My wife and I went to the doctor's to get our blood pressures checked. Hers was different to mine. Why?

Blood pressure varies from person to person and also changes in the same person. Blood pressure constantly changes within a normal range depending on what you are doing. During physical work your muscles need a greater supply of food and, to meet this extra demand, your blood flow has to be increased. To achieve this, your heart must beat faster and your blood pressure rises.

Blood pressure is lowest at night when you are asleep, but even then there are fluctuations which are presumably due to the influence of dreams. During the day the fluctuations are greater and more frequent and reflect the sort of work you are doing. Mental as well as physical stress can increase your blood pressure.

From this you will see that a doctor may need to take several readings of your blood pressure to make sure that a diagnosis of high blood pressure is a true reflection, and not due to an isolated event that could be responsible for a temporary rise in pressure. For this reason your doctor may ask you to call back to the surgery over a period of a few days or weeks in order to eliminate any temporary cause for the high level.

You can help your doctor in this respect by arriving early for your appointment, so as to avoid a rush, or worrying that you will be late. When you arrive in the surgery, relax as much as possible, because it is important to your doctor, when he is judging the level of blood pressure, to know that you are rested and calm at the time the measurement is taken (see next question).

When I went to the clinic to have my blood pressure checked, I was told that I had white coat hypertension. What is this?

This is a high reading caused by anxiety or stress when you visit your doctor -who may be wearing a white coat! At other times your blood pressure is usually normal. It may be worth checking the readings at home and during the day with a blood pressure machine that can be worn while you are walking about (an ambulatory machine; see the question later on about this.) Do several readings with your own or a borrowed machine. Blood pressure often rises under stress; throughout the day we are exposed to many stresses, so if several elevated readings occur because of environmental stress, treatment will be of value. If no elevated readings occur, your doctor should monitor your pressure regularly anyway, because we don't know if white coat hypertension is a warning for true hypertension in the future. You cannot afford to be complacent.

When I was 16, my blood pressure was lower than it is now that I am 45. Is this OK?

Yes, as a natural part of growing old, your arteries tend to lose their elastic properties to some degree. Also, the walls of your arteries tend to thicken after middle age and, consequently, the internal diameter of the vessel is slightly reduced (the hose pipe gets narrower). All these changes require a very slight increase in blood pressure, which is perfectly normal as you get older.

What are the dangers if I can't get my high blood pressure down?

If a raised blood pressure is left untreated over a 12-year period, you are more likely to die from this risk than if you had been treated. Here are some other statistics about raised blood pressure.

• It is present in 70% of people who have a stroke.

• It increases the risk of coronary heart disease by 2-3 times for men and women.

• It causes heart and kidney failure.

• It causes hardening of the arteries to the legs resulting in pain on walking owing to poor blood flow. The medical term for this is claudication, pronounced 'claw-deecashun'.

• It is responsible for a third of all heart diseases.

• It causes 7 out of 10 strokes in women and 4 out of 10 in men.

• In the UK, 300 people die every 6 weeks as a result of a high blood pressure and most of these deaths are avoidable; if a jumbo jet with 300 people on board crashed every 6 weeks, something would be done about it!

Are there any specific risk factors for high blood pressure that might apply to me?

You are more likely to have a high blood pressure if you:

• have someone in your family who has had high blood pressure;

• are African-Caribbean;

• are aged over 60 years of age;

• are very overweight;

• drink heavily;

• eat a lot of salt;

• had a high blood pressure in pregnancy, or preeclampsia;

• have a lot of stress in your life.

I have read about the rule of halves, but did not understand it. Could you explain?

This is a medical paradox but in reality it demonstrates some alarming facts about blood pressure and lack of treatment.

• Half the people with high BP have not been diagnosed.

• Half of those diagnosed have not been treated.

• Half of those treated have not got their blood pressure under control.

The rule of halves in people with high blood pressure: they remain poorly detected and poorly treated. Half the people with a high blood pressure do not know that they have it (not detected); half who have it may not have been told or may not have attended for treatment; half of those on treatment are not well controlled and finally half of those on treatment are properly treated and have normal pressures as a result - not a good record!

Figure 2.4 The rule of halves in people with high blood pressure: they remain poorly detected and poorly treated. Half the people with a high blood pressure do not know that they have it (not detected); half who have it may not have been told or may not have attended for treatment; half of those on treatment are not well controlled and finally half of those on treatment are properly treated and have normal pressures as a result - not a good record!

• Half of those treated are well treated.

• Only one-eighth of people with high blood pressure are being properly treated (see Figure 2.4).

So the responsibility is yours to keep nagging your doctor or practice nurse to check your blood pressure, whenever you go to the surgery. You must take charge of your own health.

How would I know if my blood pressure was raised?

Most people feel nothing until there is a problem, which is why it is known as 'the silent enemy'. It is thought that half the people with high blood pressure do not know they have it, because they cannot feel it and a doctor has not checked it. It is therefore important to have a blood pressure check every few years if it is normal, or more frequently if it is slightly raised or 'borderline'. If you go to your doctor for another reason, ask for it to be checked then.

 
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