High blood pressure (hypertension) - information

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Introduction
High blood pressure (hypertension) rarely has noticeable symptoms, but if untreated it increases your
risk of heart attack, heart failure, kidney disease, stroke or dementia.
Over 5 million people in England are unaware they have high blood pressure, yet it affects more than 1 in 4 adults.
The only way of knowing there is a problem is to have your blood pressure checked.
All adults should have their blood pressure checked regularly (at least every five years). Having this done is easy
and could save your life.

Find out more about getting a blood pressure test.

What is high blood pressure?

Your heart pumps blood around your body to deliver energy and oxygen. A certain amount of pressure in your
blood vessels is needed to do this. However, if there is too much pressure in your blood vessels, it puts extra
strain on your arteries and heart, which can lead to serious conditions such as heart attack, heart failure, kidney
disease, stroke, or dementia.
Blood pressure is measured in millimeters of mercury (mmHg) and is recorded as two figures:

systolic pressure the pressure of the blood when your heart beats to pump blood out
diastolic pressure the pressure of the blood when your heart rests in between beats, which reflects how
strongly your arteries are resisting blood flow

For example, if your GP says your blood pressure is "140 over 90", or 140/90mmHg, it means you have a systolic
pressure of 140mmHg and a diastolic pressure of 90mmHg.

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A reading over 140/90mmHg indicates high blood pressure (medically known as hypertension), which should be
confirmed by tests on separate occasions to reach a diagnosis. Find out more about the diagnosis of high blood
pressure.
A blood pressure reading below 120/80mmHg is considered to be ideal.
People with a blood pressure reading below 90/60mmHg are usually regarded as having low blood pressure.

Who is most at risk?

Your chances of having high blood pressure increase as you get older. There isn't always a clear cause of high
blood pressure but you are at increased risk if you:

are aged over 65

are overweight
have a relative with high blood pressure
are of African or Caribbean descent
eat too much salt
don't eat enough fruit and vegetables
don't do enough exercise
drink too much alcohol
drink too much coffee (or other caffeine-based drinks)
smoke

If you fall into any of the groups listed above, consider making changes to your lifestyle to lower your risk of high
blood pressure. Also, consider having your blood pressure checked at least once a year.

Prevention and treatment

You can take steps to prevent high blood pressure by:

losing weight if you need to

reducing the amount of salt you eat
exercising regularly
eating a healthy diet
cutting back if you drink too much alcohol

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cutting down on caffeine

stopping smoking

Find out more about how to prevent high blood pressure.

If your blood pressure is found to be high, it will need to be closely monitored until it is brought under control. Your
doctor will usually suggest changes to your lifestyle and, sometimes, medication to achieve this. Find out more
about how blood pressure is treated.

Symptoms of high blood pressure

High blood pressure (hypertension) usually has no obvious symptoms and many people have it
without knowing.
Untreated high blood pressure can lead to serious diseases, including stroke, heart disease and kidney failure.
The only way to know if you have high blood pressure is to have your blood pressure measured. All adults should
get their blood pressure checked at least once every five years.
In some rare cases, where a person has very high blood pressure, they can experience symptoms, including:

a persistent headache
blurred or double vision
nosebleeds
shortness of breath

Find out more about who is at risk of high blood pressure.

Pregnancy
If you are pregnant, it's important to have your blood pressure checked on a regular basis, even if it isn't high.
Watching your blood pressure while you are pregnant reduces your risk of developing pregnancy-induced

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hypertension.
This can lead to a serious condition called pre-eclampsia where there is a problem with the placenta (the organ
that links the babys blood supply to the mothers).
Read more about antenatal checks and tests.

