailments.
12) How can you help to control blood pressure?
A healthy lifestyle and a sensible diet are important. One of the most important things is to keep weight under control. Less weight means lower blood pressure, and it also means less diabetes, less stress on muscles and joints and less stress on the heart.
13) Can high blood pressure be cured?
Commonly we hear ‘can I stop taking my tablets now’ or ‘I have finished the course’
It is rare for hypertension to disappear by itself. The general rule is that blood pressure gets higher with time and the risk of complications goes up also.
Although not ‘cured’ as such, modern therapeutic approaches to blood pressure are very effective and generally very safe. However, if treatment is stopped the high blood pressure usually returns reasonably quickly.
14) What are the effects of high blood pressure?
Any degree of high blood pressure is associated with increased risk of stroke and heart attack, but the higher the pressure, the higher the risks.
15) How is high blood pressure treated?
If blood pressure is persistently 140/90 and greater, then some form of treatment is required, although in the first instance this might be adjustments to lifestyle, such as diet and exercise.
However, if the blood pressure is repeatedly greater than 160/110, then there is usually a need to begin drug treatment immediately, rather than relying on lifestyle changes alone.
Sustained blood pressures of over 200/120 are considered potentially dangerous and if associated with for example visual trouble or heart failure they require emergency treatment.
16) Will hypertension cause any damage to my body?
Left unchecked, high blood pressure will over the years cause damage to the blood vessels of the heart and brain that leads to heart attacks and strokes. It also places extra strain on the heart, causing thickening of the heart muscle and heart failure and it damages the kidneys and can lead to kidney failure.
17)Are there any side effects to medication?
These days drugs are safe and generally free of major side effects, but no drug is completely free of side effects in all patients.
As blood pressure drugs work by reducing blood pressure, sometimes too great a fall in blood pressure can cause dizziness on standing. This can be a problem in the summer months and especially when rising quickly from squatting. Dizziness on standing also can be worse in older patients.
There are a variety of other symptoms that can result from blood pressure medications and if these appear in the days or weeks after treatment has begun you should consult your doctor. However, do not stop medications yourself without medical advice, as sometimes the blood pressure will rebound to very high levels that can be dangerous.
18) Can I measure my own blood pressure?
Yes but it is advisable to use a machine recommended by the British Hypertension Society(BHS).
Seek advise from GP,nurse or pharmacist.
The machines should be calibrated annually.
The following Machines are validated by BHS
Lloyds Pharmacy LBP 1 *(D) £30.00 International Protocol
Lloyds Pharmacy LBPK 1 *(D) £30.00 International Protocol
19) Can your risk of stroke or heart attack be calculated?
During a consultation when recording blood pressure and other details this can be calculated.
This risk calculator uses the Framingham risk equation and the adjustments as suggested by the Joint British Societies’ (JBS2) paper and the JBS Cardiovascular Risk Assessor.
More details are obtainable on http://www.patient.co.uk or ask one of the clinicians when you attend the surgery. Those patients who have a high risk are seen more often and offered support regarding their lifestyle ie. diet, exercise,weight loss,smoking cessation
It is not the only risk calculator in use. In 2010 the National Institute for Health and Clinical Excellence (NICE) decided it could no longer recommend that the Framingham risk equation be used, as it tends to over-estimate risk by approximately 5% in UK men. The decision also coincides with the emergence of the QRISK® calculator which has been shown to predict risk more accurately. The QRISK® calculator is available at http://www.qrisk.org. For further information on QRISK® see our cardiovascular risk assessment article.
20) What is the Government doing to prevent cardiovascular disease at population level?
The Government has addressed and continues to address the risk at both the population and individual level. The Department of Health asked the National Institute for Health and Clinical Excellence (NICE) to produce public health guidance at population level. This involves multiple agencies and is outlined in the public health guidance PH25 publication.
Recommendation include the following:-
The Food Standard Agency has made considerable progress in reducing salt in everyday foods and this continues.
B) Saturated fat
The Food Standard Agency, consumers and industry have reduced the population’s intake (halving the average intake from 14% to 6-7% might prevent 30,000 CVD deaths and prevent a corresponding number of new cases of CVD annually. Eg promoting semi-skimmed milk for children aged over 2 years.
