Download Hypertension - Church End Medical Centre

Hypertension (high
blood pressure)
Dr. Fiona Gillan
GP Registrar at Church End Medical Centre
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
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.
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.
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.
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.
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.
Cardiovascular risk
Everybody has some risk of damaging their blood
vessels, some at increased risk.
Can
Treatable/partly
change/prevent treatable
Fixed
Smoking
Lack of physical
activity
Obesity
Unhealthy diet
Excess alcohol
Strong family
history
Being male
Early
menopause in
women
Age
Ethnic group
High BP
High cholesterol
High fat blood
levels
Diabetes
Kidney diseases
that affect
kidney function
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
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.
How can we lower blood
pressure?
 Two ways:
1. Lifestyle changes
2. Medications
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
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.
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.
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
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.
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
Thank you for listening