High blood pressure (hypertension) is a common condition in which the force of your blood against your artery walls is too high, too often. Ongoing high blood pressure puts stress on the heart and can lead to health problems, such as heart disease and stroke.
Key points
One in five New Zealanders has high blood pressure, but most don't know they do.
It is more common in older age groups but it can affect younger people too.
High blood pressure usually doesn't have symptoms; therefore, it is important to get your blood pressure measured regularly. Your doctor, nurse or pharmacist can do this for you.
Untreated high blood pressure can cause serious problems such as stroke, heart failure, heart attack and kidney failure.
You can control high blood pressure through healthy lifestyle habits and medications if needed.
If you need medication, take it every day as prescribed and ask questions of your doctor or pharmacist if you don't understand anything.
What is high blood pressure?
Your blood pressure is measured in millimetres of mercury (which is written as mmHg) and is recorded as systolic blood pressure over diastolic blood pressure, for example, 120/70 mmHg.
As a general guide, an ideal blood pressure is between 90/60 mmHg and 120/80 mmHg.
High blood pressure is considered to be 140/90 mmHg or higher.
A blood pressure reading between 120/80mmHg and 140/90mmHg could mean you're at risk of developing high blood pressure, if you don't take steps to keep your blood pressure under control.
Low blood pressure is considered to be 90/60mmHg or lower.
Why is high blood pressure a problem?
Ongoing high blood pressure damages the blood vessels, especially if you also have raised blood cholesterol or diabetes, or if you smoke.
If blood vessels become narrowed or blocked, a heart attack or stroke may occur. High blood pressure is also linked to kidney and eye damage and poor circulation in the arteries of the legs.
How does high blood pressure cause damage?
If you imagine a garden hose with the nozzle at a narrow setting, water will leave the hose with great force and could damage tender plants. The body behaves in a similar way when there is increased pressure (ie. high blood pressure) in the arteries.
If the arteries were delivering blood at high pressure to delicate organs such as the eyes, kidneys and brain they can cause damage, possibly permanent.
If the heart has to beat against increased artery pressure, eventually, after a period of years, it will feel the strain and tire.
Normal blood pressure delivers an effective blood supply to all parts of the body without damaging sensitive organs.
What causes high blood pressure?
Essential hypertension
In most people with high blood pressure, there is no obvious cause. This is called essential hypertension. Risk factors for essential hypertension are:
The more risk factors you have, the higher your risk of developing high blood pressure.
Secondary causes
About 10% of high blood pressure cases are due to an underlying problem or condition and are known as secondary causes.
This includes causes such as:
kidney disease
narrowing of the arteries supplying the kidneys (renal artery stenosis)
Cushing's syndrome
some medications such as the oral contraceptive pill and nonsteroidal anti-inflammatory drugs (ibuprofen, naprosyn, diclofenac etc)
other conditions such as diabetes and lupus
recreational drugs, such as cocaine, amphetamines and crystal methamphetamine
some herbal remedies or supplements.
Who needs to get their blood pressure checked?
All adults should have their blood pressure checked regularly. Most people with high blood pressure do not get any symptoms so you need to get it checked to know if you have it. You can have your blood pressure checked by your doctor, nurse or pharmacist.
How often will depend on your age, whether you are taking any medications and your general health. Regular checks are especially important for:
pregnant women and those taking the oral contraceptive pill
those with a family history of heart disease.
If you have low blood pressure, you may feel light-headed, faint or dizzy on standing up.
How is high blood pressure diagnosed?
To diagnose high blood pressure, you need to have your blood pressure checked by your doctor, nurse or pharmacist. They will often take several readings over weeks or months to see what the trend is.
Sometimes your doctor, nurse or pharmacist will suggest 24-hour blood pressure monitoring. This involves wearing a blood pressure unit for up to 24 hours to collect a series of blood pressure and heart rate readings at different times of the day and night.
For mild high blood pressure, adopting the self-care steps listed below such as stopping smoking, eating a balanced diet, less salt, less alcohol and becoming more physically active may be all that is needed.
For moderate to severe high blood pressure, you are likely to need medication as well as working hard at these self-care measures.
Self-care for high blood pressure
Stop smoking – quitting is the most important step to reduce your risk of heart attack and stroke.
