High blood pressure / hypertension

Common presenting symptoms:

Often none; may be headache if very high blood pressure


High blood pressure (hypertension) is generally defined with blood pressure above 140 / 90 mmHg; however, tighter blood pressure readings are often recommended with patients with diabetes or other high-risk conditions. High blood pressure rarely produces any symptoms. In fact, patients with reasonably high blood pressure often feel well and are entirely asymptomatic. Severely blood pressure can sometimes produce headache but this is not a reliable sign.

Hypertension is common – around 30% of adult has elevated blood pressure in the UK either treated or uncontrolled. It is more common in the older age group; but with our increasingly sedentary lifestyle and obesity problem, the age of detection of hypertension has reduced. Young people with hypertension also need special investigation to exclude secondary causes of hypertension – which may include biochemical / endocrine abnormality or underlying vascular or kidney disease.

Uncontrolled hypertension is a strong pre-disposing risk factor for a range of serious cardiovascular disease including, coronary artery disease, aortic aneurysm and stroke.

Measuring blood pressure

How do we investigate?

In investigate hypertension, our cardiologists may recommend one or more potential investigative tests such as:-

  • Echocardiography to quantify heart muscle and valve function
  • Cardiac / aortic CT to look for dilatation or restriction of blood vessels
  • Ultrasound scan of the kidneys
  • Blood tests to screen for causes of secondary hypertension, if indicated.
  • 24-hour ambulatory blood pressure monitoring (ABPM)

What are the treatment options?

There are well-described non-pharmacological interventions and pharmacological therapies to tackle hypertension. Lifestyle modification is very important. Being active with regular aerobic exercises alone can bring down systolic blood pressure by up to 10 mmHg. Salt reduction is also effective in bringing down blood pressure (the kidneys use salt level to control water reabsorption and indirectly act as the “thermostat” of blood pressure set-point). Our blood pressure, like many bodily functions, follows a circadian rhythm. Disrupted sleep or interrupted circadian cycles from shift workers may have deleterious effect in blood pressure control. Pharmacological action in blood pressure control is well studied and different combinations of medication may be more effective / advantageous depending on factors such as co-morbidities and racial background.