Causes of high blood pressure

In more than 90% of cases, the cause of high blood pressure (hypertension) is unknown but several
factors can increase your risk of developing the condition.
Where there is no specific cause, high blood pressure is referred to by doctors as primary or essential
hypertension.
Factors that can raise your risk of developing primary hypertension include:

age the risk of developing high blood pressure increases as you get older
a family history of high blood pressure (the condition seems to run in families)
being of African or Caribbean origin
a high amount of salt in your food
a lack of exercise
being overweight or obese
smoking
drinking large amounts of alcohol

Known causes
About 10% of high blood pressure cases are the result of an underlying condition or cause. These cases are
referred to as secondary hypertension.
Common causes of secondary hypertension include:

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kidney disease
diabetes
narrowing of the arteries (large blood vessels) supplying the kidneys
hormonal conditions, such as Cushing's syndrome
conditions that affect the bodys tissue, such as lupus
oral contraceptive pill
painkillers known as nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
recreational drugs, such as cocaine, amphetamines and crystal methamphetamine
herbal remedies, such as herbal supplements

Find out about how to get your blood pressure tested.

Getting a blood pressure test

High blood pressure (hypertension) often doesn't have any symptoms, so the only way to find out if
you have it is to get your blood pressure checked.
Having this done is easy and could save your life.
Blood pressure testing is available:

at your GP surgery by a GP, practice nurse, healthcare assistant or self-service machine

at a pharmacy
as part of your NHS Health Check
in some workplaces
at a health event
at home you can check blood pressure yourself with a home testing kit

Healthy adults aged over 40 should have their blood pressure checked at least once every five years.
If you are at an increased risk of high blood pressure, you should have your blood pressure checked more often,
ideally once a year.

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You can ask for a blood pressure check you don't have to wait to be offered one.
Blood pressure testing is also part of the NHS Health Check for adults aged 40-74.

The test
Blood pressure can be measured using a manual or automatic device.
A cuff is placed around your arm and pumped up to restrict the blood flow. The pressure is then slowly released as
your pulse is checked.
Hearing how your pulse beats after the cuff is released allows a measurement to be taken, giving a blood
pressure reading.
Before having your blood pressure taken, you should rest for at least five minutes and empty your bladder.
To get an accurate blood pressure reading you should be sitting down with your back supported and legs
uncrossed, and not talking when the reading is taken.

Confirming if you have high blood pressure

Having a raised blood pressure reading in one test does not necessarily mean you have high blood pressure.
Blood pressure can fluctuate throughout the day. Feeling anxious or stressed when you visit your GP can also
raise your blood pressure.
If you have a high reading, you will probably be given a blood pressure kit to take home, or be asked to wear a 24hour monitor so you can monitor your blood pressure level throughout the day. This will confirm whether you have
consistently high blood pressure.
You may also have blood and urine tests to check for conditions that are known to cause an increase in blood
pressure, such as kidney disease.

Home testing
Portable machines that measure your blood pressure at home or on the move can be a useful way of getting a

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more convenient and accurate reading.

This is because some people become anxious in medical clinics, which can cause the blood pressure to rise.
This is a condition called "white coat hypertension".
Home or portable blood pressure monitors may show that your blood pressure is in fact normal when you are
relaxed.
You can buy a variety of low cost monitors so you can test your blood pressure at home or while you're out
and about.
The British Hypertension Society (BHS) website has detailed information about clinically approved blood
pressure monitors that are available to buy.

Understanding your blood pressure reading

Blood pressure is measured in millimetres of mercury (mmHg) and it is recorded as two figures:

systolic pressure (the top number) the pressure of the blood when your heart pushes blood out
diastolic pressure (the bottom number) the pressure of the blood when your heart rests in between
beats, which reflects how strongly your arteries are resisting blood flow

If your GP says your blood pressure is "140 over 90" or 140/90mmHg, it means you have a systolic pressure of
140mmHg and a diastolic pressure of 90mmHg.
Ideally, your blood pressure reading should be below 120/80mmHg (for the lowest possible risk of disease).
However, anything under 130/80mmHg is generally considered normal.
You are said to have high blood pressure if readings on separate occasions consistently show your blood
pressure to be 140/90mmHg or higher.
If you have kidney disease, diabetes or a condition that affects your heart and circulation, your target blood
pressure should be below 130/80mmHg.
Find out how to treat high blood pressure.

