High blood pressure (hypertension) doesn’t usually cause symptoms, so it’s unlikely that you’ll feel ill if you have it. You’ll probably only find out you have high blood pressure if you have your blood pressure checked by a doctor or nurse.
Occasionally, some people with very high blood pressure may get headaches or have problems with their vision. If you’re regularly having these kind of symptoms, you should contact your GP to get it checked out.
The only way to find out whether you have high blood pressure is by having your blood pressure measured. Your GP, a nurse, pharmacist or another health professional can do this for you.
If you’re living in England and you’re between the ages of 40 and 74, you should be invited for regular health checks every five years. These may take place at your GP surgery, a local pharmacy, or at another community setting such as a leisure centre or mobile clinic. The health checks include a blood pressure test. If your blood pressure is high during your health check, you will be referred to your GP for further tests and treatment.
Measuring blood pressurePlay video
A device called a sphygmomanometer is used to measure blood pressure. This is usually an automated, digital device. It consists of a monitor attached to a cuff, which is wrapped around your upper arm. The person measuring your blood pressure will press a button to inflate the cuff, then it will automatically slowly deflate. A sensor in the cuff detects your pulse when the cuff is fully inflated. This is then converted into a measurement of blood pressure, which is shown on the display screen on the monitor. The reading will show two numbers, one on top of the other, such as 120/80mmHg (one hundred and twenty over eighty millimetres of mercury).
- The first figure is called systolic blood pressure. This is a measure of the pressure when your heart muscle is contracted and pumping blood out of your heart. This is the highest pressure in your blood vessels.
- The second figure is called diastolic blood pressure. This is the pressure between heart beats when your heart is resting and filling with blood. This is the lowest pressure in your blood vessels.
A reading of 140/90 mmHg is considered to be higher than normal. You’ll be advised to have this checked with your GP, if you haven’t already. Your GP may want to check your blood pressure two or three times during your appointment.
If your blood pressure has been measured as high several times, your GP may recommend that you monitor your blood pressure at home. This is to check whether the high reading is an ongoing problem or was a one-off when you were at the doctor’s surgery. You may be offered one of the following.
- Ambulatory blood pressure monitoring (ABPM), This is when you wear a monitoring device on your arm for 24 hours. The device will take your blood pressure at regular intervals throughout the day and night.
- Home blood pressure monitoring (HBPM). With HBPM, you record your blood pressure at home on a device that your doctor gives you. You will need to record your blood pressure twice a day – morning and evening – for at least four days.
Your doctor may ask you to have some tests to see if high blood pressure has caused any damage to your heart or kidneys. You may be offered these tests before or after your diagnosis has been confirmed, and they may include:
- a urine test – protein in your urine may be the first sign of damage to your kidneys
- a blood test to check your cholesterol and blood sugar levels, as well as the condition of your kidneys
- an electrocardiogram (ECG) – a test that measures the electrical activity of your heart to check for signs of heart enlargement or other damage
If you have high blood pressure, your doctor or nurse may suggest getting a blood pressure monitor to use at home on a regular basis. This can be useful to help you identify situations or activities in your daily life that cause your blood pressure to rise. If you’re having treatment for blood pressure, it may help you to see how well your treatment is working. Not everyone decides to monitor their blood pressure at home though. Some people find this makes them more anxious.
If you do decide to monitor your own blood pressure, choose a monitor that has been approved by the British Hypertension Society. Even if you use a blood pressure monitor at home, it’s important to have your blood pressure tested at least once a year by your GP.
Treatment for high blood pressure (hypertension) includes lifestyle changes you can make to reduce your blood pressure, and medical treatment. What treatment you are offered will depend on how high your blood pressure is and your risk of developing heart disease and stroke.
Your GP or nurse will talk you through the lifestyle changes you can make to lower your blood pressure. These may include:
- losing any excess weight
- doing more exercise
- making changes to your diet, such as reducing fat and including more fruit and vegetables
- reducing the amount of salt in your diet
- cutting down on alcohol
- drinking less coffee and other high-caffeine drinks, such as cola
You may also consider trying relaxation therapies, such as meditation and stress management, to help reduce your blood pressure.
If you smoke, your GP or nurse will encourage you to quit, as smoking further increases your risk of developing heart disease and stroke.
Depending on how high your blood pressure is and your risk of developing heart disease, your GP may prescribe medicines to reduce your blood pressure. Your GP is likely to give you one of the following medicines to try first. You may later be offered a combination of these medicines if your blood pressure doesn’t improve with just one.
- ACE inhibitors (eg ramipril) or angiotensin-II receptor antagonists (eg candesartan). These work by relaxing your blood vessels and increasing the amount of water your kidneys remove from your blood. This reduces the volume of your blood, lowering blood pressure.
- Calcium-channel blockers (eg amlodipine). These work by relaxing and widening your blood vessels.
- Diuretics (eg indapamide). These increase the amount of water and salt removed from your blood by your kidneys, lowering the volume of your blood. This reduces blood pressure.
If these medicines don’t help to lower your blood pressure, your GP may ask you to try one of the following types of medicine.
- Beta-blockers (eg atenolol). These reduce the work your heart has to do by making your heart beat more slowly and with less force.
- Alpha-blockers (eg doxazosin). These help to widen your blood vessels by relaxing the muscles in your blood vessel walls.
The medicines your GP prescribes will depend on a number of factors, including your age and ethnicity. It may take time to find the best treatment for you. It's important to take your medicines every day, even if you don't have any symptoms.
High blood pressure can be diagnosed as primary or secondary hypertension depending on whether there is an underlying medical cause.
