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But I feel well I don’t need any medication!

01 Jun

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During my time as a GP I have heard this on countless occasions after taking someone’s blood pressure for the third time and telling them they will need to be treated.

Indeed when I first started on my career blood pressure medication was certainly not free of side effects and many caused severe postural hypotension resulting in profound dizziness,  lightheadedness, unsteadiness, or feeling of loss of balance to the point of fainting when simply getting out of a chair. Many patients who felt well when they presented after being given medication then developed blurred vision, confusion, general weakness and nausea. It was not surprising that many people refused to continue or simply avoided having their blood pressure taken! However, enough patients took medication for doctors to discover how lowering people’s blood pressure could prolong life and prevent heart and circulatory disease particularly strokes.
Pharmaceutical companies have gradually produced medication with fewer side effects and now we can offer treatment with minimal side effects.

One of the most popular blogs I have written was last years blog on hypertension
https://102theavenue.wordpress.com/2013/05/17/hypertension-t…pertension-day/ ‎which focused on healthy heart – healthy blood pressure.

As a campaign to reduce the incidence of heart and circulatory disease last year the government proposed that everyone over the age of 40 years should have their blood pressure checked and this was one of every GP’s targets to make sure that was done and will remain an ongoing target. There was an increase of 9.5% of people having their blood pressure recorded in 2013/14. However, it is everyone’s responsibility to know your blood pressure!

Infact, World Hypertension Day 2014 the theme is KNOW YOUR BLOOD PRESSURE
WHD

High blood pressure is just one of the risk factors for developing heart and circulatory disease, along with high cholesterol, diabetes and other lifestyle factors. As many as 5 million people in the UK are walking around, undiagnosed, with high blood pressure.

The only way to know whether you have high blood pressure is to have it measured.
Your blood pressure can be measured at most pharmacies, in the work place or gym and many people have machines in their homes.(for home machines make sure they are approved by consulting a list of currently validated machines on British Hypertension Society  http://www.bhsoc.org//index.php?cID=246)
British hypertension
Blood pressure UK
has campaigned for people to take their blood pressure
You can have your blood pressure checked for free anywhere in the UK by simply logging in to the following website and putting in your postcode to find the nearest blood pressure station.
KNOW YOUR NUMBERS
http://www.bloodpressureuk.org/microsites/kyn/Home/Freebpchecks/Findfreecheck

High blood pressure – or hypertension

This means that your blood pressure is constantly higher than the recommended level. High blood pressure is not usually something that you can feel or notice, but over time if it is not treated, your heart may become enlarged making your heart pump less effectively, which could lead to heart failure.

Having high blood pressure increases your chance of having a heart attack or stroke.

Are you too old to be treated?
The benefits of treatment of hypertension in older patients (ie over the age of 80years is evident, reducing BP to a level of 150/80 is associated with large reductions in stroke, mortality and heart failure risk. Different regimens with equal BP reductions have similar effects on outcomes, so should be individually tailored. Systolic blood pressure (elevated top reading) rather than Diastolic blood pressure (elevated bottom reading) reduction is significantly related to lower Cardiovascular risk in older people.

There isn’t always an explanation for the cause of high blood pressure, but these can play a part:

  • not doing enough physical activity
  • being overweight or obese
  • having too much salt in your diet
  • regularly drinking too much alcohol
  • having a family history of high blood pressure.

Even if you don’t have high blood pressure, making simple lifestyle changes may help prevent you having it in the future.

What can you do to reduce your blood pressure?
If your doctor or nurse says you have high blood pressure, he/she is likely to encourage you to make some lifestyle changes to help reduce it. This may include increasing your physical activity, losing weight, reducing the salt in your diet, cutting down on alcohol and eating a balanced, healthy diet.

Salt’s effects on your body
Salt
Salt works on your kidneys to make your body hold on to more water.

This extra stored water raises your blood pressure and puts strain on your kidneys, arteries, heart and brain.