C) Trans fat
Industrially-produced Trans fatty acids (IPTFA) constitute a significant health hazard. Those who regularly eat fried fast-food may be consuming a substantially higher amount of IPTFA . In some countries e.g Denmark ,Austria and New York have successfully banned IPTFA.
D) Marketing and promotions aimed at children and young people.
Current advertising restrictions have reduced the number of advertisements for foods high in fat,salt or sugar during TV programmes made for children and young people. This policy will be extended.
E) Commercial interests
Ensure dealings between government , government agencies and the commercial sector are conducted in a transparent manner that supports public health interests and is in line with best practice. ( including full disclosure of interests)
F) Product labeling
Clear labeling describing content of food and drink products helping consumers make an informed choice. Evidence shows that simple traffic light labeling works well.
G) Health impact assessment
Where relevant government departments should assess the impact of policies on the health of the population.
H) Common agricultural policy
Negotiate at EU and national level to ensure CAP takes account of public health issues.
I) Physically active travel
Ensure government funding supports physically active modes of travel (such as walking and cycling)
J) Public sector catering guidelines
To reduce CVD would be to improve nutritional quality of food provided by public sector organisations.
K) Take-always and other food outlets
Empower local planning authorities to restrict planning permission for these (e.g within walking distance of schools)
Independent monitoring using a full range of available data is vital when assessing the need for additional measures to address health inequalities. CVD is responsible for around 33% of the observed gap in life expectancy among people living in areas with the worst health and deprivation indicators compared with those living in other parts of England .
Recommendations 13-18 provide for a comprehensive regional and local CVD prevention programme. The aim is to plan, develop and maintain effective programmes.
Recommendations 19-24 expand further on implementing the above and extending it into all public sectors.
THERE ARE USUALLY NO SYMPTOMS FOR HIGH BP
The risk of stroke is four times greater and the risk of myocardial infarction (a heart attack) two times greater if you have high compared with normal blood pressure. This risk increases the higher the level of a person’s blood pressure.
THE ONLY WAY OF REDUCE THE RISK OF DEATH OR SERIOUS CARDIOVASCULAR DISEASE IS BY FOLLOWING LIFESTYLE ADVISE AND TAKING APPROPRIATE MEDICATION
Hypertension is very common indeed and hence a major public health issue.
The prevalence is expected to increase considerably in the coming years.
In 2000, the estimated number of adults living with high blood pressure globally was 972 million.
This is expected to increase to 1.56 billion by 2025!
Lifestyle factors, such as physical inactivity, a salt-rich diet with high processed and fatty foods, and alcohol and tobacco use, are reasons for this increased disease burden, which is spreading at an alarming rate from developed countries to emerging economies, such as India, China and African countries.
Adequate treatment of high blood pressure lowers this cardiovascular risk towards normal levels.
THE GREATEST PROBLEM FOR CONTROLLING BLOOD PRESSURE IS COMPLIANCE WITH TREATMENT .
Despite very effective and cost-effective treatments, target blood pressure levels are very rarely reached, even in countries where cost of medication is not an issue.
Sadly, many patients still believe that hypertension is a disease that can be ‘cured’, and they stop or reduce medication when their blood pressure levels fall to normal levels.
Despite the availability of effective and safe anti-hypertensive drugs, hypertension and its related risk factors (obesity, high blood lipids, and diabetes mellitus) remain uncontrolled in many patients.
THE RULE OF THE HALVES
Only one half of the patients with high blood pressure in a population have been diagnosed, only half of those detected have been treated, and only half of those treated have been adequately treated to a normal blood pressure.
WHAT CAN YOU DO TO CONTROL BLOOD PRESSURE?
Stop smoking (if applies)
Alcohol & caffeine reduction (if applies)
Low fat diet high in fruit and vegetables nuts whole grains DASH diet
Low salt diet
Lose weight (if applies)
Regular exercise ( at least 20 mins 3 days/week)
Check blood pressure at least every 6 months ( or 5yearly if no problem at present)
WHAT CAN WE DO TO CONTROL BLOOD PRESSURE?
Offer smoking cessation support
Alcohol reduction support
Advise you to attend weight reducing classes or seek advise from nurse
Exercise prescription or discuss with nurse
Check your BP regularly and prescribe medication accordingly.
Check cholesterol, blood sugar and kidney function tests regularly.
Prescribe statins – cholesterol lowering medication .
Written by Dr Jacqueline Bayer