What you need to know about Ireland's high-blood-pressure problem

Ireland has a serious problem with high blood pressure. Our rates are among the highest in the world, and we have a poor track record in detecting and treating this potentially life-threatening condition. Here’s what you need to know. 

Some 43% of adults aged 50 and older have high blood pressure. That’s according to a recent report from The Irish Longitudinal Study on Ageing (Tilda), a 12-year study involving more than 8,000 people.

A SERIOUS public health issue has been identified in Ireland. Some 43% of adults aged 50 and older have high blood pressure. That’s according to a recent report from The Irish Longitudinal Study on Ageing (Tilda), a 12-year study involving more than 8,000 people.

Tilda researcher and consultant geriatrician at St James’s Hospital, Dublin, Dr Robert Briggs says there were even more worrying findings in the September report. 

“Some 36% didn’t even know their blood pressure was high. And even in the cases of those who knew and were taking medication to reduce it, 47% weren’t succeeding in bringing their blood pressure down to healthy levels.”

This isn’t the first time warnings have been sounded in relation to concerns about blood pressure levels in older people in Ireland. 

A 2019 report published in The Lancet medical journal examined data from 526,336 participants from 12 countries in the East and West, including Ireland. 

It found that Ireland had one of the highest rates of blood pressure internationally and some of the lowest levels of diagnosis, treatment, and control of the condition.

JJ Coughlan, consultant cardiologist at the Mater Private in Dublin

JJ Coughlan, a consultant cardiologist at the Mater Private in Dublin, says these issues persist.

“We have a big problem with high blood pressure,” he says. “Not only do we have more of it, but we don’t seem to be very good at identifying or treating it.”

What does blood pressure mean? Coughlan explains it as “the force of blood being pumped around the body through the arteries”.

It consists of two numbers. The top number is the systolic blood pressure, which is “the pressure with which the blood presses on the artery walls when the heart is contracting to pump the blood”. The bottom number is the diastolic blood pressure, “which is the pressure on the arteries when the heart is relaxing between beats”.

The European Society of Cardiology (ESC) classifies blood pressure into three categories: Non-elevated, elevated, and hypertension — also referred to as high blood pressure. 

Non-elevated is less than 120/70mmHg (millimetres of mercury). Hypertension is 140/90mmHg, and anything in between is elevated.

The ESC now recommends aiming for a systolic blood pressure of between 120 and 129.

GP and clinical lecturer Sumi Dunne says doctors “start to worry when the numbers start creeping up”.

She compares blood pressure in the cardiovascular system to water pressure in a water pump system.

“If the water pressure gets too high, the water pump system explodes and sustains serious damage,” she says.

“High blood pressure won’t cause the human body to explode but it can lead to major problems within the blood vessels, heart and brain; causing bleeds, heart attacks or strokes.”

According to Coughlan, high blood pressure is estimated to cause over half the cases of stroke and heart artery disease worldwide. It is also the single biggest risk factor contributing to the global burden of disease and all-cause mortality, leading to 9.4m deaths annually.

Dunne adds that high blood pressure can also affect kidney efficiency and damage blood vessels in the eye, leading to retinal diseases such as macular oedema.

Angie Brown is the medical director of the Irish Heart Foundation and a consultant cardiologist at the Bon Secours Hospital in Dublin. What most concerns her is that people are at increasing risk of hypertension, and many are entirely unaware of it.

Measuring your blood pressure

Angie Brown is the medical director of the Irish Heart Foundation and a consultant cardiologist at the Bon Secours Hospital in Dublin. What most concerns her is that people are at increasing risk of hypertension, and many are entirely unaware of it.

“Around the world, the prevalence of high blood pressure is growing,” she says. 

“It tends to increase with age, and we have an ageing population. It’s often increased in people with higher BMIs, and as people lead more sedentary lives, we are seeing higher levels of obesity. Yet studies show that a significant number of people don’t know they have high blood pressure, and those on medication may have inadequate control.”

Hypertension is a so-called silent condition. What this means, says Brown, is that there are often no symptoms: “Occasionally, people with very high blood pressure may have a headache or feel generally unwell, but more commonly, they can have high blood pressure, which puts them at higher risk of heart attack, heart failure, stroke, kidney failure, or dementia, and not know anything at all about it.

“The only way people can know for sure is to get their blood pressure measured.”

We’ve come a long way since the English clergyman Reverend Stephan Hales crudely inserted a tube into a horse’s artery to observe the pulsing of its blood in the 1700s.

Today, getting a blood pressure reading starts with sitting quietly for five minutes. Next, a cuff attached to a blood pressure monitor is placed snugly around the person’s upper arm. While the arm rests on a table at heart level, the cuff is inflated and then slowly deflates. The monitor measures the systolic and diastolic pressures — and, on most digital models, the pulse rate.

“All people have to do is sit comfortably in a relaxed position for a moment or two,” says Brown.