Achieve and maintain a healthy bodyweight. The more overweight you are, the more strain you are putting on your heart and cardiovascular system. For some people, losing 5-10kg of excess weight is all that is needed to get their blood pressure back to normal. Check with your doctor, nurse or pharmacist as to what is right for you.
Eat a balanced diet – low in saturated fat with whole grains, eight servings of coloured vegetables and fruit, and two to three servings of low-fat milk or milk products a day. Learn more about the DASH eating plan to lower high blood pressure.
Eat less salt. Use herbs, spices, fruit and vinegar for flavouring and dressings and choose low-salt versions of packaged foods, avoid pickled food and avoid salty or fatty takeaway foods.
Watch alcohol consumption. Aim to have no more than one to two alcoholic drinks a day.
Avoid liquorice – it contains a chemical that can raise blood pressure.
Be active every day. Find ways to put a little bit more activity in your day at every opportunity. Take the stairs at work. Park 5 minutes further away. Aim to get 30 to 60 minutes of moderate activity most days of the week. Walking, cycling and swimming are ideal. Find an activity you enjoy so you can keep it up.
Get your blood pressure checked. Every adult should have their blood pressure checked regularly. Your doctor, nurse or pharmacist will advise you how often – it will depend on your age, whether you are taking any medications and your general health.
Medications for high blood pressure
Medications can help control high blood pressure and reduce the damage from high blood pressure, but they do not cure it. Usually, medication will need to be taken for life, unless losing weight and the lifestyle changes are so successful that your blood pressure returns to normal levels without medication.
There a variety of medicines that can be used to lower blood pressure each of these groups of medicines works differently. Often two or three medications are needed and it may take time to find the right combination and dosage. It is important to let your doctor or pharmacist know about any side effects you may have and to follow instructions carefully.
Examples of medicines to treat blood pressure:
ACE inhibitors such as cilazapril, lisinopril, quinapril.
ARBs such as candesartan, irbesartan, losartan.
Beta blockers such as bisoprolol, metoprolol, propranolol.
Calcium channel blockers such as amlodipine, diltiazem, felodipine.
Diuretics (also called water pills) such as bendroflumethiazide, chlortalidone, indapamide.
Because high blood pressure puts you at increased risk of cardiovascular disease, you may also be prescribed other medicines to help reduce your risk of heart disease and stroke, such as:
Credits: used with permission from Heart Foundation. Latest update Oct 2015. Images from123rf.com. Reviewed By: Health Navigator
How can high blood pressure be prevented?
High blood pressure is one of the most common health problems as people get older. With a little effort, there is much you can do to reduce your risk of getting high blood pressure and the increased risk of strokes and heart disease that goes with that.
Keep to a healthy body weight
One of the key risk factors for high blood pressure is being overweight. Talk to your doctor, nurse or Pharmacist about what is the best goal for you. Often, by reducing your weight by 5-10%, this can noticeably improve your blood pressure.
Eat a balanced diet
This is a diet low in saturated fat, whole grains, eight servings of coloured vegetables and fruit, and two to three servings of low fat milk or milk products a day.
Eat less salt
Use herbs, spices, fruit and vinegar for flavouring and dressings. If you have pre-prepared foods, avoid pickled food and avoid salty or fatty takeaway foods.
Watch alcohol consumption
Have no more than two (for women) or three alcoholic drinks a day and some alcohol free days per week.
Avoid liquorice
Liquorice contains a chemical that can raise blood pressure.
Be active regularly
Strive to put a little bit more activity in your day at every opportunity. Aim to get 30 to 60 minutes of physical activity most days of the week. Walking, cycling and swimming are ideal. Find an activity you enjoy so you can keep it up.
Look for opportunities to add a few minutes here and there - take the stairs whenever you can, park 5 minutes further from work, go for a walk at lunchtime or when you get home.
Stop smoking
Being smokefree is one of the best things you can do to lower your blood pressure and risk of heart attack and stroke.
Medicines for high blood pressure
Medicines can help control high blood pressure and can reduce the damage from it, but does not cure high blood pressure. Usually medication will need to be taken for life, unless losing weight and the lifestyle changes are so successful that your blood pressure returns to normal levels without medication. Medicines that are used to control high blood pressure are called antihypertensives.
