Medical matters

by Dr Jeremy Beckett

High blood pressure the silent killer - Part 2

In part 1 we looked at hypertension (high blood pressure) and the damage it causes to arteries, potentially leading to heart attack, stroke, kidney failure and other life threatening conditions.

How is hypertension diagnosed?

Blood pressure is measured using an inflatable blood pressure cuff and a stethoscope, but hypertension can't be diagnosed on just one reading. Your blood pressure fluctuates from moment to moment and is affected by stress, pain, exercise, caffeine and cigarettes.

The most accurate way to assess your blood pressure is to have it checked at home at different times of the day and night. There are two ways of doing this. One option is to take home an automatic blood pressure machine, which can be purchased from pharmacies or sometimes borrowed from your family medical practice, and keep a record of your results. Alternatively you can wear a portable blood pressure recorder that takes a reading each hour (for 24 hours), which needs to be arranged by your doctor.

Blood pressure readings are described in two numbers: the systolic pressure (when the heart contracts) and the diastolic pressure (when the heart relaxes). It is then expressed as the systolic pressure over the diastolic pressure: for example, 120/80. Persistent readings of 140/90 or above are considered to be high, and can be dangerous in the long term.

What happens next?

1

Investigating to find the cause. Your family doctor should examine you, and may order some tests, to search for treatable causes of hypertension. As mentioned in Part 1, in more than 90% of cases there is no obvious cause.

2

Looking for organ damage. Your doctor should also examine you to see if your high blood pressure has damaged any organs. This may also involve an electrocardiogram (ECG) of your heart, and blood and urine tests to check your kidneys.

3

Addressing other risk factors. It is important to also deal with other risk factors that increase the danger of hypertension: smoking, diabetes, high cholesterol and obesity.

4

Lifestyle changes. There are several lifestyle changes that have been shown to reduce blood pressure in most people, which may mean that less (or no) medication is required:
? Weight loss ???
? Exercise ???
? Reduced salt ?

5

Medication. In most instances hypertension will not be controlled by lifestyle changes alone, though these changes can make a big difference. There are a huge range of different blood pressure medications, and they have different side effects. Many patients find that they require more than one type of medication to control their blood pressure.

Hypertension should not be underestimated – just because you feel fine doesn't mean that you are. There are no reliable symptoms of hypertension: many people are not even aware that they have the problem. The only way to know is to have your blood pressure checked. It's a simple enough thing to uncover this silent killer.

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