Under pressure: Dr Phil Kieran on the dangers of hypertension

The big three issues affecting life expectancy and quality of life are smoking, obesity, and high blood pressure, which is often undiagnosed in men.

Dr Phil Kiernan

“I’m just here for an NCT doc.”

This is a phrase, which often starts an interesting consultation conundrum.

On the one hand, I relish the opportunity to practice preventative medicine, give people advice and guidance which will have big rewards and potentially life-altering effects for years into the future.

But, on the other hand, I worry is there a specific question or expectation here which I am missing.

A lot of the time what people actually mean is they want to know they don’t have cancer and will not go on to develop it in the near future.That question is a lot harder than you might think to answer.

Does this mean it is a useless exercise then? I don’t think it is but there are a few areas that can be hugely beneficial if people know what to expect.

How does it work?

With any screening procedure you need to look for conditions that:

1. We know cause problems for people;

2. Progress from early stage to late stage (something that is unfortunately unclear for a lot of cancers);

3. Have no symptoms so we can’t wait for people to notice the problem;

4. We can treat relatively easily.

All this is a tall order for a doctor with 15 minutes and an expectant patient in search of answers.

The big three issues effecting life expectancy and quality of life are smoking, obesity, and high blood pressure. These are things most patients are aware of, although some who fall into the medical category of obese are often surprised with the news as it is a lot lighter than most of us think (14 stone for a person who is 5’8” tall).

Blood pressure is one, however, which goes unnoticed unless you check it and may be something you don’t know about until you find yourself with a heart attack, kidney failure or a stroke.

Why is it a concern for men?

High blood pressure tends to cause problems younger and more severely for men and it often goes unnoticed in men.

Men tend not to look at their blood pressure unless prompted to do so. I will usually try to cram in this check as part of a consultation, as I know it may be my only chance to do so. Hypertension affects 65% of Irish over the age of 50 and is undiagnosed about half the time.

What’s normal?

120/80 is normal but this varies. A bit higher for taller people and lower for smaller people is probably normal too.

Some people will notice that their blood pressure is always high in the doctor’s surgery.

This may be due to a phenomenon called white-coat hypertension (even though very few doctors still wear white coats). The best way of diagnosing this condition is to do a 24hour BP monitor.

This is small device that you wear attached to your belt with a cuff around your upper arm.

It will automatically check your BP at intervals, usually every 15 to 30 minutes during the day and 30 to 60 minutes at night.

This gives us the best idea of what your blood pressure is doing and is considered the gold standard for diagnosing hypertension. For someone who only has white-coat hypertension, we see a high reading for the first three to four checks and then it all settles down.

For most an acceptable blood pressure is 135-140/85-90 or lower for a blood pressure reading done during a consultation or125-135/80-85 or lower on a 24-hour blood pressure reading (a very recent trial may mean we start lowering these targets).

Why treat it?

High blood pressure strains the walls of your blood vessels and causes them to stiffen and narrow. This can cause heart attacks, strokes, kidney failure or heart failure.

These are slowly progressing conditions, which you don’t know about until severe damage is done at which point it is too late to reverse.

This is why getting checked is so important. If your blood pressure is normal repeating it every three to four years is probably enough.

What can I do? (no meds)

This depends on whether or not there is anything driving your blood pressure up. If you are overweight (and using an online BMI checker is a good way to be honest with yourself about this) then losing the excess weight is enough for a lot of people to avoid medication.

Regular exercise is a good treatment to help get BP down (with every 10 minutes per day of walking reducing your risk of high BP by 12%). If you drink more than the recommended 21 units per week or if you are drinking more than three days per week, reducing this can help hugely too.

A diet high in salt and processed food seems to increase BP too, so healthy eating is always a good idea. These few seemingly obvious changes in your lifestyle can have a huge effect on your blood pressure.

So meds it is?

A lot of patients, however, will need medication to help bring down their blood pressure. It is important to take these medications regularly and to follow up with your GP to make sure your BP is brought down enough, as there is no point in taking the meds and not getting the benefit from them.

High blood pressure is common, it kills people and it has no symptoms. Thankfully, it is easy to find and usually straightforward to treat. If you want to try the lifestyle route to fix it, I suggest you go all in before getting the BP checked again, but be aware you may still need medication.

Most importantly, get it checked and take the advice offered as it can save your life.

Hypertension

• High blood pressure or hypertension affects 65% of over 50s
• Half of this is undiagnosed
• It is the number one risk factor for stroke, heart attack and kidney failure
• High blood pressure usually has no symptoms until it’s too late
• Lifestyle changes can help lower your blood pressure but medication is often needed to get it down to what it should be
• Normal blood pressure is 135/85 or lower
• A 24-hour blood pressure monitor is the most accurate way to diagnose hypertension and to monitor response to treatment