 Reducing salt by 3g/day might prevent approx 10,000 deaths and 10,000 Cardiovascular events each year
 This would exceed the benefits of smoking cessation programmes, weight loss interventions and statins
 Reducing salt intake by as little as 1g/day may be more cost effective than BP lowering drugs

High sodium effervescent drugs should be avoided in patients with or at risk of hypertension or Cardiovascular events.
It is advised not to take soluble Over The Counter(OTC) medication such as painkillers, vitamin C etc. (NB this does NOT apply to 75mg dispersible aspirin which is fine. See what is the sodium content of medicines? )

The Consensus Action on Salt and Health (CASH) has looked at examples of the most popular foods eaten by several different age groups based on the National Diet and Nutrition Survey (NDNS), and has compiled ‘typical shopping baskets’, which have revealed some alarming results. For example, based on types of foods eaten by a student (18-22 year old), a shopping basket of higher salt products can contain up to 58g of salt, while that of a mother (30-39 year old woman) can contain up to 64g of salt – the equivalent of 128 bags of crisps. However, if they were to make some simple switches to lower salt options, the shopping basket of the student could be reduced to 22g of salt and that of the mothers’ could be reduced to 18g of salt, the equivalent of just 36 bags of crisps – cutting their salt intake by a staggering 62% and 72% per week respectively. This shows us that by making more informed choices we could all improve our long term health and reach the 6g a day maximum recommended intake for salt.

Heart and saltHow to reduce salt intake

(6g of salt a day is the maximum you should eat, and the less you eat the better.)
NB 6g of salt = 2400mg sodium

Sodium: reduce intake to
o 80% of salt is hidden in processed foods, and only 20% added
 Bread, breakfast cereals, table sauces tend to be high in salt
o To avoid hidden salt, start label looking and look for
 Low salt (1.5g per 100g food) avoid!
o Confusingly, some labels cite sodium rather than salt content
 1g sodium = 2.5g salt, so 0.6g per 100g food is high Potassium: potassium rich foods include:
 Fruit (not just bananas!), pulses, beans, vegetables (esp spinach), oily fish, chicken

10 practical tips

  • Eat out less
  • Remove the salt shaker from the dinner table
  • Add other flavours (herbs and spices) when you’re cooking
  • Remove the salt cellar from the dinner table
  • Eat less processed foods
  • Use fresh or frozen vegetables
  • Use shop-bought sauces and marinades sparingly
  • Limit processed and cured meats
  • Use lower salt cheeses
  • Pay attention to sweet foods
  • Use the FREE SaltSwitch App is a new feature of the popular health app, FoodSwitch, which was developed by CASH. The app allows users to scan the barcode of nearly 90,000 packaged foods sold across major UK supermarkets using their smartphone camera to receive immediate, easy to understand colour-coded nutritional information along with suggested similar, less salty products by 100g.

Salt reduction programme results released on 15/4/2014 showed has led to a fall in population blood pressure. From the fall in blood pressure that was due to salt reduction, there has been a saving of approximately 18,000 stroke and heart attack events a year, 9,000 of which would have been fatal

Another way of reducing salt is increasing potassium but if you are taking medication for blood pressure discuss this with your doctor.

Why potassium helps to lower blood pressure
potassium is a chemical which helps to lower blood pressure by balancing out the negative effects of salt. I heard potasquoted as”Potassium could be called the great detergent of arteries.

Your kidneys help to control your blood pressure by controlling the amount of fluid stored in your body. The more fluid, the higher your blood pressure.

Your kidneys do this by filtering your blood and sucking out any extra fluid, which is then stores in your bladder as urine. This process uses a delicate balance of sodium and potassium to pull the water across a wall of cells from the bloodstream into a collecting channel that leads to the bladder.

Eating salt raises the amount of sodium in your bloodstream and wrecks the delicate balance, reducing the ability of your kidneys to remove the water. By eating more fruit and vegetables, you will increase your potassium levels and help to restore the delicate balance. This will help your kidneys to work more efficiently – and help to lower your blood pressure to a healthy level.

However, it is possible to have too much of a good thing. To make sure that you don’t overdose on potassium, it is best to get your daily potassium from natural sources (fruit, vegetables and other foods) and avoid taking supplements.
To reap the benefit of more potassium in your life, try to eat at least five portions of fruit and vegetables every day. (A portion is about the same size as your closed fist). Not only will this help to lower your blood pressure, it will also help you to avoid certain cancers, bowel problems and even heart attacks or strokes.

Good sources of potassium include: potatoes, sweet potatoes, bananas, tomato sauce (without added salt or sugar), orange juice, tuna (fresh, frozen or tinned, but avoid tuna packed in brine), yoghurt and fat-free milk.
Potassium

If you have kidney disease, or are taking certain blood pressure medications, a large increase in potassium could be harmful. In this case, avoid taking potassium supplements and check with your doctor before dramatically increasing your potassium intake.

If your blood pressure is very high or these lifestyle changes do not reduce it enough, your doctor is likely to prescribe you medication to control it and to reduce your risk of having a heart attack or stroke.

Especially if you are 40 years or older get your blood pressure checked and
KNOW YOUR NUMBERS

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