World Hypertension Day: symptoms, risk factors and treatment options

Posted: 11/05/2020

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Sunday 17 May is World Hypertension Day. It is designated by the World Hypertension League, which is an umbrella organisation of some 85 national hypertension societies.

The day seeks to raise awareness of hypertension, thought to cause around 7.5 million deaths a year worldwide – around 13% of all deaths. In the UK, it affects up to one in four of the population.

This article covers the basic concepts of hypertension, along with some management techniques and treatment options.

What is hypertension?

Hypertension is high blood pressure. A blood pressure reading uses two numbers – the systolic and diastolic pressure. Systolic pressure is when the heart beats and pumps blood around the body. Diastolic pressure is the pressure within the blood vessels when the heart is resting between beats.

It is measured in mmHg (ie millimetres of mercury) from the historical measurement using a sphygmomanometer, containing a tube of mercury, where a cuff is inflated over the upper arm and the pressure at which the pulse can be heard is then registered by the clinician using a stethoscope. Digital versions of the same instrument are used today, with the pressure registered automatically.

A normal blood pressure would be around 90/60mmHg to 120/80mmHg, although there are variations within a population. The systolic pressure (the top number in a blood pressure reading) will increase with exercise as the heart pumps harder, but the diastolic pressure (the bottom number) will remain around the same.

High blood pressure is generally considered to be any reading over 140/90mmHg, or 150/90mmHg for those over 80. Regular readings will assist medical staff in assessing whether any particular measurement is high for that individual.

What are the risks of hypertension?

Hypertension that persists in the longer term puts an increased strain on the heart and blood vessels, along with other organs such as the brain, eyes and kidneys. The constricted vessels are more prone to ‘furring up’ with fatty material, reducing the flow of blood.

As a result, hypertension is a major risk factor in heart attacks, strokes, kidney disease, dementia, erectile dysfunction and retinopathy (eyesight problems).

What are the symptoms of hypertension?

In most cases an individual will not have any symptoms at all before a serious event. Sometimes the first sign is one of the above serious illnesses, or sudden death, and for this reason it is essential that blood pressure is checked regularly by a GP or other health professional.

What are the risk factors?

Factors that raise a person’s risk of hypertension include:

• age - older people are more prone to high blood pressure;
• genetics, or a family history of hypertension. The Afro-Caribbean population is particularly at risk;
• salt intake, as extra salt causes more fluid to be retained in the body, directly increasing blood pressure;
• obesity;
• smoking;
• alcohol;
• lack of exercise; and
• high caffeine intake.

Fortunately many of these factors are within our control, and some basic alterations to lifestyle including even gentle exercise and an improved diet can help. Stopping smoking and maintaining a healthy weight are of great benefit.

Occasionally, hypertension can be secondary to another disease such as diabetes and kidney disease.

What is the treatment for hypertension?

As some of the above steps can be so effective at reducing hypertension, it is likely that patients will be advised to make these changes as a first step. However, where lifestyle changes are not effective, or in cases where a patient may be at risk of heart attack or stroke, medication may be required:

• ACE inhibitors – angiotensin-converting enzyme is part of the complex system designed to regulate blood pressure in the body. Simply put, ACE causes the blood vessels in the body to constrict, meaning that blood pressure increases. By inhibiting ACE, the blood vessels dilate, reducing blood pressure.
• Calcium channel blockers – as with ACE, calcium ions are used by the blood vessels to contract, and by blocking these channels, the blood vessels remain relaxed, lowering blood pressure and giving the heart less work to do.

Treatment for secondary hypertension will include management of the underlying factors.

What can I do now?

A blood pressure check can be arranged at your GP, some pharmacies, or at an NHS Health Check appointment if you are between 40 and 74 (at the time of writing, some of these services are likely to be affected by the current Covid-19 outbreak).

If you are concerned about your blood pressure or want to look at ways to start making lifestyle changes, the following sites offer assistance:

• British Hypertension Society
• Help with lifestyle changes
• British Heart Foundation

Emma McCheyne, a solicitor in the clinical negligence team at Penningtons Manches Cooper, said: “Now, more than ever, people are aware of the risks to their own health. While the current coronavirus outbreak is a highly visible danger, hypertension is often known as a ‘silent killer’. Being confined to our homes with little exercise, potentially a poor diet, and the stress of social isolation can all add to the risk factors for hypertension. By ensuring that we maintain a healthy lifestyle as far as possible, we can all improve our overall health and reduce our risk of hypertension and the associated problems.”

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