Blood pressure 1 - Quick on the Net Limited



Web page - General Advice Section

BLOOD PRESSURE

Key Points (drop down)

Hypertension affects 7 - 10 million people in the UK

High blood pressure is one of the three risk factors for heart attack and stroke. The others are smoking and raised cholesterol.

Hypertension is related to high salt intake, being overweight and drinking too much alcohol.

About half of all people who are hypertensive need two or more drugs to control their blood pressure.

Some occupations require an individual to have a normal blood pressure (with medication if required) e.g. lorry drivers.

Commonly asked questions (drop down)

What is hypertension?

A blood pressure measurement that is higher than average

What is wrong with having high blood pressure?

If it is not treated, it can increase the risk of having a heart attack or a stroke

How do I find out if I have high blood pressure?

The only way to find out is to have it measured. This can be done at your GP practice, an NHS walk-in Centre or by a self-referral to an Occupational Health provider at work.

What is the cause of high blood pressure?

Usually a result of inherited factors and lifestyle factors. Key is too much salt, being overweight and too much alcohol.

What are the symptoms?

Unfortunately, there is no association between high blood pressure and specific symptoms, including headaches. Some people however report that they "just didn't feel well" and having been to have a check, hypertension was incidentally diagnosed.

What treatment will I need if I am diagnosed?

You may initially be advised to remedy any poor lifestyle factors and this sometimes improves the blood pressure so that medication is not required. Commonly however medication will be prescribed to treat hypertension and this will usually be for life if the risk of heart attack and stroke is to be avoided.

General Advice Section

Blood pressure is a measurement of the pressure of the blood in your arteries and persistently elevated blood pressure is called Hypertension.

During each heartbeat, the heart muscle contracts to push blood around the body. Two pressures are measured to get a blood pressure result. The first is taken when the heartbeat rises to a peak, as the heart pumps blood out and this is called the systolic pressure. The second reading is taken when the heart is at rest just before the next heartbeat and is called the diastolic pressure.

In addition to the variations within the cycle, blood pressure varies constantly with the level of physical exertion, with anxiety, stress, emotional changes, and other factors. So single measurements are not particularly meaningful and the blood pressure should be checked under resting conditions, at different times.

Blood pressure is measured in terms of millimetres of mercury (mmHg) and hypertension is usually defined as a sustained systolic (top reading) pressure of 140 mmHg or more, or diastolic (lower figure) pressure of 90 mmHg or more, at rest.

Lifestyle changes, such as dietary control, reducing salt and alcohol intake as well as increased exercise are important for everyone with raised blood pressure.

Drug treatment is usually recommended in cases of sustained systolic pressure of 160 mmHg or more and/or diastolic pressure 100 mmHg or more.

When blood pressure is between 140/90-160/100mmHg tablets may not be necessary providing that the lifestyle changes work and there are no other risk factors for heart disease and stroke, such as high cholesterol, smoking or a previous stroke or heart attack.

Diastolic pressures of 90–109 mmHg are found in about 20 per cent of the middle-aged adult population. They are less common in younger people and more common in those who are older. Diastolic pressures of 110–129 mmHg are found in about 4% of the adult population.

Preventing Hypertension

Make lifestyle changes

✓ Eat a healthy diet

✓ Lose weight if necessary.

✓ Stop smoking.

✓ Exercise regularly

✓ Reduce alcohol consumption.

Regular checks of the blood pressure, especially if there is a family history of hypertension, are important. Advice or treatment can be started before complications arise.

Treatment

The treatment of hypertension involves both a change in lifestyle and, if necessary, the prescription of drugs.

In many cases of mild hypertension, a change in eating habits, regular exercise, a low fat diet, no smoking, and if necessary a reduction in salt intake and alcohol, will be sufficient to get the blood pressure down to normal.

If these changes are not successful, then drug treatment is necessary.

Three main classes of drugs are used to treat hypertension:

Diuretics (also known as water tablets)

These act on the kidneys to cause them to pass more water and salt in the urine and reduce the volume of the blood, so bringing down the pressure.

Beta- blockers

This medication interferes with the hormone and nervous control of the heart, slowing it and causing it to beat more slowly, so reducing the pressure.

Vasodilators

Acts on the arteries to widen them and this group contains drugs acting in quite different ways.

If there is an underlying medical cause, such as a hormonal disorder, treatment of this disorder often results in blood pressure returning to a normal level.

Causes of Hypertension

The cause of hypertension in approximately 90% of cases is unknown, in such cases this is called essential hypertension. Essential hypertension is very common, and affects perhaps 20 per cent of the adult population and lifestyle and genetic factors may contribute. It is slightly more common in men.

Obese people or those who drink excessive amounts of alcohol are more likely to develop hypertension and stress may contribute to the condition.

In a few people, the underlying cause of the hypertension is known as it can be a complication of other medical problems. e.g. kidney disease.

The combined oral contraceptive may cause hypertension.

In pregnant women, pre-eclampsia and eclampsia leads to raised blood pressure, which is potentially life- threatening.

A general rise in blood pressure is known to be damaging to arteries, and arterial damage affect the elasticity of arteries, which become stiff and rigid. It also promotes the arterial disease atherosclerosis, which can lead to narrowed arteries. The condition is most common in older people because the arteries become more rigid with age.

Complications

No one can afford to ignore raised blood pressure, because its complications cause more deaths and severe disability than any other group of diseases.

Sustained high pressures are very damaging to the blood vessels, causing an acceleration of the ageing processes.

In particular, they promote the killer arterial disease atherosclerosis, in which hardening of the arteries are associated with the deposits, of plaques of cholesterol and other material in the inner lining of the arteries.

Coronary thrombosis and stroke the two major killers of the Western world are the major risks, but raised blood pressure can also severely damage the heart, kidneys and eyes.

Hypertension has to be looked for and every adult should have regular checks.

Fortunately, proper and effective treatment can largely eliminate the additional risk of serious complications.

Manager Section.

An individual who has been diagnosed with high blood pressure - which is well controlled - is no less able or reliable than anyone else.

There are some occupations which require an individual to have a normal blood pressure result - this can be with medication if required. Once a diagnosis of high blood pressure is made, and whilst adequate control is being established however, an individual may be temporarily restricted from that particular type of work and then once controlled, the work can resume. An example of this is an LGV driver - for further advice and information see that particular section..

The key to wellness is in compliance with any medication or lifestyle adjustments.

Individuals with raised blood pressure are encouraged to lose weight, reduce salt intake and reduce alcohol units.

There is no reason why this person should not be able to provide full and sufficient attendance.

There should be no adverse effects on capability or performance.

Short Term Sickness Absence.

When carrying out a sickness absence review with an employee known to have been previously diagnosed with high blood pressure, a manager is recommended to ask the following questions:

Is there anything at work that is contributing to your problem

Do you think your poor attendance is related to your known medical problem

Are you taking your medication regularly as prescribed by your doctor

Are you paying enough attention to the lifestyle adjustments which you may have been advised to look at

When did you last have your blood pressure checked

Do you need to have a check up with your doctor

Long Term Sickness Absence

All cases of long term sickness must be referred to the OH Consultant for an on-site review.

Manager Options

□ Ask employee to see his GP

□ Use AskLine option to get further advice - click on icon

□ Refer to Occupational Health Consultant - Link to referral paperwork

Further Information (on selected topic) Links

British Hypertension Society Information Service

hyp.ac.uk/bhfinfo/

British Heart Foundation

.uk

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