High blood pressure
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This factsheet is for people who have high blood pressure (hypertension), or who would like information about it.
Blood pressure is a measure of the force that the blood applies to the walls of the arteries as it flows through them. Its normal for blood pressure to increase when you exert yourself, or when you feel stressed or anxious. But if your blood pressure is consistently higher than the healthy level when at rest, this is high blood pressure (hypertension).
Blood carrying oxygen and nutrients is pumped around your body by your heart. As a result of the pumping action of your heart and the size and flexibility of your arteries that carry blood, the blood is under pressure. This blood pressure is an essential part of the way your body works. You can get high blood pressure if the walls of your larger arteries lose their elasticity and become rigid. A Hospital Authority community survey conducted in 2004 revealed an estimated prevalence of 24% in people aged 40 years or above.
Most people with high blood pressure do not have any symptoms.
If you have very high blood pressure, or a rapid rise in blood pressure, you may have headaches, problems with your vision, fits or black-outs.
If you have high blood pressure, you have an increased risk of major illnesses including:
- cardiovascular disease such as angina (chest pain caused by reduced blood flow), stroke, heart attack, heart failure or atrial fibrillation (irregular heart beat)
- kidney damage
- damaged sight
More than nine in 10 people with high blood pressure have what is called primary or essential hypertension. This means that it has no single clear cause. Although the exact cause of primary hypertension is not fully understood, its known that some factors to do with your lifestyle can contribute. These include:
- obesity (being very overweight)
- drinking a lot of alcohol - especially if you binge drink
- lack of exercise
- your diet
If someone else in your family has high blood pressure, you also have a higher risk of developing it.
Around one in 20 people with high blood pressure have secondary hypertension. This means your condition can be linked to a recognised cause such as:
- kidney disease
- endocrine disease (hormone disorders - a hormone is a regulatory chemical that occurs naturally in your body)
- a narrowing of the aorta (the largest artery leading from the heart) or the arteries leading to the kidneys
Secondary hypertension can also be caused by:
- steroid medicines
- the contraceptive pill
- pregnancy, which can cause pre-eclampsia - this can be serious and harm your baby
As you might not have any symptoms, your GP may diagnose high blood pressure when you have your blood pressure taken as part of a medical examination. That is one good reason to have a regular check-up with your GP, especially if you are over 50.
Your GP or nurse will measure your blood pressure with a monitor called a sphygmomanometer. A cuff is placed around your upper arm and inflated to a certain level, then deflated slowly. A sensor in the cuff provides information about your blood pressure.
The result is expressed as two numbers, such as 120/80mmHg (one hundred and twenty over eighty millimetres of mercury).
- The first figure - the systolic blood pressure - is a measure of the pressure when your heart muscle is contracted and pumping blood. This is the maximum pressure in your blood system.
- The second figure - the diastolic blood pressure - is the pressure between heart beats when your heart is resting and filling with blood. This is the minimum pressure in your blood system.
Hypertension is defined as a consistently increased systolic blood pressure of 140 or over and/or a diastolic blood pressure of 90 or over. If your blood pressure is around this level, your GP will probably want to monitor it regularly.
If you have diabetes, your blood pressure should be lower than this - ideally less than 130/80.
Your GP may ask you to come back for repeat measurements over a number of weeks before suggesting that you have treatment. This is so he or she can check that the high reading is an ongoing problem and not a one-off.
You may also need some tests to see if hypertension is affecting the rest of your body. These may include:
- a urine test - protein in your urine may be the first sign of a kidney problem
- a blood test to check your cholesterol and blood sugar levels, as well as the condition of your kidneys
- an electrocardiogram (ECG) - a test that measures the electrical activity of your heart to see how well its working
24-hour ambulatory monitoring
You may be given a 24-hour ambulatory monitoring to confirm your diagnosis. This will measure your blood pressure over 24 hours. A monitoring device will be strapped round your waist and attached to a cuff wrapped around your upper arm. The cuff will inflate and deflate automatically throughout the 24 hours and take recordings of your blood pressure.
Blood pressure monitors
You might consider getting a blood pressure monitor to use yourself at home - discuss this option with your GP.
It is important to take readings on different days - for example you should not just measure your blood pressure when you feel stressed. Set days in the week to take the measurement so that you can get a consistent reading.
You should continue to have your blood pressure tested regularly by your GP even if you use a blood pressure monitor at home.
You are likely to need long-term treatment for high blood pressure as it is not curable.
You may not need much treatment if you only have slightly raised blood pressure, but regular monitoring is important.
If you have very high blood pressure, you may need to go to hospital for treatment. But it is much more likely that you will be cared for by your GP and/or a nurse.
