Do you suffer from high blood pressure? Do you think that you could be at risk? Chances are that the answer is yes to at least one of these questions. Dr Bell will be discussing this extremely common condition which affects one in every three women and one in every five men and which often gives no symptoms but is a major risk factor for heart disease and stroke.

One of the dangers of hypertension is that in most cases it causes no symptoms but, because of its effect on the arteries of the body, it is one of the most important preventable causes of heart disease and strokes unless it is diagnosed and properly treated.

Dr Bell will look at the implications of having Hypertension, how you can check that you don't have it and what you can do to help yourself if you do have the condition.

Join Dr Martin Bell live online on Wednesday 11th April at 2pm to discuss this very important subject.

H: Liz Speight, host
M: Dr Martin Bell

H: Hello and welcome to the Healthcare Show, I’m Liz Speight. On today’s programme we’re going to be talking about hypertension, or high blood pressure. Now this is a very common condition which affects one in every three women and two in every five men. Now there are often no symptoms, but if you have high blood pressure you’re at a much greater risk of developing heart disease or even stroke. I’m delighted to say that to talk about high blood pressure, or hypertension I’m joined in the studio by GP, Dr Martin Bell, welcome along Martin

M: Thank you

H: Now Martin has a particular interest in hypertension so if you have any questions about your blood pressure then do get them into us, all you have to do is type your name and where you’re from, and your question in the box that’s on the screen, press submit, it’ll come through to us here in the studio and we’ll try to get through as many as we can. We’ll try to answer them won’t we?

M: We certainly will

H: But starting off let’s have a little discussion first of all about high blood pressure, or hypertension – why is it so common?

M: That’s a very very good question and the honest answer is no one really knows, because the basic cause of high blood pressure is still not known. Even though an awful lot of research has been done into the subject, in fact probably about 90% of people with high blood pressure probably still don’t know why they have high blood pressure, and basically we tend to call that essential hypertension, which is a sort of strange way of saying we really haven’t got a clue why these people have got high blood pressure. The other sort of 10% we sometimes do know because it’s linked with some other condition, but it is one of those hot topics that people have been working on for many many years and we still don’t really understand why it’s such a common problem. It’s almost like the barometer of your blood pressure is set in the wrong way, it’s set too high

H: Right, so your body’s just gone a bit off track?

M: Yes exactly. It’s strange because you do have some patients, or we see the occasional patient and you almost wonder if their body is trying to tell us something

H: Right so there might be an underlying problem that you can’t quite work out exactly what that is either?

M: That’s exactly right, yes absolutely. Sometimes obviously there are links with lifestyle etc which perhaps we can talk about in a little while

H: Yes

M: But 9 times out of 10 somebody with high blood pressure, you just can’t put your finger on why they have it or why it’s so common really

H: So you can be fat or thin, man or woman

M: Absolutely

H: And you could get high blood pressure?

M: Absolutely right, which is one of the important factors, you cannot see – you know you cannot look at somebody and say that person’s got high blood pressure

H: Right, they’ve not got steam coming out of their ears or anything like that?

M: Not got steam coming out of their ears, no, not blowing a gasket or anything like that, no, and that’s one of the sort of spooky things slightly because you may be very fit, you may go jogging, you may have a perfect lifestyle, may have a very good diet, and still quietly in the background your arteries could be being furred up by having high blood pressure.

H: So how do you know if you’ve got it?

M: Well really the only way is to have it checked, to go to your doctor or a nurse or sometimes at work there is often a nurse who can take your blood pressure and have it checked. It’s something that I would say every adult should have their high blood pressure checked at least once every 5 years

H: Right. It’s just like having your eyes tested or something really

M: Absolutely right, because without that test you really will not know until it’s sometimes too late and you have a stroke or a heart attack. As you know really as I’m sure everybody knows the test is very simple, safe, effective, just involves having your blood pressure taken by a professional and they can then give you an idea as to whether your blood pressure is normal or a bit high, or very high etc

H: And explain to us how that test works then, because I’ve had my blood pressure done, and they give you these two numbers an d they say that’s fine, and you go away feeling fine

M: Yes yes

H: I don’t really understand it

M: No exactly yes we like to keep these things very mysterious

H: Yes. You’ve got a job to do after all

M: Absolutely yes. No basically what it is is, I don’t know if you remember the old style mercury sphygmomanometers -

H: Right

M: The instrument that you used to take your blood pressure, which is sort of being phased out and we now use these battery ones

H: Actually those mercury ones, they’ve still got those at our doctor’s surgery

M: Yes in fact I still use mine until somebody comes and takes it away from me

H: You like what you know don’t you?

M: I really like what I know, absolutely, I still trust it. But the modern ones, good quality modern ones are as effective. And essentially the way they work is they pump the cuff up, on your arm, above your top blood pressure, above the pressure at which your heart is contracting

H: Right. So when it’s contracting it’s pumping the blood around

M: Pumping the blood round your body that’s right. So the cuff will blow up to the point where it blocks off, essentially, the arteries in your arm

H: Right

M: So it’s above your highest point blood pressure, and then you’ll remember when somebody’s taking your blood pressure that pressure will gradually release, and sometimes people get a bit of a strange feeling

H: It does feel odd sometimes doesn’t it?

M: It feels very strange

H: Like quite a lot of pressure in your veins almost

M: Absolutely, exactly you almost feel like a whooshing feeling going through

H: Yes

M: That is the top number, ok, something called the systolic, and that is your blood pressure when your heart is pumping, it’s squeezing the blood out

H: Right. And what is a good number?