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Treating high blood pressure

You can take effective steps to lower your blood pressure with changes to your lifestyle and by taking
medication.
In all cases, you can benefit from making some simple lifestyle changes (outlined below). Whether you are also
recommended to take medication will depend on your blood pressure level and your risk of developing a
cardiovascular disease, such as a heart attack, stroke or kidney failure.

If your blood pressure is consistently above 140/90mmHg (or 135/85mmHg at home) but your risk
of cardiovascular disease is low you should be able to lower your blood pressure by making some
changes to your lifestyle (see below). You may be offered yearly blood pressure assessments.
If your blood pressure is consistently above 140/90mmHg (or 135/85mmHg at home) but below
160/100mmHg you will be offered medication to lower your blood pressure if you have existing or high
risk of cardiovascular disease.
If your blood pressure is consistently above 160/100mmHg you will be offered medication to lower
your blood pressure.

Find out about the health risks of not treating high blood pressure.
Read information about treating high blood pressure during pregnancy.

Lifestyle changes
Below are some changes you could make to your lifestyle to reduce high blood pressure. Some of these will lower
your blood pressure in a matter of weeks, others may take longer.

Cut your salt intake to less than 6g (0.2oz) a day. Find out how you can reduce the amount of salt in
your diet.
Eat a healthy, low-fat, balanced diet, including plenty of fresh fruit and vegetables. Get tips on
eating more healthily.
Be active: being physically active is one of the most important things you can do to prevent or control high
blood pressure. Get tips on being more active.
Cut down on alcohol. Get tips on cutting down, download a drinks diary and keep track of your drinking.
Lose weight. Find out what your ideal weight is using the BMI healthy weight calculator.
Stop smoking. Smoking greatly increases your chances of getting heart and lung diseases. Get help

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when you need them.
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quitting.
Drink less coffee, tea or other caffeine-rich drinks such as cola. Drinking more than four cups of
coffee a day may increase your blood pressure.

You can take these steps today, regardless of whether or not you're taking blood pressure medication. You dont
need a doctor to prescribe lifestyle changes.
The more healthy habits you adopt, the greater effect there is likely to be on your blood pressure.
In fact, some people find that, by sticking to a healthy lifestyle, they do not need to take any medicines at all. Find
out more about preventing high blood pressure.

Medication
There is a wide range of blood pressure-lowering medicines to choose from and a combination is usually needed
to treat high blood pressure most effectively and with the minimum side effects.
Taking such a combination of medication is nothing to worry about. The different types of medication work in
different ways on your body. Read an FAQ page from Blood Pressure UK on Taking more than one medicine for
high blood pressure.
The first medication you are offered will depend on your age.

If you are under 55 years old you will usually be offered an ACE inhibitor or an angiotensin receptor
blocker (ARB).
If you are aged 55 or older (or you're any age with African or Caribbean family origin) you will
usually be offered a calcium channel blocker.

In some cases, you may need to take blood pressure-lowering medication for the rest of your life. However, if your
blood pressure levels stay under control for several years, your doctor might be able to reduce or stop your
treatment.
It's really important you take your medications as directed. If you miss doses, the treatment will not work as
effectively and you could lose protection against future illness. The medication won't necessarily make you feel
any different, but this doesn't mean it's not working.
Here are some questions you might like to ask your doctor or nurse about your treatment.

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You can also ask your pharmacist any questions about your medication, or approach them for advice on how to
stick to your treatment plan.
Medications used to treat high blood pressure can have side effects but most people don't experience any. If they
do, the large choice of blood pressure medicines means that they can often be resolved by changing treatments.
Let your GP or nurse know if you have any of the following common side effects while taking medication for high
blood pressure:

feeling drowsy
pain around your kidney area (on the side of your lower back)
a dry cough
dizziness, faintness or lightheadedness
a skin rash
swelling of your feet

ACE inhibitors
Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by relaxing your blood vessels. The most
common side effect is a persistent dry cough. If side effects become particularly troublesome, a medication that
works in a similar way to ACE inhibitors, known as an angiotensin-2 receptor antagonist (ARB), may be
recommended.
ACE inhibitors can cause unpredictable effects if taken with other medications, including some over-the-counter
ones. Check with your GP or pharmacist before taking anything in combination with this medication.
Find out more about ACE inhibitors.
Calcium channel blockers
Calcium channel blockers keep calcium from entering the muscle cells of the heart and blood vessels. This
widens your arteries (large blood vessels) and reduces your blood pressure.
Drinking grapefruit juice while taking some types of calcium blockers can increase your risk of side
effects. You can discuss the possible risks with your GP or pharmacist.
Find out more about calcium channel blockers.

