High blood pressure
Raised blood pressure is one of the few conditions that gets in the way of nothing for years while quietly wearing out the arteries every single day.
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Medicines commonly prescribed for High blood pressure
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 5 MGActive substance: amlodipineManufacturer: Tad Pharma GmbhPrescription requiredDosage form: TABLET, 5 mgActive substance: ramiprilManufacturer: Laboratorios Cinfa S.A.Prescription requiredDosage form: TABLET, 5 mgActive substance: ramiprilManufacturer: Teva Pharma S.L.U.Prescription required
Raised blood pressure is one of the few conditions that gets in the way of nothing for years while quietly wearing out the arteries every single day. It is usually found by accident — at an occupational check, before an operation, at a pharmacy counter. By then the numbers have been high for a long time. The encouraging side is that hypertension responds well: taking ten points off the upper figure measurably lowers the chance of a stroke, and half the work is done by habits rather than tablets. What follows is how to get honest readings, what sits behind them, and when waiting is a mistake.
Why it climbs unnoticed
Blood pressure is the force the blood exerts against the walls of the arteries. It shifts through the day on its own: lowest during sleep, higher in the morning and on exertion, and it jumps with anger or pain. What counts as disease is not a single spike but a level that stays up.
As a rule it causes no symptoms at all. The artery wall stretches slowly, the body adapts, and somebody at 170/100 may feel exactly as they do at 120/70. At very high figures there can be headache, blurring, tightness in the chest or nosebleeds, but that is the exception rather than the rule.
Hence the commonest misconception: "I can tell when mine is up." Studies in large groups of people show that headache, a flushed face, ringing in the ears and tiredness line up with the actual reading barely better than chance. Sensations cannot be trusted in either direction: people feel dreadful with normal pressure and excellent with pressure through the roof. There is one way to know, and that is to measure.
Measuring so the numbers mean something
Half of all odd results are explained not by illness but by how the reading was taken. A home monitor is inexpensive and pays for itself when used properly.
- Choose a device with an upper-arm cuff rather than a wrist one: wrist monitors respond more to the position of the hand than to the pressure.
- The cuff has to match the size of the arm. A narrow cuff on a large arm inflates the result by tens of points, and that is the single most frequent cause of apparent hypertension.
- Sit quietly for five minutes first, back supported, both feet on the floor, legs uncrossed. Rest the arm on a table so that the cuff sits level with the heart.
- In the preceding half hour do not smoke, drink coffee or exercise. Empty your bladder: a full one pushes the reading up.
- Do not talk while the machine is running and do not watch the display.
- Take two or three readings a minute apart and write down the average of the last two. The first is usually the highest, and that is normal.
- A diagnosis needs a series: morning and evening for a week. A single figure means nothing.
Home readings matter for two further reasons. In some people the pressure rises only in the consulting room — the white-coat effect, which is not something to treat with tablets. In others it works the other way round: respectable numbers at the appointment, high ones at home and at work. That masked form is only picked up with a home diary or with twenty-four-hour monitoring, where the device is worn for a full day and records overnight as well.
Which numbers count as high
A reading is written as two figures, for instance 130/80. The upper one is the pressure at the moment the heart contracts; the lower is what remains between beats, while the heart fills.
- In the consulting room, hypertension is diagnosed at repeated readings of 140/90 or above.
- At home the same diagnosis corresponds to a lower threshold, 135/85, because people are calmer at home.
- The band running roughly from 130/85 to 139/89 is not classed as disease, but it is already a reason to change habits and to measure regularly.
Either of the two figures being over the line is enough. In older people it is common for only the upper one to rise while the lower stays normal — that is not a harmless variant but a full form of hypertension, and it needs treating too. At very advanced ages the reverse applies: targets are relaxed and the pressure is brought down more cautiously, because dizziness and falls matter more than five extra points.
The diagnosis is almost never made at one visit. The usual course is to watch over several weeks, unless the figures are very high or changes are already visible in the heart, the kidneys or the back of the eye.
Who is more likely to get it
The odds are higher with hypertension in close relatives, past the age of fifty, when spare weight settles around the middle, when there is a lot of salt in the food and little movement. Regular alcohol, smoking, short sleep, night-time snoring with pauses in breathing and sustained strain without recovery all add to it. In people of African, Caribbean and South Asian descent hypertension starts earlier and runs a harder course, which is worth bearing in mind when deciding at what age to have the first reading taken.
One cause is missed remarkably often: medicines. Blood pressure is pushed up by anti-inflammatory painkillers taken regularly, by decongestant drops and tablets, hormonal contraceptives, steroids and some antidepressants; outside the medicine cabinet, by energy drinks and by liquorice in quantity. If the pressure has risen over recent months, it is worth reviewing what is new on the shelf.
When something else lies behind it
In roughly one person in ten, high blood pressure is not a disease in itself but a symptom. These forms are worth hunting for: some are entirely curable, and once the cause is dealt with the pressure settles without lifelong tablets.
Suspicion is reasonable when:
- the pressure first goes up in a young person or, conversely, appears abruptly after many years of normal readings;
- it is very high from the outset;
- three medicines at full dose fail to control it;
- blood tests show a low potassium;
- there are attacks with palpitations, tremor, drenching sweats and headache, in which the pressure surges and then drops;
- there is loud snoring with pauses in breathing and daytime sleepiness;
- urine tests or a scan show changes in the kidneys.