M: Well a good number, an average number for an adult would be something like 125 /130, but probably important to emphasise, particularly that top number, the systolic, does vary tremendously according to whether you’re worried, whether you’re relaxed, whether you’re stressed

H: If you’ve rushed to the doctor because you’re late which is what I normally do

M: Exactly, exactly right, which is what most people normally do, they’re late, they rush in, doctor takes their blood pressure, they’re nervous in the doctor’s surgery -

H: No one likes going to the doctor do they? You could get a bit of a false reading from that

M: Yes you can

H: It’s not wildly different

M: Absolutely, perhaps that’s something we can talk about in a minute, the old white coat hypertension thing. But that is this systolic blood pressure which does vary tremendously, but yes like 120-135, something like that -

H: That’s sort of normal and healthy?

M: Yes exactly. Then the cuff will carry on deflating, and now it’s beginning to become a little bit more comfortable, and you’re probably not really aware of it, but what it will be picking up is when the whooshing noises, that it can hear with its sensor stop, or when the you know my old method of taking it with the -

H: Stethoscope

M: Stethoscope, you stop hearing a whooshing noise and it all goes quite, that’s the diastolic

H: Right

M: And that’s the blood pressure as your heart is filling up

H: Right

M: Because through the miracle of the body your blood is still going round and you still have a blood pressure even when your heart is filling up

H: Right

M: Because of valve systems and all that sort of thing

H: Amazing isn’t it?

M: It is absolutely incredible. So that’s your diastolic blood pressure which again is something that does vary a bit with stress and pain and so on, a little bit less so than the systolic, and a normal reading for that would be anything from, you know 60 – 80 / 85-ish, that sort of thing

H: Right. And which one of those would be higher if you had high blood pressure or would they both be higher?

M: Well, they would tend to both be higher, but there is something called isolated systolic hypertension

H: Right, oh dear -

M: Sorry to get a bit technical at this point, you know for advanced viewers only! But systolic hypertension is a phenomenon of its own. Some people, you know some patients that we have, you measure the blood pressure, diastolic, the lower figure, absolutely fine, every single time you take it the higher figure, the systolic is a bit too high. Now it used to be because it seems to me that sometimes we do our best as the medical profession to confuse people and therefore we change the rules every so often

H: Right

M: And it used to be we would say to people it’s the lower figure that matters you know

H: Ah right

M: What we feel at the moment is they both matter

H: Right

M: So even if you have this thing called isolated dystolic hypertension where the top number is a bit too high but the bottom number’s fine, we still worry about that

H: Yes

M: Because even that can cause problems with furring up of your arteries

H: And why does it cause furring up of your arteries then?

M: Yes. Well the thinking is – it’s a bit like – because the pressure in your arteries is too high, it sort of squeezes the artery wall and makes it harder for a start, and it also tends to do things like if your cholesterol, your – the fats in your blood – are a little bit high, it tends to almost like squeeze the fats out, so that you know it gathers inside the pipe of your artery, a bit like, if you’ve ever seen your old water pipe filling up with, you know, limescale – it’s a little bit like that. And it’s one of the risk factors for, you know, furring up your arteries essentially

H: And so what comes first, the furring up of your arteries or the high blood pressure?

M: Right, very good question

H: Because I would have thought that one would cause the other or something

M: It does, you’re absolutely right. Almost always the first is the hypertension, and as I’ve said before we don’t know why that happens, it’s just a phenomenon, and you can be 25 and still have hypertension. So that’s usually the first thing, but you’re right that to a degree the furring up of the arteries then can promote hypertension, partly because – little known fact to those outside the medical profession – but the kidneys are one of the main determinants of your blood pressure

H: Oh I’ve never heard that before

M: Absolutely, so there is this sort of vicious circle thing that you can get where the arteries to your kidneys fur up, your kidneys then think your blood pressure is a bit lower than it is

H: Ah right

M: Ok, because you’ve got this narrowing, your kidneys then think it’s a bit too low, I need to crank up the blood pressure. Blood pressure goes even higher, more furring up, that sort of thing. Also hypertension itself can cause kidney damage

H: Oh right

M: And that can have a bit of a vicious circle thing

H: So going on to the effects of hypertension then. If you have high blood pressure and you don’t know you’ve got high blood pressure, what effects can that have on you?

M: Yes

H: Can it be fatal?

M: It can be fatal, I mean going back you know 20 years or so, or perhaps longer, our grandparents era when really hypertension wasn’t recognised or blood pressure wasn’t really treated, often the first thing you would know about your high blood pressure is you would have a stroke, or a heart attack or die

H: Right. And people died much younger those days didn’t they as well --

M: That’s exactly right

H: You can expect to live into your 80s now don’t you?

M: Absolutely right and you know, if we talk to our patients and we talk to them about their grandparents or their older parents and you say did they have high blood pressure, often they will sort of shrug their shoulders, don’t know, but they died of a heart attack, and you think probably they did

H: So is it hereditary high blood pressure?

M: Yes it really is, it’s quite unusual to find somebody with hypertension who has absolutely no family history, it’s quite unusual that. Almost always, mother, father, brother, sister – somebody will have it. It’s not always the case but that again comes back to having your blood pressure measured is – if you’re one of these shrug your shoulders, I don’t know but my dad died at 80 of a stroke, as a doctor you’re thinking probably had high blood pressure

H: Right. So if it’s hereditary, you’re not necessarily going to get it?