About 95 in 100 people with high blood pressure have primary hypertension. This means there’s no single, identifiable cause. However, various lifestyle factors can contribute, including:
- being overweight or obese
- drinking too much alcohol
- not doing enough exercise
- having too much salt in your diet
If someone else in your family has high blood pressure, you have a higher risk of developing it.
About five in 100 people with high blood pressure have secondary hypertension. This means there is a known underlying medical cause such as:
- kidney disease
- endocrine diseases (hormone disorders)
- a narrowing of part of your aorta (the largest artery leading from your heart) or the arteries leading to your kidneys
Secondary hypertension can also be caused by certain medicines, including steroid medicines and the contraceptive pill.
Having high blood pressure puts extra strain on your blood vessels, which can lead to various problems around your body. These can include:
- cardiovascular disease such as angina (chest pain caused by reduced blood flow to the heart), stroke, heart attack, heart failure and aneurysms (swelling of your blood vessels)
- kidney disease
- problems with your vision caused by damage to your retina (the layer that covers the back of your eye)
Getting your blood pressure checked regularly and taking measures to control it if it’s high, can help to prevent these problems.
If you're pregnant, you’ll have your blood pressure monitored regularly, regardless of whether you have high blood pressure or not. Long-term high blood pressure may be picked up at an antenatal appointment. It's possible that you may develop high blood pressure during your pregnancy (gestational hypertension). High blood pressure that develops after 20 weeks of pregnancy can increase your risk of developing pre-eclampsia. This is a condition in which the blood supply to your baby becomes restricted. Pre-eclampsia can be dangerous for both you and your baby.
If you have high blood pressure and think you may be, or are trying to become pregnant, it's important to speak to your GP. Certain medicines for treating high blood pressure (eg ACE inhibitors and angiotensin II receptor blockers) aren't suitable for pregnant women.
If you're of African–Caribbean descent, you’re at a higher risk of getting high blood pressure. You may also be at a higher risk of developing heart disease and diabetes if you’re of South-Asian origin. Check with your GP how often you need to have your blood pressure checked if you fall into one of these groups.
Does stress cause high blood pressure?
Your blood pressure can rise temporarily if you're anxious or stressed. However, there’s no evidence that being stressed can permanently affect your blood pressure.
Your blood pressure changes throughout the day and can increase if you become anxious or stressed. This is a normal response by your body and is usually only temporary. There’s no proof that regularly being stressed can affect your blood pressure over the long term. It’s possible though, that if you’re stressed, you may be more likely to have an unhealthy lifestyle. For example, you may be drinking too much alcohol, not doing enough exercise or eating an unhealthy diet high in fat or salt. These things may put you at greater risk of developing high blood pressure.
If you have high blood pressure, you may find it helpful to try techniques to help you manage your stress better. These may include:
- relaxation techniques such as meditation or yoga
- stress management
- cognitive behavioural therapy (CBT) – a type of talking therapy that can help you focus on how you think and feel and cope with stress
Can I travel by plane if I have high blood pressure?
Yes, you can fly – travelling by plane won't affect your condition.
Blood pressure isn't affected by air travel so it is usually perfectly safe for you to travel by plane if you have high blood pressure. If your blood pressure is unstable or very high though, check with your GP before you travel.
If you’re taking medicines for high blood pressure, make sure you’ve packed enough for your whole trip. You could also pack some in your hand luggage in case your suitcase goes missing. It’s also a good idea to keep a note of your prescription in case you get stopped at customs.
You should bear in mind that travelling can be stressful, and this can cause your blood pressure to rise temporarily. Making sure you leave in plenty of time for your departure will help to stop you feeling stressed. And don't pack too much – struggling with a heavy suitcase could increase your blood pressure.
Can my blood pressure be higher in one arm than the other?
Yes, it’s possible for your blood pressure to be recorded as higher in one arm than the other. If the difference is small, it’s usually nothing to worry about. But a large difference can be a sign of an underlying problem.
Your blood pressure can change throughout the day, depending on what you’re doing. A slight difference in blood pressure between arms is common. When you first have your blood pressure measured, your doctor or nurse is likely to check it in both arms. If there’s a large difference between the two measurements, your doctor or nurse will want to check the readings again. A large difference can be a sign of a problem affecting an artery on one side of your body. This can increase your risk of certain heart and circulatory diseases. Your doctor will explain this to you, and may recommend further tests or treatment.
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- Cardiology and vascular disease. Oxford handbook of general practice (online). Oxford Medicine Online. www.oxfordmedicine.com, April 2014
- Blood pressure. British Heart Foundation, 2009. www.bhf.org.uk
- Health survey for England – 2012 (chapter 10). Health and Social Care Information Centre, December 2013. www.hscic.gov.uk
- Hypertension: Clinical management of primary hypertension in adults. National Institute of Health and Clinical Evidence (NICE), August 2011. www.nice.org.uk
- Map of Medicine. Hypertension. International View. London: Map of Medicine; 2012 (Issue 4)
- NHS health check programme. Best Practice Guidance. Department of Health and Public Health England, September 2013. www.healthcheck.nhs.uk
- What is blood pressure? Blood Pressure UK. www.bloodpressureuk.org, accessed 21 October 2014
- Why measure your blood pressure with a home blood pressure monitor? Blood Pressure UK. www.bloodpressureuk.org, accessed 17 October 2014
- How to choose the right blood pressure monitor. Blood Pressure UK. www.bloodpressureuk.org, accessed 17 October 2014
- FAQs. Blood Pressure UK. www.bloodpressureuk.org, accessed 21 October 2014
- Orme S, Ralph SG, Birchall A, et al. The normal range for inter-arm differences in blood pressure. Age Ageing 1999; 28: 537–42.
- What is high blood pressure? Blood Pressure UK. www.bloodpressureuk.org, accessed 21 October 2014
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Reviewed by Pippa Coulter, Health information team, November 2014
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