Hypertension
Hypertension is a condition of a raised arterial pressure. Hypertension varies in its definition, however it is generally accepted as over 140 systolic (that is when the heart contracts) and 90 diastolic when the heart relaxes. It is very rare for patients to have symptoms of high blood pressure and it is only through taking patients blood pressure in the surgery that it is possible to detect the condition. The majority of patients that we see in the surgery have essential hypertension, this is hypertension of no known cause, although it usually runs in families and presents over the age of 40. Occasionally we see patients with secondary hypertension due to kidney or disturbances of the endocrine glands.
Hypertension is associated with an increased risk of heart disease, strokes, kidney disease and eye disease. It is therefore important that all patients from time to time have their blood pressure taken and particularly those specifically at risk with a family history, obesity, diabetes and renal disease. Blood Pressure various considerably from day to day and can only be diagnosed when patients are resting and their blood pressure is raised on repeated readings over a three-month period.
Investigations. All patients with hypertension are offered an ECG, blood tests and general health advice which includes losing weight (there is a 1mm mercury drop in blood pressure for every kilogram last lost), taking regular exercise, stopping smoking where appropriate, reducing salt, avoiding excess alcohol and encouraging fruit which is high in potassium.
Some patients have artificially raised blood pressure when they are seen in the surgery this is called ‘white coat hypertension’. It is now accepted practice to encourage patients to record their own blood pressure using digital machines that are readily available in most chemists. These machines will always record lower readings than in the surgery and therefore a degree of interpretation of results is important. It is clear however that patients who have extremely normal blood pressures at home and high blood pressure is in the surgery have ‘white coat hypertension’ and some allowances for this are inevitable.
Treatment for some patients with mild hypertension: health advice and monitoring is all that is appropriate. However most patients require medication and there are now at least 6 different classes of medication which can be initiated. The aim is to commence medication which does not create any side-effects but manages to drop the blood pressure to the target of 140/85 as defined by the HOT study. (Hypertensive Optimum Treatment study). In diabetics and patients with renal disease the target level is even lower. Most patients require at least 2 or 3 medications to achieve this target level and sometimes as many as 4. Aspirin is usually advised for hypertensive patients and occasionally patients are also taking statins to lower their cholesterol. This is a fairly significant amount of daily medication but as a practice we are seeing a significant reduction in the complications of hypertension with this aggressive treatment and it is clearly to the patients advantage to receive this management.
Monitoring. When the hypertension is controlled with the appropriate medication it is only necessary to have 1 reading taken every six months. All patients should attend either their GP or nurse for this to be carried out along with annual recordings of blood tests to check the kidney function.
Investigations. All patients with hypertension are offered an ECG, blood tests and general health advice which includes losing weight (there is a 1mm mercury drop in blood pressure for every kilogram last lost), taking regular exercise, stopping smoking where appropriate, reducing salt, avoiding excess alcohol and encouraging fruit which is high in potassium.
Some patients have artificially raised blood pressure when they are seen in the surgery this is called ‘white coat hypertension’. It is now accepted practice to encourage patients to record their own blood pressure using digital machines that are readily available in most chemists. These machines will always record lower readings than in the surgery and therefore a degree of interpretation of results is important. It is clear however that patients who have extremely normal blood pressures at home and high blood pressure is in the surgery have ‘white coat hypertension’ and some allowances for this are inevitable.
Treatment for some patients with mild hypertension: health advice and monitoring is all that is appropriate. However most patients require medication and there are now at least 6 different classes of medication which can be initiated. The aim is to commence medication which does not create any side-effects but manages to drop the blood pressure to the target of 140/85 as defined by the HOT study. (Hypertensive Optimum Treatment study). In diabetics and patients with renal disease the target level is even lower. Most patients require at least 2 or 3 medications to achieve this target level and sometimes as many as 4. Aspirin is usually advised for hypertensive patients and occasionally patients are also taking statins to lower their cholesterol. This is a fairly significant amount of daily medication but as a practice we are seeing a significant reduction in the complications of hypertension with this aggressive treatment and it is clearly to the patients advantage to receive this management.
Monitoring. When the hypertension is controlled with the appropriate medication it is only necessary to have 1 reading taken every six months. All patients should attend either their GP or nurse for this to be carried out along with annual recordings of blood tests to check the kidney function.