M: No absolutely right

H: But -

M: Not necessarily -

H: It’s good to be aware and have it checked out?

M: That’s absolutely right

H: So when you fill in the form at the doctors’ surgery and it asks what your family history is, that’s why heart attacks or strokes is quite -

M: Absolutely

H: Important

M: Definitely. Because it will set our mind thinking this person probably ought to have a blood pressure check, and I would say most surgeries these days when somebody joins a practice, one of the basic things to do will be to check their blood pressure because you know, don’t want to generalise, but you know you do get your typical man who does not go to the doctor, and I’m always very very wary of men who haven’t been to see the doctor for 15 or 20 years, because you’re thinking this person could easily be walking around with a -

H: Storing up trouble aren’t they?

M: Exactly right, they are the people who will just have a heart attack in the street or somewhere like that and actually retrospectively you’ll think they had high blood pressure

H: So it doesn’t hurt to have your blood pressure taken?

M: It really does not

H: Will your GP be a bit like oh no, the nurse could do it I suppose

M: A nurse could do it, most GPs would not be – oh you know blood pressure

H: I always feel like I’m wasting my doctors’ time

M: Not at all, no. I mean if you have had your blood pressure checked only 2 months before and you say can I have my blood pressure checked again, he might you know roll his eyes slightly

H: You’re a hypochondriac

M: Exactly. But if you haven’t had your blood pressure taken for a year or two or in a few years anyway it would be sensible to book in the doctor or the nurse and have it checked. It’s safe, it’s pretty painless although as I say sometimes the cuff feels a bit tight, no real side effects from having your blood pressure taken, and you know the answer immediately

H: Puts your mind at rest

M: In terms of a test, it’s a beautiful test really

H: Now you can get these blood pressure machines from the chemist

M: Yes

H: My mum has one, my mum has high blood pressure which probably means I’ll get it, and she takes her blood pressure now and again. Are they a good idea or do you think you just get completely paranoid about it doing your blood pressure every five minutes -

M: Yes. Well my own personal view is I think they’re fantastic because I would far rather somebody checked their own blood pressure and if they were in doubt they’d come to me with a couple of readings and say look I’ve got these readings, I’m a bit worried about them. Quite often we’re getting into the habit now of checking somebody’s blood pressure machine so they will take their blood pressure with their monitor in our surgery. We will check it with our monitor at the same time

H: To calibrate the two

M: To calibrate the two. Almost always they are very very similar. I would far rather somebody do that and we know that they have either high blood pressure or normal blood pressure than be walking around afraid to come to us. So I think they’re a fantastic thing. Personally I tend to think that the cuff ones are probably more accurate, I have read a couple of reports that do support that. Because you can buy wrist ones

H: Oh right

M: And you can even buy ones where you literally put your finger in a hole and it tells you

H: We’ve actually got a question in on high blood pressure kits. Rina wants to know “Are home blood pressure kits reliable?”

M: The short answer is yes, increasingly reliable. I tend to give my patients a couple of names of particularly reliable manufacturers, and actually if you go on the British Hypertension Association website, they will often give you a recommended names that they have trialled the machines and made sure it’s -

H: And where do you get them from, the chemist?

M: The chemist, most chemists will sell them, I think the supermarkets sell them as well

H: Or on the internet I suppose

M: Or on the internet, and they’ve come down in price massively because I know from my own patients. They used to be very reluctant because they would cost something like £90 or £100 and I would actually feel a bit guilty suggesting it

H: Yes it’s a lot especially if you’re a pensioner

M: Exactly, and that’s exactly the age group that should possibly be measuring blood pressure. But now you can – there’s one chemist that for some time has sold them at £9.99

H: That’s good isn’t it?

M: Yes I actually bought one from this chemist, tested it out myself, seemed perfectly reliable. So to my way of thinking that’s a wonderful thing to do.

H: Do you think you’re more likely to get a calmer reading when you’re at home as well?

M: Yes I think you really are. I mean to give the more politically correct answer, the jury is out on how you should treat home readings and how reliable they should be and whether you know, whether that really does match up with what your doctor measures and all that

H: It gives you an idea though doesn’t it? Even if it’s a little bit out – if it’s way high or way low, you would go to your doctor then I suppose

M: Well my logic is firstly I’d rather know this person’s blood pressure for a start or something, secondly my logic is we want to treat these people for their normal life, and I am aware that when people come into the doctor’s surgery the minute they walk through the door their blood pressure’s going to go up. I mean my goes up and I work there, you know!

H: Just finding a parking space is bad enough, isn’t it?

M: Yes, particularly our car park. You know their blood pressure’s going to be up, they’re nervous, they’re worried, you know sometimes their blood pressure goes up because they’re worried what their blood pressure will be

H: Yes it’s a vicious circle isn’t it?

M: It’s that terribly vicious circle. So my logic is, we’re treating these people for their normal lives, and I’m a major fan of people getting these blood pressure cuffs, not being totally neurotic about it, just checking their blood pressure at random, you know sometimes in the morning, sometimes in the afternoon, sometimes relaxed, sometimes when they’re sort of stressed with the children, bring me the results and that gives me a lovely picture of – on the whole – is this person’s blood pressure normal, are they getting some high blips, is it generally running horribly high. I think that’s just a fantastic way of doing things, and we could argue all day about the absolute tiny research things, but personally I live in the real world and I would rather that than have somebody coming in, have one blood pressure check which is -

H: And then don’t come again for 10 years

M: Don’t come again for 10 years or we start basing decisions on one blood pressure reading which I think is a bit -

H: Exactly

M: A mistake

H: We’ve got a question actually from John in Plastone, he wants to know “how many times should you measure your blood pressure to get an accurate reading?”