What usually sits behind it: narrowing of a kidney artery, chronic kidney disease, an excess of the hormone aldosterone — the commonest of the curable causes — sleep apnoea, thyroid disorders and, in the young, a congenital narrowing of the aorta. A rare but dangerous finding is a hormone-producing tumour of the adrenal gland: it causes precisely those attacks and is dealt with surgically.
What untreated pressure does
Permanently raised pressure loads the arteries and the organs that depend on them. Artery walls thicken and lose their give, plaques build up faster, and the heart works against resistance and gradually enlarges.
Over the years that shows up as heart attack, stroke, heart failure, rhythm disturbances, loss of kidney function that can end in dialysis, vascular dementia, aortic aneurysm, and damage to the vessels at the back of the eye with loss of sight. Of all the causes of stroke, high blood pressure is the heaviest.
The reassuring part is that the relationship runs in reverse as well, with no threshold to it: any sustained fall lowers the risk, and even a modest shift in the numbers shows.
What genuinely brings it down
Habits here are not an add-on to treatment but part of it, and in the early stages they are sometimes the whole of it.
- Less salt. The strongest single lever. The salt cellar is less to blame than it looks: most of it arrives with bread, cheese, cured meats, sauces, ready meals and snacks. The palate takes a couple of weeks to adjust to less salty food.
- Losing weight. Every kilogram registers on the monitor, and the first few show almost at once.
- Moving regularly. The benchmark is about two and a half hours of moderate activity a week, and brisk walking counts perfectly well.
- More vegetables, fruit and pulses. They supply potassium, which works against sodium. The exception is kidney disease and certain diuretics, where potassium is a matter for the doctor.
- Less alcohol. There are people whose pressure normalises on this step alone. Drinking regularly holds the numbers up whatever tablets are taken.
- Stopping smoking. Its effect on the figures themselves is moderate, but smoking together with raised pressure ruins arteries faster than anything else.
- Sleep. Chronic short sleep and untreated apnoea raise night-time pressure, and night-time figures predict complications better than daytime ones.
The limits are worth stating honestly: well above the threshold, habits alone rarely do the job, and putting off medication in order to "try it my way first" is a losing strategy. This is not a choice between the two.
Medicines and what to expect from them
They are started when the figures are high, when overall cardiovascular risk is substantial, or when the change of lifestyle has not been enough. There are several main groups: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, calcium channel blockers and thiazide-type diuretics; beta blockers are kept for particular situations. The choice turns on age, descent, kidney function, diabetes and any plans for pregnancy.
Useful things to know in advance:
- two medicines at low dose are prescribed more often than one at maximum dose, because that works better and causes fewer side effects; frequently it comes as a single tablet with the combination already made up;
- they are taken long term, usually once a day and as a rule for life. Good numbers on treatment mean the treatment is working, not that it can be dropped: once stopped, the pressure returns within weeks;
- the enzyme inhibitors can cause a dry cough, which is not dangerous but is a reason to switch to a related drug; calcium channel blockers may swell the ankles and diuretics send people to the lavatory more often. All of that is discussed with the doctor rather than settled by abandoning the tablets;
- anti-inflammatory painkillers blunt the effect of nearly every blood pressure drug;
- if a pregnancy is being planned, the regimen is changed in advance: some of these medicines must not be taken by a pregnant woman.
When to call an ambulance
High figures on their own, with no symptoms, are a reason to see a doctor the same day rather than to call an ambulance. Still less are they a reason to swallow extra tablets to force the number down fast: a sharp drop is more dangerous than the rise itself.
An ambulance is needed straight away if any of the following appears (across Europe the number is 112):
- crushing or burning chest pain lasting more than a few minutes and spreading to the arm, neck, jaw, back or abdomen, particularly with sweating, nausea and breathlessness;
- a drooping corner of the mouth, an arm that will not lift, slurred speech, or the person stops understanding what is said to them — these are signs of a stroke, and here minutes count;
- a sudden headache of an intensity never felt before, like a blow to the back of the head;
- abrupt loss of vision or double vision;
- severe breathlessness at rest, inability to lie flat, frothy pink sputum;
- a tearing chest pain that goes through to the back between the shoulder blades;
- a seizure or confusion;
- in a pregnant woman, high pressure together with headache, flashing lights in the vision, pain below the breastbone or the sudden swelling of face and hands.
Do not drive yourself in any of these situations. Take with you a list of the medicines you are on and your record of home readings if you keep one.
Online consultation
More can be done remotely about blood pressure than people expect, because what settles matters here is not the examination but the numbers and the reading of them. The doctor will go through your measurement diary, say whether this really is hypertension or whether the technique and the nerves are at fault, and decide which blood tests and investigations are needed to avoid missing a secondary form and to assess the state of the organs. An online appointment is also a convenient place to work through side effects, to understand why the pressure is not coming down on the current regimen and to adjust it from your own records instead of spending the visit reciting figures. The emergency signs listed above are not dealt with remotely: those mean calling an ambulance straight away.
This material is for information only and does not replace medical advice.
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