Hypertension
Evaluation and treatment of persistently high blood pressure and associated cardiovascular risk
What is hypertension?
Blood pressure is the force of blood against the artery wall. It is called high when it stays above target on repeated readings, and in the great majority of people no single cause is found.
It produces no symptoms at all until it is extremely high, which is the difficulty with it. Headache, nosebleeds and dizziness are not reliable signs, and normal readings do not rule it out on a single measurement.
What you might notice
- A blood pressure reading that keeps coming out high
- Dizzy spells or near-blackouts
How it is diagnosed
One high reading is not a diagnosis. Your doctor confirms it with readings taken away from the clinic, either at home over several days or with a monitor worn for twenty-four hours, because pressure rises in a good number of people simply from being measured.
Once confirmed, your doctor looks for damage already done and for the small number of treatable causes: kidney function, the urine, glucose, cholesterol, an ECG, and an examination of the retina.
Recovery
Treatment is long-term. Pressure usually settles to target within four to eight weeks of finding the right medicine, and it climbs again if the medicine stops, which is not a sign that it was unnecessary.
Home readings are the most useful measure. Take them at the same time of day, sitting and rested, and bring the record to each review. Most people end up on more than one tablet, and that is expected and not a failure.
If it is left untreated
Sustained high pressure thickens and stiffens arteries everywhere. It is the single largest contributor to stroke, and a major one to heart attack, heart failure and kidney failure.
None of this announces itself. The damage accumulates over years at a pressure that feels like nothing at all, which is the whole argument for treating a number in the absence of symptoms.
Questions about hypertension
Do I have to take tablets for life?
Usually yes. The pressure returns when the medicine stops, because the medicine controls it instead of curing it. Weight loss, less salt and regular exercise can reduce the dose and occasionally remove the need.
My readings are fine at home but high at the clinic.
That is common and it is why readings away from the clinic are used to make the diagnosis. Bring your home record, taken at the same time each day, sitting and rested, to each review.
Can I stop if I feel well?
High blood pressure does not produce symptoms, so feeling well tells you nothing about the reading. Stopping lets the pressure climb back within weeks, usually without you noticing.
Other general medicine treatments
One doctor for the whole family, for everyday illness, long-term conditions, check-ups and referral to the right specialist
Day CareDiagnosis and long-term medical management of diabetes, including blood sugar, lifestyle and complication monitoring
Day CareTalk to a care coordinator about hypertension
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one