M: Yes, good question. The proper answer to that is to measure your blood pressure probably monthly for 3 months, ok. If you’ve got your own blood pressure monitor probably I would say why don’t you do it once a week

H: Right. Just out of curiosity I couldn’t bear it, I’d have to have a look

M: Yes, absolutely, most people do -

H: I think the novelty wears of though after a while after you’ve had it on your arm all day!

M: Yes absolutely. I mean sometimes, and I love these people actually, they come in with their, you know with a million and one readings put on the, on something, they bring a graph – it’s absolutely fantastic. Not expecting people to do that, but it’s wonderful when it happens

H: But Holly in Kent actually wants to know “are there times during the day when my blood pressure will be higher than at other points in the day?” So when you get up, or when you’re dealing with the kids, when you’re driving -

M: Yes

H: How does that pan out with your blood pressure?

M: Well that’s a really good question because your blood pressure varies tremendously. You know if I took your blood pressure now and then I repeated it in about 5 minutes time, it would be different, it varies that much, ok? It would only be slightly different but it varies that much

H: Because your body is constantly reacting

M: It’s always reacting. I mean there is a phenomenon where – if you’re crouching down for a while and then you stand up, often people say I feel a bit faint

H: I get like that when I get out of bed in the morning sometimes actually

M: Do you?

H: Why does that happen?

M: It’s probably because you don’t want to go to work or something

H: It could be couldn’t it?

M: Absolutely. No what it is, is your body has adjusted itself to lying flat, and it does not need a high blood pressure to supply your brain with blood, because basically it wants to supply your brain and your kidneys with blood. The minute you stand up it needs a higher blood pressure, and sometimes, particularly in the morning it can be slow to react

H: Right your heart’s kind of a bit asleep kind of thing?

M: Exactly or the absolute classic is you’ve been down crouching on the floor, getting in some cupboards or something, you stand up and you go a bit faint, and that’s a classic, something called postural hypotension, which is the opposite of hypertension, where your blood pressure is dropping too much

H: Right and you see stars as well sometimes

M: You see stars sometimes, that is actually normal, it’s not a sign of anything bad in most people

H: I quite like seeing stars, I think it’s quite fun

M: Do you?

H: But it goes a bit black sometimes as well doesn’t it? I sort of feel like I want to hang on to something

M: Well that’s literally because the blood is not getting to the back of the eyes, so your retina is deprived the back of your eyes is deprived of blood, it’s blacking out, hence the term blacking out, and it’s a sign that your brain also is not getting enough blood. The mechanism for that is if push comes to shove, you faint, which is a very good method of making sure you’re lying down

H: You’re on the floor

M: And everything restores itself

H: You do feel like your body goes glug glug glug, you almost feel your blood settling down again, it’s a really odd feeling

M: So that’s how much your blood pressure varies ok, and to answer this lady’s question, yes her blood pressure will go up when she’s stressed, when she’s in pain, if she’s anxious about something, and it will go down when she’s asleep, when she’s relaxed, when she’s watching the television, and that’s why again, just coming back to that home monitoring thing, I think it’s so good that people can do it when they’re watching the television and equally if they have the presence of mind they can do it again when they’re a bit stressed

H: Yes, just to see how

M: How much it varies, because there are some people who let’s say 80% of the time their blood pressure will be fine, but 20% of the time they will be prone to having a slightly high blood pressure

H: And is that a problem then, if it’s normal most of the time but then when you’re stressed it goes up – is that normal or -

M: Well that is a question that actually there is no answer, no answer to at the moment

H: Sorry about that

M: No no, it’s a really good question because that’s one where we don’t quite know what to do because you could argue that you still possibly ought to treat those people because -

H: Are you at higher risk of heart attack when you’re stressed?

M: Yes, yes. I mean when you think about it, in that 20% of the time that their blood pressure is a bit too high they will be quietly furring up their arteries, even though in the 80% of the time it won’t be, so you know it’s one of those slight dilemmas for GPs when you get these people who, a lot of the time, fine. 20% of the time, bit horrible, and on those sort of things you really have to try and use your best judgement as to what to do for this person

H: Right and that’s why stress is so bad for you is it?

M: That’s one reason why stress is so bad for you, and one reason why, just to come back to that white coat hypertension thing where your blood pressure goes up when you look at a doctor or a nurse, is because if you’re not careful you’ll be assuming that these people have a high blood pressure all the time whereas in fact perhaps the only time in the day when their blood pressure is up is when they’re in the doctor’s surgery

H: Right

M: And funnily enough, I mean I have these patients who take their blood pressure you know very frequently. What they will do is they will take their blood pressure all week, fantastic, all the readings are great, then they will take their blood pressure the morning they’re coming to see me and it’s up

H: And it’s up

M: Now I like to think that’s the excitement of coming to see me

H: Oh goody I’m going to the doctor

M: Probably more – that’s right - the stress and that is a beautiful illustration of how your blood pressure varies tremendously and how one single reading in the doctor’s surgery you know can give you a false idea

H: Yes well we’ve had another question in from Angus Douglas and he wants to know, his wife – he says he’s aged 76, has quite good blood pressure shown by home and surgery tests, so she’s been doing both, yet her doctor seems to keen to get her onto blood pressure pills. Why is this?