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Diuretics
Sometimes known as water pills, diuretics work by flushing excess water and salt from the body through urine.
Find out more about thiazide diuretics.
Beta-blockers
Beta-blockers work by making your heart beat more slowly and with less force, thereby reducing blood pressure.
Beta-blockers used to be a popular treatment for high blood pressure, but now they only tend to be used when
other treatments have not worked. This is because beta-blockers are considered to be less effective than the
other medications used to treat high blood pressure.
Find out more about beta-blockers.

Complications of high blood pressure

High blood pressure (hypertension) puts extra strain on your heart and blood vessels.
If untreated, over time this extra pressure can increase your risk of a heart attack, stroke, kidney disease and
vascular dementia.

Cardiovascular disease
High blood pressure can cause many different diseases of the heart and blood vessels (medically known as
cardiovascular diseases), including:

stroke when the blood supply to part of the brain is cut off
heart attack when the supply of blood to the heart is suddenly blocked
embolism when a blood clot or air bubble blocks the flow of blood in a vessel
aneurysm when a blood vessel wall bursts causing internal bleeding

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vascular dementia when blood flow to the brain is reduced, causing parts of the brain to become
damaged

Kidney disease
High blood pressure can also damage the small blood vessels in your kidneys and stop them from working
properly. Mild to moderate chronic kidney disease does not usually cause any symptoms.
Kidney disease may need treatment with a combination of medication and dietary changes.
More serious cases may require dialysis (a treatment where waste products are artificially removed from the
body) or a kidney transplant.
Find out about how to prevent high blood pressure.

Preventing high blood pressure

Having high blood pressure can be prevented by eating healthily, maintaining a healthy weight, taking
regular exercise, drinking alcohol in moderation and not smoking.

Diet
Cut down on the amount of salt in your food and eat plenty of fruit and vegetables. The eatwell plate highlights the
different types of food that make up our diet, and shows the proportions we should eat them in to have a well
balanced and healthy diet.
Salt raises your blood pressure. The more salt you eat, the higher your blood pressure. Aim to eat less than 6g
(0.2oz) of salt a day, which is about a teaspoonful. Find out more about how to cut down on salt.
Eating a low-fat diet that includes lots of fibre (for example, wholegrain rice, bread and pasta) and plenty of fruit
and vegetables helps lower blood pressure. Fruit and vegetables are full of vitamins, minerals and fibre that keep
your body in good condition. Aim to eat five 80g portions of fruit and vegetables every day. Find out more about

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getting your 5 A DAY.

Alcohol
Regularly drinking alcohol above the NHS recommended levels will raise your blood pressure over time. Staying
within the recommended levels is the best way to reduce your risk of developing high blood pressure.
The NHS recommends:

men should not regularly drink more than three to four units a day
women should not regularly drink more than two to three units a day

Find out how many units are in your favourite tipple, track your drinking over time and get tips on cutting down.
Alcohol is also high in calories, which will make you gain weight. This will also increase your blood pressure. Find
out how many calories are in popular drinks.

Weight
Being overweight forces your heart to work harder to pump blood around your body, which can raise your blood
pressure. Find out if you need to lose weight with the BMI healthy weight calculator.
If you do need to shed some weight, it is worth remembering that just losing a few pounds will make a big
difference to your blood pressure and overall health. Get tips on losing weight safely.

Exercise
Being active and taking regular exercise lowers blood pressure by keeping your heart and blood vessels in good
condition. Regular exercise can also help you lose weight, which will also help lower your blood pressure.
Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (such as
cycling or fast walking) every week. For it to count, the activity should make you feel warm and slightly out of
breath. Someone who is overweight may only have to walk up a slope to get this feeling.
Physical activity can include anything from sport to walking and gardening. Get more ideas on being active.

