Blood Pressure (Hypertension)

The advice is based on Guidance from Blood Pressure the UK and British Hypertension Society Guidance

All patients must use a validated BP device that measures BP from your upper arm, and ensure that the cuff size is appropriate for your arm. Check below to choose the right BP machine

http://www.bloodpressureuk.org/BloodPressureandyou/Homemonitoring/Choosingyourmonitor

Please make you are relaxed and wear loose-fitting clothes so that you can easily roll up your sleeve.

Please avoid smoking, caffeine or exercise within 30 minutes of BP measurements and ensure at least 5 minutes of quiet rest before readings. Please sit with back straight and supported, with feet flat on the floor and legs uncrossed. Keep arm supported on a flat surface with the upper arm at heart level. Keep still and do not talk whilst recording.

Home Blood Pressure monitoring – recommended for diagnosis

Measure BP in both arms & if a difference of ≥ 15 mmHg, higher reading decides the treatment plan. High Blood Pressure should be confirmed ideally by the use of ambulatory BP monitoring (ABPM).

Take two BP readings at least 1 minute apart and ideally 5 minutes apart twice daily, in the morning and evening for 7 days. If there is a big difference between the first and second readings, then take further readings until they level out. Initially take your BP in both arms. If there is a big difference between the two let your doctor or nurse know, and use the arm with the higher reading.

Ignore the first day of readings. Record all subsequent readings in a BP diary and calculate the average. Do not round readings up or down and make sure you record both the upper (systolic) and lower (diastolic) readings.

How do I know I have a Blood Pressure?

Hypertension (High Blood Pressure) diagnosis is confirmed in those with clinic BP ≥ 140/90 AND ABPM/HBPM ≥135/85

There are various stages of BP mainly designed for doctors to act accordingly and decide how to act and offer medicine at each stage.

When should I worry?

If taking your own blood pressure makes you feel anxious or stressed it may not be appropriate for you. Discuss with your doctor or nurse.

Do not worry if you get a one-off high reading, but repeat it later. If the upper reading (systolic) is > 180 or < 100, or the lower reading (diastolic) > 100 then contact your doctor or nurse.

Your doctor or nurse will advise on your ideal BP target level, but an average BP of <140/90 (or <130/80 for patients with other conditions such as cardiovascular or kidney disease) is ideal. Let your doctor or nurse know if your average readings are higher than this.

Calibration (machine accuracy testing and adjustment)

To ensure that it remains accurate your device will need to be re-calibrated (tested and adjusted for accuracy) every year or so. Your device will come with instructions as to how this should be done.

• Do all you can to keep your BP down naturally with your lifestyle with exercise and diet, including making sure you eat less salt.

Treatment with Medications

We refer adults <40 with hypertension consider specialist referral for secondary causes/treatment.

High BP is treated with lifestyle advice as above and medications

We start drug treatment to any patient (any age) who has clinic BP readings of 160/100-179/119 and Home BP readings average of ≥ 150/95.
Treatment is also considered in those < 80 yrs old with clinic BP readings of 160/100-179/119 and Home BP Readings of ≥ 150/95 and has an established effect on the cardiovascular system (Heart/Kidneys) or has related conditions (diabetes) or the predicted 10-year cardiovascular disease risk is greater than 10%.

Frankly speaking, Drug treatment is considered in younger adults <60 years old even if the predicted 10-year cardiovascular disease risk is less than 10%.

If one is 80 yrs old and above the threshold of the BP management is higher and so is the target

If one is less than 80 years old then the target and threshold are <140/90 but if one is 80 years old and above the target is <150/90  but there are exceptions whereby one has diabetes and previous heart problems and lower targets are beneficial to health.

Monitoring of BP readings

A series of morning and evening readings over 4 to 7 days every 3 to 6 months is typical, more often if medication is being changed.

How is your BP managed?

Treatment guidelines have updated last year. Please don’t be surprised if previously you have been offered a different medication, all that matters is if your good BP control and management of cardiovascular risk

 

If you are under 55 years of age and are not of African or Caribbean family origin or one has diabetes and of family origin, you would be commenced on a medication called Ramipril or similar medication described as (ACE inhibitors). Generally, these medications are well tolerated but on a few occasions, they have to be discontinued due to allergy or dry cough. We do ask everyone to have a blood test 2-3 weeks after commencing the medications to check the kidneys.

In the circumstance, Ramipril has to be discontinued we commence a medication called Candesdartan or similar medication (Angiotensin II receptor blockers)

 

If you are over 55 years of age or of Afro Caribbean origin you would have been offered amlodipine 5mg or similar medication (Calcium Channel Blockers)

 

These are good drugs and bring BP to control faster but the way they act can have initial side effects of dizziness, headache, and swollen legs. Infact swollen legs are the most common reasons one has to stop the medication. It happens more so if one is prescribed amlodipine 10 mg. (Higher dose).

 

In this scenario, if one has to stop the medication we do prescribe water tablets like Indapamide (use thiazide-like diuretic).

 

We often ask you to bring a urine sample each year to check protein in urine; many times I am asked what does that mean? High levels of protein in the urine indicate a negative effect on kidneys. It is affected by BP, diabetes and other cardiovascular risk factors like high BMI (weight). Smoking. Keeping them under control and following a good lifestyle would ensure lower levels and healthy kidneys.

 

If BP is not controlled with once start combining the medication.

 

Like Ramipril with amlodipine or Candesartan with amlodipine.

Sometimes three medications including the above two combinations and a water tablet are necessary.

for example Candesartan with amlodipine and Indapamide.

 

Please make sure you discuss with the doctor if you do feel dizzy when you stand up as there is a risk of a postural drop in BP when you stand up.

 

Please take your medications when your BP is well controlled. Many people think if my BP is normal I should stop the medication.

BP is Normal because you are taking the medications.

 

If you do have a very high BP (>180/120) with no signs of new-onset confusion, chest pain, shortness of breaths, swollen face or swollen legs check your BP after relaxing if its still high speak to the doctor he will commence the medication with few Blood tests to assess cardiovascular risk.

 

Repeat BP in 7 days with a health professional.

 

If you do have very high BP of (>180/120) with visual problems with a bad headache, of new-onset confusion, chest pain, shortness of breaths, swollen face or swollen legs please contact emergency services.

 

Stay Healthy and Happy

Dr. S Sharma