M: Yes. Right one of the reasons is, remember I said that doctors try and confuse people by giving them one message and then they change the message? That’s because the message to us sometimes changes, and the message we’ve been given constantly is to get people’s blood pressure lower and lower and lower. So what he and she may feel is an ok blood pressure now by the GP may, he may feel - bit too high

H: Little bit high

M: I mean as a general rule, if your blood pressure is 140 systolic, the top figure, over 90 diastolic, the bottom figure, if it’s 140 over 90 or more on 3 separate readings, this person would be thought to have hypertension there

H: Right and what sort of pills can – I suppose there’s so many pills you can be put on

M: Yes

H: Why would you not want to take them, are there bad side effects?

M: That is one reason, and I mean one phrase that patients will often use when I start people on blood pressure treatment is they’ll say once I’m on these blood pressure tablets I’m hooked on them for life you see -

H: And is that true? That’s what I tend to think

M: They’re not really hooked on them, it’s the condition that they’re hooked on, if you catch my drift. So the condition unfortunately is very unlikely to get better on its own

H: So there’s no cure for high blood pressure

M: There is no cure for hypertension

H: You can’t lower your cholesterol or lower your stress level and your hypertension will go?

M: Well to a degree, and I mean I ought to mention lifestyle changes ok, so if somebody’s got slightly raised blood pressure, the first thing we would try, because believe it or not doctors don’t like to put people on medication, strangely, you know, we’d rather they sorted it out themselves

H: Managed it, lifestyle-wise

M: Exactly. So probably worth spending a bit of time on lifestyle. Certainly if you do regular exercise, if you keep your weight down to your optimum level and if you eat healthily and reduce your salt intake to 6g a day or less, there is evidence to show that will help to reduce your blood pressure and also if there was a way of you reducing your stress levels, even better although that’s often quite difficult. That can make a difference and certainly I will sometimes say to my patients, ok you’re onto like probation, if you’re blood pressure-

H: See if you can go and sort it out first

M: Exactly, as long as it’s not too horrendous

H: And put you on pills later

M: Yes

H: Well talking about tablets though, Stephy from Richmond has sent in a question, she wants to know “I take aspirin quite often for headaches, does this thin my blood and would that affect my blood pressure?”

M: It does thin her blood, I mean aspirin as you probably know has been found to be an excellent blood thinning drug, we use it in lots of different cases to thin blood. It will thin blood only on those days that she takes it, obviously, but it won’t make a scrap of difference to her blood pressure

H: Oh that’s interesting

M: It’s completely different

H: Why is that then? Is it too confusing to explain?

M: I think – no it’s not actually – if you look at blood pressure as an independent risk factor for things like stroke and heart disease, and you then put it into the context of that person, ok, so supposing you have an otherwise completely well non-smoking, non-diabetic person with a slightly raised blood pressure this person is still going to be at relatively low risk of heart disease or stroke, because they really just have that one factor. Same blood pressure in a diabetic who smokes 20 a day, and weighs 20 stone, this blood pressure is a worry because in the context of that second person, they have lots of factors. You know I sometimes actually draw a diagram for my patients where I would draw their artery and will have arrows coming in, smoking, cholesterol, weight, all those sorts of things

H: A lot of pressure

M: Yes all these factors are impacting on this artery, so if you only have one, ie. slightly raised blood pressure, you can afford to be a bit more relaxed about this person, but if you have lots then you need to be worried about this person’s blood pressure, and as for the aspirin, we do put people on aspirin if they’ve had a heart attack, angina, etc because it thins their blood, and it is a way of perhaps counteracting the risk factor thing, if that’s a way of describing it

H: Right

M: So if you have somebody who’s at high risk of heart disease, or furring up of their arteries, in certain cases taking an aspirin will sort of undo some of that risk factor

H: Right but blood pressure-wise, hopeless. Don’t bother

M: Won’t make a scrap of difference

H: Never mind. It was worth a go wasn’t it? Vicki in Glasgow wants to know “how fragile are veins and arteries?”

M: Yes a very good question

H: I tend to think arteries are really thick and veins are really skinny

M: Yes

H: Is that right?

M: Pretty much spot on

H: My old biology days back in school

M: Pretty much spot on. If we had like an artery and a vein on the table, you would be able to tell the difference, with – I’m assuming you’re not medically trained?

H: No

M: But you would be able to tell the difference, because the vein would be thin walls as you say, quite sort of flabby, thin – a bit like a worm. Most arteries would be quite thick, it would be quite hard to cut through them, and that’s because there’s a difference in the pressure. The pressure of the blood going away from the heart to supply your organs is quite high

H: So your arteries take your blood away from your heart

M: Take your arteries away from the heart, they need to be able to handle the quite high pressure. I mean it’s the sort of thing you know on Casualty when somebody cuts their artery, you know there’s this sudden spurt -

H: Does that really happen?

M: It does actually, if you cut through an artery -

H: You know about it

M: Yes you absolutely know about it because it’s what they call in theatre a spurter, you know you will literally get it spurting across the room. So these pressures are quite high in the arteries, therefore the wall of the artery needs to be able to withstand that pressure, and therefore it needs to be quite thick walled. The veins are taking blood back to your heart and they do it in quite a leisurely fashion, so you know vein pressure is quite low, you don’t need something thick walled, particularly if they’re on your legs you want them not showing up too much, so the veins don’t have to be thick walled, and those are the things that if you cut them, yes they bleed but -

H: It’s no major drama

M: No

H: You’re not having to go to A&E hopefully

M: Absolutely right

H: Now Jill in Rugby has sent in a question, she wants to know “are certain blood types more prone to hypertension than others?” If you know your blood type that is, a lot of people don’t, do they?