Your GP or nurse is likely to discuss lifestyle changes which might help. For example, he or she might advise you to:
- stop smoking
- change your diet to a low-fat, low-salt diet that includes fruit and vegetables
- cut down on alcohol
- cut down on coffee and high-caffeine drinks, such as cola
- take some regular, moderate exercise
- lose any excess weight
It may also help to try to reduce the stress in your life to prevent short-term rises in blood pressure - try relaxation techniques or meditation.
If your blood pressure remains high, your GP may prescribe you one or more of the following antihypertensive medicines.
- ACE inhibitors (eg ramipril) or angiotensin II receptor antagonists (such as candesartan cilexetil eg Amias) - these relax and widen the walls of your blood vessels.
- Calcium-channel blockers (eg amlodipine) - these help to widen your blood vessels.
- Diuretics (eg bendroflumethiazide) - these increase the amount of water and salt removed from your blood by your kidneys. This lowers the volume of your blood which reduces blood pressure.
- Beta-blockers (eg atenolol) - these medicines reduce the work your heart has to do by reducing your pulse rate at rest and when you exercise.
- Alpha blockers (eg doxazosin) - these help to widen your blood vessels.
The medicines your GP prescribes will depend on a number of factors, including your age and ethnicity. It may take time to find the best treatment for you; one that balances benefits against any side-effects.
It is important to be committed to taking your medication every day even if you do not have any symptoms of high blood pressure.
If you are pregnant your blood pressure will be monitored regularly whether you have hypertension or not. Its possible that you may develop high blood pressure during your pregnancy (pregnancy-induced hypertension) which can lead to serious problems (this is called pre-eclampsia).
If you have high blood pressure and think you may be, or are trying to become pregnant, it is important that you tell your GP. Certain medicines for treating high blood pressure are not suitable for pregnant women.
1. Does stress cause high blood pressure and if so how can I reduce my stress levels?
Your blood pressure can rise if you're anxious or stressed. Long-term stress isn't thought to cause permanently high blood pressure. You may be able to help reduce your stress levels using relaxation techniques and exercise.
Your blood pressure will change throughout the day and can increase if you become stressed or anxious. This can also happen if you get worried about seeing your GP to have your blood pressure measured - this is known as 'white coat syndrome'. Your GP will want to take at least two measurements of your blood pressure to be certain that it's consistently high.
If your blood pressure rises when you're stressed, there are therapies you can try to help you control these short-term increases.
- You may find relaxation techniques such as meditation or yoga is helpful.
- Stress management can help to prevent you getting stressed.
- Cognitive therapy (a type of talking therapy) can help you to focus on how you're feeling and how you cope with your problems.
Ask your GP for more advice about these therapies for blood pressure control.
Checking the results from a blood pressure monitor in different situations lets you see if your blood pressure is rising so that you can try to control it.
2. Can I travel by plane if I have high blood pressure?
Yes. Travelling by plane won't affect your blood pressure but you should consult your GP before you fly.
Blood pressure isn't affected by air travel so it's perfectly safe for you to travel by plane if you have high blood pressure.
It's a good idea to consult your GP before you travel, especially if your blood pressure is unstable. Make sure that you have packed enough medicines to last you for your whole trip; you can get a prescription for up to three months from your GP. It's a good idea to pack some in your hand luggage and keep a note of your prescription or a letter from your GP in case your suitcase goes missing or if you get stopped at customs. You may have to pay a fee to obtain documents from your GP.
You should also be aware that travelling can be stressful and this can cause your blood pressure to rise. Make sure you leave in plenty of time for your departure and don't pack too much as struggling with a heavy suitcase could also increase your blood pressure.
3. Can medicines cause high blood pressure?
Yes. Certain medicines can cause high blood pressure.
High blood pressure (hypertension) that has a known cause is called secondary hypertension.
There are a number of substances and medicines that are known to cause hypertension including:
- stimulants such as caffeine, nicotine and cocaine
- non-steroidal anti-inflammatory drugs such as etoricoxib (Arcoxia)
- the oral contraceptive pill and other hormone treatments
- some medicines used to treat anaemia, such as erythropoietin and corticosteroids
- certain medicines that are used to treat rheumatoid arthritis, for example ciclosporin and leflunomide (Arava)
- certain herbal medicines that contain liquorice
- sodium in soluble medicines
Always consult your GP before you start taking any new medicines.
You should also be aware that certain medicines can interact with each other to cause hypertension. For example, some over-the-counter nasal decongestants contain ingredients that can interact with certain antidepressants to cause hypertension.
Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
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- British Cardiac Society, British Hypertension Society, Diabetes UK, HEART UK, Primary Care Cardiovascular Society, The Stroke Association. Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart 2005;91:1–52 http://heart.bmj.com/content/91/suppl_5/v1
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