Hypertension (Blood Pressure)

What is Hypertension or High Blood Pressure?

With normal blood pressure, arteries are elastic and flexible, but high blood pressure increases risk of heart problems in two main ways.

Firstly, high blood pressure or hypertension makes the heart work harder and the force of extra blood pumping around your body can cause the left heart to enlarge or stiffen. 

Over time, a stiff heart fails to pump effectively and starts to fail. 

Secondly, high blood pressure can cause cellular changes to the lining of the arteries, which allows more fat and plaque to collect or “block” the arteries. 

Add weight, salt, smoking, family history of blood pressure, excess alcohol or high cholesterol on top and you could be a ticking time bomb for stroke, heart attack and heart failure.

Today 6 million Australians have hypertension or high blood pressure and of these 68% have resistant Hypertension, that is more difficult to treat, even with medications. 

Blood pressure is more common in men up to age 55, but women do develop higher  blood pressure after menopause without the heart protective benefits of oestrogen.

Other Hypertension culprits include Obstructive Sleep Apnoea, Kidney Disease, Adrenal Disease and Thyroid Disease.

What are the symptoms of high blood pressure (hypertension)?

Blood pressure often has no symptoms, but if not checked and regularly monitored, it can lead to stroke and heart attack. When there are symptoms of blood pressure these may include:

• Fatigue or confusion
• Vision problems
• Nosebleeds 
• Dizziness 
• Extreme headache
• Chest pain
• Difficulty breathing
• Sleep Difficulties 
• Irregular heartbeat
• Blood in the urine
• Mood disorders (often a side effect of BP medications) 
• Pounding in the chest, neck, or ears

What is the treatment for Hypertension?

Because blood pressure tends to fluctuate over the day, a diagnosis of high blood pressure should as a gold standard be averaged on three readings taken at the same time. 

The first reading should be taken in each arm, and the third in the arm with the higher reading. 

Your doctor may also suggest a 24-hour monitoring of blood pressure at home, called Ambulatory Blood Pressure testing. This monitors your blood pressure changes over a 24-hour period. 

If you do have high blood pressure, your doctor may recommend medication and lifestyle changes, especially if there is underlying kidney disease, heart disease or diabetes. Lifestyle strategies are extremely important and include:  

• Weight reduction 
• A low-salt diet 
• Limiting alcohol 
• Smoking cessation 
• Stress reduction – through mindfulness, exercise, meditation 
• In healthy patients, sometimes small lifestyle changes such as 10% weight loss are enough to make a difference, in other cases medication is essential to minimise heart attack and stroke risk.
• Studies show that taking blood pressure medication if you have high blood pressure can reduce the risk of stroke or heart attack by 30%*. However blood pressure medication has side effects and taking this medication is a long-term decision. Medication if often not always necessary with mild blood pressure increases and weight loss and a low salt diet are often enough to keep it in check in milder cases. 
• The pros and cons need to be carefully discussed with your doctor.

How high is too high for blood pressure?

For patients without diabetes or kidney disease, follow the guidelines for blood pressure categories in Australia as per the Heart Foundation. 

How high is too high for blood pressure?

For patients without diabetes or kidney disease, follow the guidelines for blood pressure categories in Australia as per the Heart Foundation. 

What about in kidney disease and diabetes patients?

The ideal maximum blood pressure for people with kidney disease, diabetes, or who have other risk factors like smoking, or family history should be 130/85 mmHg. However the gold standard “goal” is 120/80 mmHg.

What are the common mistakes people make when taking BP medications?

• The most common mistakes we see with blood pressure issues in our practice is people going off medication suddenly, perhaps due a common side effect such as a cough. This can sometimes happen with ACE Inhibitors. 
• However this can cause serious complications and can quite easily be resolved by swapping to another type of medication such as angiotensin-receptor blockers. 
• Another common mistake we see quite often is that patients give up on all medications, because they feel there has been a poor response to the first, despite up-titration (increasing the dose). However frequently complementing with a second medication and monitoring can resolve this issue. Taking a tablet is generally always a better option than having a heart attack or stroke.
• Less commonly, some people “increase or double the dose” before they come back to their GP or specialist. However trying to “beat the test” or “keep the doctor happy” is really just a good way to cause an acute kidney injury. 
• Any increased or reduced dosing should be strictly under your doctor’s supervision.

When measuring blood pressure at home what are the 10 biggest mistakes?

• Don’t take it on a very full bladder. Taking blood pressure on a very full bladder can increase reading. 
• Don’t slouch. Not supporting your back or feet can also increase a reading as can slouching or dangly feet. Sit on a chair with your back supported and feet on the floor or foot stool, rather than sitting back on a sofa or recliner. 
• Do not cross your legs. This squeezes leg veins.  
• Support your arm on a desk or counter so the cuff is level with your heart make sure your fist is not clenched 
• Avoid wrapping the cuff over heavy clothing as this can increase reading. Wear a short sleeved shirt and this goes for the doctor’s office too.  
• Get the right-sized cuff. Using a too small or too tight cuff can elevate your pressure by several points and a too large cuff can give falsely low readings. Monitors with upper-arm cuffs are generally more reliable than those that fit on the wrist too.
• Rest for 3 minutes first. To get an ideal reading you should be at rest for a couple of minutes in the chair. 
• Be silent. Talking or even listening actively can boost blood pressure. Be silent to ensure an accurate measurement.
• Don’t smoke or consume caffeine or alcohol directly before a reading. This can also increase blood pressure 
  

Further Reading

68% have resistant hypertension (4 million Australians.)

Mood disorders and medication 

Medication reduces heart attack risk by 30%