There are different groups or classes of medicines that can be used to lower blood pressure - each of these groups work differently. It is important to let your doctor or pharmacist know about any side effects you may have and to follow instructions carefully.
Classes of blood pressure medicines
Angiotensin-converting enzyme (ACE) Inhibitors (also called ACE inhibitors)
ACE inhibitors block a hormone in the blood that causes blood vessels to tighten, and in this way relax the blood vessels and lower blood pressure. Examples include:
captopril
cilazapril
enalapril
lisinopril
perindopril
quinapril
trandolapril
Angiotensin receptor blockers (also called ARBs)
These also control hormones that affect blood pressure. Examples include:
candesartan
irbesartan
losartan
Beta blockers
These medicines are often used to reduce blood pressure when other options are not suitable or working well enough. Examples include:
atenolol
bisoprolol
carvedilol
celiprolol
labetalol
metoprolol
propranolol
Calcium channel blockers
These medicines block calcium from getting into your cells and in this way relax the blood vessels and lower blood pressure. Examples include:
amlodipine
diltiazem
felodipine
isradipine
nifedipine
verapamil
Diuretics
These medicines remove unwanted fluid from the body, which helps lower blood pressure. Examples include:
Choosing the right blood pressure medicines for you
Research shows that some types of blood pressure medicines work better in different types of people, and the choice of blood pressure medicines can depend on your:
age
ethnic origin
medical problems (such as kidney disease or angina)
medical history, for example which blood pressure medicines you have tried in the past.
Since everyone is different, some medicines will work better for others than they do for you. Your doctor and nurse will usually go through a number of steps to find the right blood pressure medicines for you. Often two or three medications are needed and it may take time to find the right combination and dosage.
Side effects
Medicines used to treat high blood pressure can cause side effects, although not everyone gets them. It is important to let your doctor or pharmacist know about any side effects you may have and to follow instructions carefully.
If treatment lowers your blood pressure too much, you may feel faint or dizzy, or notice excessive tiredness or heaviness in your legs. If you sit or lie down, these feelings will pass. Some medicines may make you feel faint if you get out of bed or stand up too quickly, suddenly exert yourself or get out of a hot shower or bath.
A cough, and erection problems in men are other possible side effects. Other medications can sometimes affect your blood pressure medication.
If you are prescribed new medications for other issues, remember to tell your doctor that you are taking blood pressure medication, and also any other medications you are taking. Your doctor needs this information to ensure the combination of medications is safe and effective.
If you are concerned about any side effects you are experiencing, talk to your doctor for further advice.
Tips on how to take your medicines effectively
Establish a routine; take your pills at the same time every day.
Do not keep your pills in the kitchen or bathroom: high temperatures or humidity can deteriorate them.
On long journeys, keep separately labelled supplies of your tablets in more than one bag.
All blood pressure drugs are dangerous to children and must be kept out of their reach.
Resources for health professionals
In general, high blood pressure (BP) is managed as part of overall cardiovascular risk. Current guidelines suggest also treating:
People with BP equal to or over 170/100 with drug treatment and specific lifestyle advice to lower risk factor levels.
People aged 75 years and over with isolated raised systolic BP 160 mm Hg, (DBP ≤ 90 mm Hg) as their risk of stroke is higher and BP should be managed aggressively.
Regional pathways (Password may be required) A number of regions have clinical pathways including diagnosis, management and local referral or request contact details. Contact your DHB or PHO for access if not already known:
Tight BP control improves CV outcomes in high-risk patients Results of the SPRINT trial have found that in high-risk CVD patients (20% risk of an event in 10 years), a target BP of 120 mm Hg showed improved outcomes (reduced CVD events and death) as compared with a target BP of 140 mm Hg.
Managing hypertension in primary care An overview of the latest guidance on managing patients with hypertension and a guide to differentiating between primary and secondary hypertension. (1 hour) Sept 16
What’s new in hypertension? This module describes recent developments in the management of hypertension and the practical implications for doctors working in primary care. (1 hour) Sept 16
Ongoing high blood pressure damages the blood vessels, especially if you also have raised blood cholesterol or diabetes, or if you smoke.
Hypertension diagnosis & management guidelines