M: Most people don’t know their blood type, you tend to only know your blood type if you’ve been pregnant you’ve had it taken or had surgery or something. Short answer to this one, no there is no known difference

H: No difference at all

M: No

H: So Jill should stop worrying about it, it’s ok. Jocelyn wants to know “I’m 67 years of age” – that might be my mum actually, I wonder whether it is “and I’ve had hypertension for many years. My doctor has recently changed my tablets, an ace inhibitor and a calcium antagonist” – I hope that makes sense to you -

M: Yes

H: To a cheaper version of the same drug

M: Right

H: My systolic pressure has risen my about 10ml – could this be due to the change in the tablets or is my hypertension worsening?

M: It’s option b, he hypertension’s worsening

H: Right

M: The reason is, I mean this is another very very good question because we get asked all the time, because doctors are encouraged to prescribe medication, what they call generically, so by the proper drug name as opposed to the sort of trade name, but actually what you get in it is absolutely identical

H: Pretty much the same

M: Yes, the tablets might look different, they might come in a slightly different looking packet but the tablet will be identical. Totally understand that when people see a different packet, it’s suspicious

H: No one likes change do they?

M: No on likes change, they’ve got used to their particular brand, now they’re taking something different, totally understand that people will have concerns but actually the GP will be doing the best for her, and actually the best for the NHS because generics tend to be cheaper

H: Tend to be cheaper, right

M: And so he or she will be being a very responsible GP doing the best for both parties as it were

H: We touched a little bit on side effects from taking drugs for blood pressure

M: Yes yes

H: We never really went down that road. What sort of side effects might you get from blood pressure tablets?

M: Well it depends on which ones, and obviously when you get a newly diagnosed hypertensive, I normally say to the patient is look, what I’m aiming for is not only to get your blood pressure down to where I’d like it to be, but in a way that involves the fewest number of tablets

H: Right, so sometimes you’re taking more than one?

M: Sometimes you’re taking more than one and in fact it’s not unusual now with the sorts of targets we’re trying to reach to get the blood pressure down for somebody to be on 3 or 4 different types

H: Right ok

M: And I’m very aware that you know if somebody asked me to take 3 or 4 different types of medication every day I would not be a happy bunny really

H: No, you’re just wondering what’s going on in your body really

M: Exactly

H: But does it take a while as well to get that sort of cocktail of drugs right?

M: Yes

H: if you’re having, I don’t know what sort of symptoms you might be having – what sort of symptoms would you have with some tablets?

M: Well it depends on the type, some of them give absolutely no side effects, but some of them cause ankle swelling

H: Right

M: The calcium channel blocker, the calcium antagonist that she mentioned can sometimes cause ankle swelling which can be quite painful, so totally understand that this person may not be desperately happy about that. Some will cause a cough, the ace inhibitor for instance that she mentions – about 20% of people on an ace inhibitor will develop a dry cough that just does not get better

H: That’s annoying isn’t it/

M: Drives them and their spouse absolutely bananas, and in those people usually there is an alternative that can be given

H: Right

M: Another type of blood pressure which a lot of people refer to as their water tablets actually is something called bendroflurozide actually is a blood pressure tablet, but it is a very mild diuretic, it is a very mild water tablet so unfortunately sometimes people find that when they take it, about 2 hours later they spend a bit of time in the toilet, and you can get other symptoms like rash side effects etc like rash and so on, but I want to – absolutely very reasonable for people to ask about the side effects, completely understand but one thing is to mention that most people get no side effects

H: Right, oh that’s encouraging

M: Yes

H: And if you do, you can generally sort it out can you?

M: That’s exactly right, so you know any sensible GP will be going for the best recipe for that patient that brings their blood pressure down, but we’re not here to actually make this person’s life worse, by giving them a persistent dry cough, ankle swelling, spend the time in the toilet

H: You may live longer because you’ve got your blood pressure sorted out but there’s no point if you’re feeling so dreadful

M: It’s like that old joke you know you don’t live longer it just feels like it, but you know we’re not here to actually poison people we’re here to make them live longer, good quality of life

H: So keep going back to your GP until you get sorted out then really, even if he’s sick of the sight of you by the end of it

M: And also, sorry, one last perhaps a tiny bit of a hobby horse of mine is that, people do tend to get a bit tied up with the side effect business of tablets and I totally understand because you know if I was in that situation I would be going to my GP and complaining, but what they’ve got to remember is there are side effects to not having high blood pressure treated

H: Right. Death for example

M: Well death is one

H: No laughing matter really is it

M: Exactly. Or a heart attack or a stroke, and people sometimes, we live in an era when sometimes you get a feeling as a GP that it’s sort of trendy to knock the medication, and look at all the bad things – oh these are terrible tablets but actually remember that there’s absolutely overwhelming evidence that even lowering somebody’s blood pressure by a few millimetres of their systolic or diastolic, can make a massive difference to their percentage chance of getting a heart attack or a stroke. So remember there’s this balance, you know -

H: You’ve got to weigh it all up and make your own decision

M: Exactly right, you know we’re not here to make people’s lives worse with the side effects, but remember why we’re doing it

H: Ok we have a question in from Barry Ellison, we have 2 questions actually. There’s some good drug names here, I hope I’m going to be able to pronounce -

M: Go on

H: Firstly he says “I’m taking bendroflurozide” – this is what you said earlier -

M: Yes

H: “And linsinopril”

M: Yes

H: That’s for hypertension, “as well as alopurenol for gout”

M: Yes

H: “I’ve been told that bendroflurozide aggravates gout”

M: Yes

H: “Is there a solution for this?”