Smoking

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Smoking doesn't directly cause high blood pressure but it puts you at much higher risk of a heart attack and
stroke. Smoking, like high blood pressure, will cause your arteries to narrow. If you smoke and have high blood
pressure, your arteries will narrow much more quickly and your risk of heart or lung disease in the future is
dramatically increased. Get help to stop smoking.
Find out how your blood pressure is tested.

Caffeine
Drinking more than four cups of coffee a day may increase your blood pressure. If you are a big fan of coffee, tea
or other caffeine-rich drinks (such as cola and some energy drinks), consider cutting down.
It is fine to drink tea and coffee as part of a balanced diet but it is important that these drinks are not your only
source of fluid. Find out if you are drinking enough fluids.

"My diet and lack of exercise contributed greatly to my stroke

Andy Jones liked to eat a lot of salt with his food. Whatever he ate, whether it was a Chinese takeaway
or fish and chips, Andy would always add plenty of seasoning.
Although he didnt consider himself unhealthy, Andy didnt exercise and was overweight, which earned him the
nickname Chunky.
The excessive salt Andy was adding to his food had raised his blood pressure to dangerous levels. High blood
pressure caused his arteries to fur up and put extra strain on his heart.
Most people with high blood pressure dont have any symptoms, but the condition sharply increases the risk of
having a stroke.
In December 2003, Andy, who ran a courier business in Warwick, collapsed at someones doorstep during a
delivery.

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I had a feeling like vertigo and I felt dizzy, he says. I knocked on the door and I told the person who answered
that I was feeling unwell. I collapsed moments later.
He had lost the use of his right side and his speech was slurred. Hospital tests confirmed he had had a stroke
caused by a blood clot.

Cholesterol control
Andy was in hospital for a week, where he was given physiotherapy and speech therapy. He took medication to
control his blood pressure and cholesterol.
I was home for Christmas Eve, he says. I was walking again by then, but it took me three months to regain the
use of my hand and arm.
My speech and my ability to swallow came back within 24 hours. However, even now I struggle with tying
shoelaces and using keys.
He says his family were crucial in his recovery. They helped with my determination to get better, he says. My
mother walked with me every day.
Having a stroke at 40 was a big shock for Andy. I thought strokes didnt happen to people my age, he says.
In fact, out of the 150,000 people who have a stroke in the UK each year, 31,000 are under 60.
It took me a long time to come to terms with my stroke, Andy says. I still suffer bouts of anxiety and depression.

Returning to work
Andy says the stroke has left few traces, but its less obvious effects include moments of extreme tiredness.
Its a hidden disability thats hard to explain, he says. Its a fatigue Ive never experienced before and its quite
debilitating.
He lost his business soon after the stroke, but was keen to get back to work as soon as possible, to rebuild his
self-esteem. After working as a driver in the voluntary sector, Andy now works part-time in a betting shop.

Cutting out salt

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He is now a lot more careful about what he eats, has cut down on takeaways and greatly reduced the amount of
salt in his diet.
I dont add salt to my food, he says. If I feel like a snack, Ill have fruit.
He says he eats his meals more slowly, which leaves him more satisfied. I always aim to be the last to finish, he
says. It means I eat less but feel fuller.
Andy believes his excessive consumption of salt helped lead to his stroke. My diet and lack of exercise
contributed greatly to my stroke, he says.
I wish I had known I had high blood pressure. I would have done something about it and would probably have
prevented the stroke.
Some good has come out of Andy's experience: he may have saved his younger brother from a stroke.
After my stroke, he went to have his blood pressure checked and found it was too high. Now hes addressing
that.

Additional information
Useful organisations
British Heart Foundation
Greater London House 180 Hampstead Road London NW1 7AW
Tel : 0300 330 3311

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http://www.bhf.org.uk/
Blood Pressure Association
60 Cranmer Terrace London SW17 0QS
Tel : 0845 241 0989
http://www.bpassoc.org.uk/

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NHS Choices has been developed to help you make choices about your health, from lifestyle decisions about
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