“GPs and many local pharmacies offer these blood pressure checks. Some people even buy their own monitor so they can check their blood pressure at home.”

There are several key points to consider when understanding our own blood pressure. One is that there can be a genetic component, which means hypertension can run in families.

Another is that women tend to have lower blood pressure than men until they reach menopause. 

Plentiful oestrogen levels protect them until that point but “their risk increases significantly afterwards,” says Coughlan: “Women also have other gender-specific risk factors. Women who have high blood pressure in pregnancy, for example, are at higher risk of developing high blood pressure later in life.”

We should all pay more attention to our blood pressure as we age, says Brown: “Our arteries stiffen with age. That can cause blood pressure to rise.”

Other issues that can impact blood pressure include obesity, insulin resistance, and medical conditions like obstructive sleep apnoea and thyroid disease.

“Some drugs like amphetamines, steroids, and NSAIDs [nonsteroidal anti-inflammatory drugs] can increase the blood pressure too,” says Brown.

Dunne is keen to point out that one high blood pressure reading doesn’t necessarily indicate hypertension.

“Blood pressure varies over time,” she says. “Stress and exercise can cause it to spike, so a one-off reading means nothing.

“The trend is what matters.”

If a doctor is concerned that someone’s blood pressure may be high, they will recommend a portable 24-hour blood pressure monitor.

“It takes readings every half hour or so throughout the day and night, providing an average reading and an insight into the patterns throughout the day,” says Dunne.

Regularity of checks

The good news for anyone diagnosed with high blood pressure is that there are several steps that can be taken to reduce it.

“In many cases, blood pressure can be effectively controlled with lifestyle measures,” says Coughlan — see sidebar for details.

People whose blood pressure remains high despite implementing lifestyle changes may be prescribed medication.

“There are four main classes of blood pressure medication,” says Coughlan. “Doctors often recommend a combination as it can result in better control.”

According to statistics, he adds, “Treating blood pressure with medication lowers the risk of stroke, heart attack and heart failure and may also result in a lower risk of dementia. Those statistics reinforce the importance of getting blood pressure measured regularly and treating it if and when it’s high.”

How often should we get our blood pressure taken? Brown recommends that anyone with a first-degree relative who has high blood pressure should start getting their blood pressure checked from the age of 18 and have it checked every three years until they are 40. The guidelines for everyone after the age of 40 are the same: Our blood pressure should be taken annually.

That way, according to Briggs, we can take proactive steps to reduce it if ever it becomes elevated.

“The window of time between 45 and 75 is when it’s most important to control blood pressure,” he says.

“It’s when we should all get our blood pressure checked regularly and take action to prevent it from having a negative impact on our health in the long term. If we don’t check our blood pressure, we can’t know if it’s high and the consequences of that can be serious. But by detecting and managing hypertension, the risks of any adverse outcomes are much reduced.”

Dr Sumi Dunne. Photograph Moya Nolan

Simple steps to help you take control

Dr Sumi Dunne has a hopeful message for those diagnosed with elevated or high blood pressure.

If you are otherwise well and healthy, “there are a lot of simple things you can do to bring it back within healthy parameters”.

1. Take a look at your diet, starting with your saturated fat intake.

This is the fat found in fatty cuts of meat, processed meats such as bacon and sausages, dairy products such as cheese and butter, as well as pastries and fried foods.

“It’s best to only eat these foods occasionally,” says Dunne.

2. If you’re wondering what to eat instead, she suggests the Mediterranean diet. 

“It’s rich in fruit, vegetables, olive oil and fish,” she says.

“It’s also easy, tasty, and full of health-giving antioxidants.”

3. Control your salt intake.

Dunne cites studies that show reducing salt intake can significantly impact systolic blood pressure levels.

4. Stop smoking. 

Each cigarette you smoke causes a temporary rise in blood pressure while also damaging the walls of the blood vessels.

5. Keep your alcohol intake within the recommended levels. 

That’s 17 standard drinks per week for men and 11 for women. A standard drink is half a pint of beer, stout, or cider, a measure of spirits, a small glass of wine, or an alcopop.

6. Don’t drink more than two cups of coffee or other highly caffeinated drinks a day.

7. Move your body.

“We should all do cardiovascular exercise that makes us sweaty,” says Dunne. “This could be a brisk walk, cycle, or swim, and raises the heart rate for about 20 or 30 minutes. A good marker is being slightly out of breath doing it.”

8. Prioritise sleep.

Experts recommend that adults get between seven and nine hours of sleep per night.

9. De-stress.

“The likes of mindfulness, yoga, or just taking reflective time to reset can all help decrease stress,” says Dunne.

10. If you’ve tried all of the above and your blood pressure remains high, try medication. 

“You don’t want to risk hypertension causing chronic disease or organ damage. You need to get your blood pressure down to healthy levels.”