M: Yes there is and actually the – again – he’s spot on that bendroflurozide, that’s the sort of water, what people call their water tablet even though it isn’t really for that reason, can actually aggravate gout, so what I suggest he does is actually go back to his GP and says look I think this is causing me a bit of a problem, perhaps could I come off the bendroflurozide and go on some other medication that doesn’t aggravate my gout, because it’s one of those situations where potentially if he did that he could come off his bendroflurozide, probably need to go on an alternative but he may even then be able to come off his alopurenol which is this gout preventor tablet

H: Right

M: Because he might then find that because he’s not on the bendroflurozide

H: It’s not as bad

M: He doesn’t need to be on the alopurenol, so that’s like a win win situation you know, fewer tablets, you know NHS saves money etc etc

H: And Barry’s happier!

M: And Barry’s happier

H: He has a second question actually, he says “I’m worried about the long term effects of the hypertension medication, is there an alternative?”

M: Yes there is, I mean one would be to try lifestyle

H: Right

M: I’m not hesitant to say that because lifestyle absolutely you know is the best thing to do, but just to I suppose a bit of a note of caution that it’s quite unusual to be able to really solve your hypertension through lifestyle alone. I mean if you have somebody with just mildly raised hypertension and they get themselves down from 16 stone to whatever they should be and they do regular exercise, all those sorts of things, yes you know you can find those people who bring it down, or an absolute classic is stressed executive retires and I’ve definitely had those sort of people come to me and their blood pressure goes lower and lower, and you think hold on a minute -

H: That’s amazing isn’t it

M: Start taking them off the treatment

H: So it just shows you what your lifestyle, what sort of effect it can have -

M: It absolutely can, particularly things like stress and lack of exercise etc. So there is an alternative but that just brings me back to the – interesting his phrasing there, you know I’m worried about the long term side effects of the medication, totally understand, but remember the long term side effects of having untreated hypertension are far worse

H: Far worse

M: So you know you’ve just got to bear that in mind that you know when you’re taking these tablets there is a reason for them

H: Ok well just about, just over halfway through the show now, this is the Healthcare show and we’re talking today about hypertension or high blood pressure and we have in the studio with us GP Dr Martin Bell and he’d love to take your questions on high blood pressure so if you want to get in touch then all you have to do is type your question in the box that’s on the screen, put your name in there and where you’re from, press submit and it’ll come winging its way through to us here. We’ve had loads of questions in already, we’ll try to get through as many as we can, so let’s crack on with a few more. Nigel Chapman has written in, he wants to know “I know drinking isn’t very good for you” – but we all like a little bit of a drink now and again don’t we – “if you have high blood pressure” as he said it’s not very good for you “I love wine. Is red or white wine better for you?” We’ve read quite a lot about red wine recently haven’t we, the antioxidants and all that

M: Yes well red wine tends to be better for you, is my understanding, because of the antioxidants, and even I have read a couple of reports that say you know a glass of wine in the evening can be quite therapeutic for you

H: I find it very therapeutic, a glass of wine in the evening

M: Absolutely and they do say you only need to worry if you drink more than your doctor, but these days we try and be a bit healthier as GPs

H: I’ve never heard that before.

M: So he’s probably quite safe. So probably the odd glass of wine, it’s a bit like this everything in moderation thing

H: But would red wine or white wine, would it effect your blood pressure?

M: It really wouldn’t actually no there really is no difference

H: Ok. We have another question in from Sid in Chepstowe, he wants to know “I’m a 5’9” male and he weighs 18 stone – will my weight contribute to hypertension?”

M: It will contribute to his hypertension

H: And why?

M: because if you think about it his heart is trying to pump blood through a larger physical body. Made harder by the fact that there will be an outside pressure on his arteries so you know all the way struggling

H: That’s interesting

M: To get blood round this larger person, against the odds because the arteries are being pressed on. So sometimes it comes down to simple physics like that, so this heart is struggling and to get it round it needs a higher pressure. It’s a little bit like I guess if you suddenly extended your house by 5 times you would be really pushing this pump to get the water round your -

H: The central heating boiler

M: Exactly, it’s exactly the same sort of thing

H: Right. That’s a really good analogy actually isn’t it?

M: Almost exactly the same. So it really will be, but I suppose you could say with this gentleman, the flip side is he is an absolutely fantastic candidate for sorting his blood pressure out through lifestyle means

H: Right, so maybe lose some weight

M: If he lost some weight and did some exercise and you know was a bit careful about his salt intake, because there is evidence that if you have a lot of salt that definitely can make a difference to your level of blood pressure

H: And do you know why that is?

