With high blood pressure affecting 60% of adults over 60 in the UK – increasing to 66% over the age of 75 – it has never been more important to take it seriously.
We all need some pressure to circulate blood around our bodies, but if it’s too high, it can lead to problems ranging from an early heart attack or stroke to kidney disease, vision loss, and even dementia.
According to reports, for every 10 people who’ve been diagnosed with high blood pressure, there are thought to be another seven who remain undiagnosed and untreated, because they show no signs or symptoms.
When people do get diagnosed, some are reluctant to agree to take medication. (And even when they’re prescribed it, up to one in three don’t take it regularly).
Added to that, it’s claimed that doctors often start patients on too low a dose to reduce their blood pressure to healthy targets.
It’s a subject that Saga Magazine columnist and GP Dr Mark Porter discusses on the first edition of our new podcast, Experience is Everything: The Health Edition, with leading blood pressure expert Dr Pauline Swift. She describes the statistics as “a travesty of our health care system”.
“We’ve got decades worth of evidence showing that treating high blood pressure works,” explains Dr Swift, consultant nephrologist and chair of the charity Blood Pressure UK. “And yet we still have this vast number of individuals who have not been diagnosed and don’t know they have high blood pressure, because it’s symptomless.
“Put very simply, it’s the leading cause of death and disability globally. Not just in the UK, but across the world. But it is highly treatable.”
While there are easy and natural ways to lower your blood pressure, Dr Swift is keen to emphasise the importance of taking blood pressure tablets if you need them and believes there is a stigma around them, which is why people are scared to take – or admit to taking – them.
You haven't failed if you need blood pressure tablets
Having high blood pressure can come with a feeling of shame, especially if people have made adjustments to their lifestyles such as reducing salt intake, exercising more and cutting down on alcohol. But Dr Swift insists nobody should feel embarrassed.
“You really shouldn’t feel shame, you haven’t failed,” she tells Dr Porter. “High blood pressure is the most common condition affecting one in three adults in the UK. So you haven’t failed. You should do the try and make the lifestyle changes, but if you need medication, you need medication. And the vast majority will need medication.
“In the UK, we start drugs at a far too low a dose. We don’t tell people, ‘You’ve got high blood pressure, which is a leading cause of death and disability in the whole wide world, we’re going to have to treat this. And it may take two medications. It may take three medications’.
“But we don’t do that, do we? So I think this is something that we’re doing really wrong in the UK by just not saying, ‘You’ve got high blood pressure we need to get you to target. We’re going to start a reasonable dose of a drug and then we’re going to double it to the maximum dose and then we’re going to have you to target in three months.’ We don’t do that and that’s my ambition.”
Why untreated high blood pressure is so dangerous
In the podcast, Dr Swift talks about how important it is to discuss blood pressure as the more that people know about it, the more they can help themselves, especially as it is very treatable.
“I think it’s the way we sell it, there are no health campaigns,” she explains. “Everybody’s aware that cancer is a killer but it kills far less people than high blood pressure. But do people out there really understand that risk? If I tell a patient they’ve got cancer, they’ll say, ‘Okay, what am I going to do to get it treated? How quickly can I get it treated? And I want it now. I want to know what the pathway is.’ And there’s a good pathway for treatment. If they’ve got high blood pressure, we sort of have a bit of a laissez-faire attitude to it. And I want that to stop.
“This is a lifetime treatment. In general, you’re going to need escalating treatment through your lifetime because your blood pressure goes up with age. But in general, they’re a pretty well-tolerated group of drugs that we’ve been using for decades.”
When asked by Dr Porter if we have the evidence to show that treating someone with medicine dramatically reduces their risk of stroke and heart attack or significantly reduces their risk of heart attack, Dr Swift replies, “Yes, we have so much evidence”.
“Treating high blood pressure is the most cost-effective and organ-saving and life-saving thing that you can do,” she explains. “As a medical intervention, it is the easiest, best, cheapest, most well-tolerated medical thing that you can do to help somebody.”
Different medication suits different people
There are different types of blood pressure tablets and what you’re prescribed will depend on your age, sex and health.
They include:
- ACE Inhibitors: Often end in “pril” – including ramipril, lisinopril. They widen blood vessels to ease blood flow, though they can sometimes cause a dry cough.
- ARBs (Angiotensin II receptor blockers): Often end in “artan” including losartan and candesartan, and work similarly to ACE inhibitors but are typically prescribed if a cough is an issue.
- Calcium Channel Blockers: Often end in “pine” such as amlodipine. They relax and widen artery walls so blood pumps more easily.
- Diuretics: (furosemide, indapamide). Also known as water pills, these remove excess salt and fluid from the blood to lower vessel pressure.
- Beta-Blockers: Often end in “olol” including bisoprolol and atenolol. They slow the heart rate and reduce the force of the heartbeat and are often prescribed if you have underlying heart conditions
The most common two are ACE inhibitors and calcium channel blockers which Dr Swift says are “highly, highly effective”.
Regarding the side effects, she says: “The amlodipine, the idipines or the calcium channel blockers, the main side effects of those are swelling in the ankles and most people can tolerate a little bit of that. But for that reason I tend to use a lower dose, particularly in women.
"Younger men can tolerate higher doses, but occasionally you can get sexual dysfunction with high doses of medication. So again, I would prefer to use lower doses and combinations of them.
“With the calcium channel blockers, there can be swelling in the ankles and sometimes you can get gum hyperplasia [overgrowth]. So you do need to keep an eye on your gums but that’s a much rarer side effect. I tend to stop if people have got gum problems and switch to a different medication.
“The ACE inhibitors can cause a cough and it took probably 10 years or so for us medics to realise. But the angiotensin receptor blockers don’t do that, so we can switch.”
How to take control of your blood pressure
Dr Swift also stressed the importance of taking your prescribed medication even if you don’t have any symptoms – as up to one in three people with high blood pressure don’t regularly take their pills.
But she said one of the best things we can do is take control of our blood pressure by knowing our numbers, making lifestyle adjustments and getting treatment if we need it.
When asked to share her three top tips for Saga readers and listeners, Dr Swift said:
- Know your numbers. Know what your blood pressure is. Take control and share that control with your GP and with your family, but mostly for yourself.
- Small changes make big differences – reducing your salt, reducing your alcohol, losing a bit of weight, doing some exercise, meditating and mindfulness, all of those things added together will help to control your blood pressure.
- If your blood pressure is high, please, please, please don’t ignore it. Please don’t ignore it because it is a big risk factor for heart attack, stroke, heart failure dementia and chronic kidney disease. And it’s highly treatable so let’s try and work a bit better together to get your blood pressure to target.”
You can listen to the full interview with Dr Swift and Dr Porter wherever you normally listen to your podcasts or watch the video above.
Insurance
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