Understanding high blood pressure: causes and control

High blood pressure is the most common condition we manage, and the one patients are most surprised to be told they have. It is silent by nature: the first symptom, for many people, is the event it caused.

What the numbers mean

A reading has two parts. The upper number is the pressure while the heart contracts; the lower is the pressure between beats. Under 120/80 is ideal. Consistently at or above 140/90 in clinic is hypertension, and the word "consistently" is doing real work — a single high reading in a waiting room is not a diagnosis.

Why one reading is not enough

White-coat hypertension is real and common. We often ask patients to take readings at home, morning and evening, for a week, and bring the log. It is a better picture than anything we can capture in a fifteen-minute visit.

What raises it

Age and family history you cannot change. Salt intake, weight, alcohol, inactivity, poor sleep and untreated sleep apnoea you largely can. So can some common medicines, including several anti-inflammatories and decongestants — worth mentioning everything you take, including what you bought without a prescription.

What brings it down

In roughly the order of how much they move the number for most people: losing weight if there is weight to lose, cutting salt substantially, regular aerobic exercise, reducing alcohol, and increasing potassium from fruit and vegetables. Together these are often worth as much as a first medication.

When medication is the right answer

When lifestyle change is not enough, or when the reading is high enough that waiting is the greater risk. Modern blood-pressure medicines are cheap, well understood and generally well tolerated. Most people end up on a low dose of two rather than a high dose of one, because that gives better control with fewer side effects.

The part people get wrong

Blood pressure treatment is not a course. It does not finish. Stopping because the number is now normal is stopping because the treatment is working.

If you have not had yours checked in the last year, it takes two minutes. Book a check-up and we will do it at the same visit.