M: Well it is, it gets a little bit technical at this point but it’s basically a little bit to do with your kidneys and trying to get rid of the salt and the -

H: You were talking about kidneys earlier weren’t you

M: fact that salt is essentially fluid-retaining

H: Oh I see

M: So it’s a little bit like that, so salt intake is quite an important factor. 6g or less is what you’re meant to take in your diet

H: It’s surprising how much salt we do eat actually, because it’s in a lot of things and we don’t know

M: You don’t know, absolutely

H: The government’s quite keen isn’t it to lower our salt

M: Yes. So he, yes it’s not good, this is not sounding good, but the flip side is this is a fantastic candidate for solving his blood pressure problems without possibly needing medication. The tricky thing being to lose the weight, but you know that’s what he needs to do, and step one – I don’t know if he’s had his blood pressure taken

H: He doesn’t say

M: But he should do because at least his GP or practice nurse can keep an eye on his blood pressure and if we have time we might just talk about the link between blood pressure and diabetes and obesity

H: We’ll move onto that now then, what – explain a little bit more about that

M: Well there is a thing that used to be called Syndrome X but probably has a more technical name now where it’s been discovered that there is a link between people that have high blood pressure and a tendency towards type II diabetes, the adult onset diabetes, and that is often triggered by being obese, so most GPs if they see somebody walking through their door who is obese and they have high blood pressure, lights are flashing

H: Pretty much bound to be diabetic, almost

M: Pretty much in – this person is going to have a tendency or at least we should be looking for type II diabetes and more and more we are getting better and better at checking these people and getting them to have a fasting blood sugar test

H: Right

M: Because there is such a strong link. Now this link is not a good link because remember what I said about the risk factors? You know, artery here, smoking, blood pressure, cholesterol – type II diabetes is another risk factor for heart disease, so if you’ve got this obese person, you know arrow in here, high blood pressure here and then you add in type II diabetes over here, this artery is not a very happy artery

H: No

M: So you know he would be, walk through my door and would almost – whatever he had come to me about I would be wanting his blood pressure checked, I would want to do his cholesterol, his fasting blood sugar, even if he didn’t like it I’d pin him down and make him – you know but flip side being this chap can do a huge amount through lifestyle to reduce his risk

H: Ok. Now we have an interesting question in from Leo from Stoke Newington and he wants to know “I’m developing a lot of heartburn directly after eating. I don’t eat very spicy foods, so is my blood pressure causing this?”

M: No. It’s a good question because often people will very understandably get the diet thing and high blood pressure and – high blood pressure I hope you’re discovering is a slightly strange thing

H: Yes

M: You know we don’t know why it happens, we don’t know you know, we haven’t got a cure etc

H: So anyone can get it

M: Anyone can get it. You can be, you know an athlete and still have high blood pressure. So I find it, you know totally understandable that people have slightly weird ideas about it, but no his symptoms will be purely related to his spicy diet. My suspicious brain is ticking that, you know the weight thing

H: Right

M: Just because acid reflux and things like that are often, not always ok, but quite often weight related, so I’m thinking is this chap perhaps a little bit overweight, that would make him more liable to heartburn

H: And I know heartburn, we tend to think it’s something to do with a heart attack or -

M: Yes

H: Or something to do with your heart, but it’s not actually is it?

M: Not, no

H: It just feels as though it’s your heart but it’s not

M: Exactly right. Because where the acid is going, up your swallowing tube, is bang right where your heart is so it can be quite difficult to you know to tell the difference

H: But you’re not going to have a heart attack so don’t panic

M: No

H: Generally probably

M: Well – I was going to say - the only rider being you know if he’s getting chest pain, particularly on exertion or if he’s got any doubts about his chest pain, obviously he should see his GP, but no if it truly is heartburn it’ll be his spicy food that -

H: Nothing to do with the blood pressure

M: Exactly

H: So I hope that’s put your mind at rest. Eat fewer curries, maybe that’s a tip

M: Yes

H: Now Jack in Ashford wants to know “the doctor has told me to cut down on weight training as it is putting too much strain on my heart. However since I stepped down the weights I’m feeling a lot of tension in my heart” – that’s interesting. “I’m still doing cardio-vascular exercise but I’m wondering if my body is suffering from hypertension?

M: Yes

H: Confusing isn’t it?

M: Well she’d know if she was suffering from hypertension simply by having that beautiful test that we just talked about before

H: Yes

M: And just having high blood pressure, so that will be very much a yes or a no, in other words have your blood pressure checked

H: Go back to your doctor -

M: Go back to your doctor. Interesting that the doctor is saying that she’s putting stress on her heart -

H: It’s Jack actually

M: Sorry Jack, he’s putting stress on his heart, because I wonder if the GP knows something that we don’t about whether his heart perhaps is slightly enlarged. Sometimes this can show up on an ECG that the heart muscle is slightly enlarged, or thicker

H: Right

M: And therefore this GP may have a little bit of a worry about Jack in particular.

H: It’s difficult to diagnose somebody when you can’t see them and you don’t know the history I suppose

M: It’s an enormous task

H: Isn’t it?

M: I mean as a generalisation there is no problem you know with sensible exercise, even things like weight training etc, but as always you would need to have a discussion with somebody who really knows what they’re talking about

H: You can overdo it can’t you?

M: You can overdo it, you know if you’re trying to be macho man and go from doing nothing to lifting heavy weights, this is a recipe for disaster ok? But there’s absolutely no problem if you’re doing it sensibly, there is no problem you know unless you are a total and utter fanatic and who knows perhaps Jack is one of those

H: Well maybe. So maybe go back to his doctor

M: Yes just to run it past and have his blood pressure checked

H: Have his blood pressure checked again. Now Justin from Crawley wants to know “I’m thinking about giving blood but I don’t know if I have high blood pressure or not. What should I do?”

M: Right well bonus, if he went along and donated blood they would take his blood pressure first

H: Oh hooray. Two birds with one stone!

Still got a question or comment?

Name

Your question Question

Enter code