High blood pressure: is your doctor on the case?

Hypertension may cause no symptoms, but if it goes undiagnosed, you could be in for trouble. Barbara Rowlands reports

Deborah Hart discovered she had high blood pressure, four years ago during a routine check-up. A GP took one reading and said it should be regularly monitored - but he did not tell her how serious high blood pressure can be or offer any advice ab out howto reduce it.

"I'm slightly overweight, I smoke and have the odd drink but he never mentioned the effects of diet, smoking or alcohol," says Ms Hart, a 38-year-old publicity officer.

"He never explained what the consequences of high blood pressure could be. I went back two years ago and he just told me I should continue to be monitored. A year ago he put me on diuretics, [drugs that promote fluid loss by increasing urine production] but they didn't lower my blood pressure."

Caring for patients with hypertension is not always doctors' strongest suit. A study carried out at Charing Cross and Westminster Medical School three years ago revealed that a third of junior hospital doctors did not know how to take blood pressure properly.

"A lot of blood pressure measurement is very badly done, partly because medical students are only shown how to do it in their first year," maintains Professor Gareth Beevers, vice-president of the British Hypertension Society and a consultant general physician who runs an antenatal hypertension clinic at the City Hospital, Birmingham.

Mistakes are frequently made, he says. "Because it's a relatively simple procedure, familiarity breeds contempt. A significant minority of people are being treated for hypertension when their blood pressure is probably normal - and vice versa."

One in seven people in Britain has high blood pressure - and most of them feel perfectly well. There are usually no symptoms - the only way to find out if your blood pressure is creeping up is to have it checked regularly. High blood pressure puts a considerable strain on the heart and blood vessels and is dangerous: a 40-year-old with hypertension is 30 times more likely to have a stroke than someone with normal blood pressure.

"High blood pressure is very serious," says Dr Sylvia McLauchlan, director general of the Stroke Association. "The risk of a stroke increases if you're overweight, if you smoke and as you get older, and high blood pressure is an unnecessary additional risk. If you don't treat it, you will inevitably get trouble."

Some doctors prescribe drugs for hypertension on just one reading, which is often inaccurate because of "white coat hypertension", where blood pressure shoots up at the sight of a doctor wielding the arm cuff. It should be measured four times to get an accurate reading.

Blood pressure is the pressure exerted by the flow of blood through the main arteries and two levels of pressure are measured. The first, the systole, is when the heart contracts and the second, the diastole, is when it relaxes. Both are usually measuredwith a sphygmonamometer, a piece of equipment that has been largely unchanged for 90 years.

A cuff containing a rubber balloon is placed around the arm and inflated so tightly that it stops the blood from flowing. When the cuff is released the blood begins to pump, and at the height of the pressure wave it creates a thumping noise - the systolic pressure. As the pressure in the cuff falls the sound becomes muffled and disappears, and the blood flows steadily through the now open artery, giving the diastolic pressure. The device commonly used consists of a glass column filled with mercury or, in more modern instruments, a digital display.

Normal pressure in an adult is around 130/80 systolic over diastolic, expressed as millimetres of mercury (mm Hg). Blood pressure is considered to be high when the systolic is over 160 and the diastolic is consistently greater than 90. Deborah Hart's blood pressure was about 160/100.

For a diagnostic method that relies on the detection of sounds in the artery, and the observer's sharpness of hearing, taking blood pressure can be a hit and miss affair.

In a paper published in the Lancet last July, Professor Thomas Pickering, who runs the Hypertension Center at New York Hospital, wrote that even under ideal conditions blood pressure readings could be inaccurate by as much as 25mm of mercury.

In Britain, hospitals and general practices often have poorly maintained equipment, which is irregularly serviced. A service means checking that the tubing has not perished and that there is enough mercury in the machine. If the tubing is weak the mercury will drop too fast. "If the mercury drops too quickly many doctors just guess at the reading," says Michelle Beevers, president of the Nurses Hypertension Association, based at the City Hospital. "The diastolic sound should disappear completely, but some doctors take the reading from a muffled sound. Some use the wrong sized cuff - there are two adult sizes. The result is they can be up to 10mm out on a reading.

"It's worrying that people are on drugs for hypertension when there is nothing wrong with them. What is more worrying is that there are people who should be on drugs who aren't. They're the ones who are going to get strokes."

For those in need of treatment, there is a range of highly effective drugs on the market - beta blockers, calcium channel blockers (both lower blood pressure by reducing the contraction of heart muscle), diuretics, and ACE (angiotensin-converting-enzyme )

inhibitors, which reduce the constriction of blood vessels. In most people these drugs are well tolerated.

But some people who should be on anti-hypertensive drugs are refusing treatment. A recent survey by the Stroke Association revealed that some people who know they have hypertension fail to return to their GPs for treatment. Sylvia McLauchlan understands this ostrich-likeattitude.

"It's quite hard to keep on going back to the doctor, particularly when you've got something that doesn't make you feel ill. We do know that half the people with raised blood pressure go undetected, and only half of those who are detected have effective treatment."

Deborah Hart finally managed to control her blood pressure after holidaying in France where a doctor, worried by her condition, persuaded her to take up regular exercise. "During the summer in France I exercised every day and when I returned to Britain my blood pressure was normal.

I've just joined a gym and I eat healthily. So hopefully I've got it under control."

The Stroke Association, CHSA House, Whitecross Street, London, EC1Y 8JJ. Tel: 071 490 7999.

Voices
voices
Life and Style
Upright, everything’s all right (to a point): remaining on one’s feet has its health benefits – though in moderation
HealthIf sitting is bad for your health, what happens when you stay on your feet for a whole month?
Arts and Entertainment
Peter Griffin holds forth in The Simpsons Family Guy crossover episode
arts + ents
Sport
Laura Trott with her gold
Commonwealth GamesJust 48 hours earlier cyclist was under the care of a doctor
PROMOTED VIDEO
Life and Style
ebookA wonderful selection of salads, starters and mains featuring venison, grouse and other game
Arts and Entertainment
Gal Gadot as Wonder Woman
arts + entsFilmmaker posted a picture of Israeli actress Gal Gadot on Twitter
News
Bryan had a bracelet given to him by his late father stolen during the raid
people
Arts and Entertainment
Chris Pratt stars in Guardians of the Galaxy
arts + ents
Arts and Entertainment
Pedro Pascal gives a weird look at the camera in the blooper reel
arts + entsPrince Oberyn nearly sets himself on fire with a flaming torch
News
Danny Nickerson, 6, has received 15,000 cards and presents from well-wishers around the world
newsDanny loves to see his name on paper, so his mother put out a request for cards - it went viral
Sport
France striker Loic Remy
sportThe QPR striker flew to Boston earlier in the week to complete deal
News
Orville and Keith Harris. He covered up his condition by getting people to read out scripts to him
People
Arts and Entertainment
Zoe Saldana stars in this summer's big hope Guardians of the Galaxy
filmHollywood's summer blockbusters are no longer money-spinners
Arts and Entertainment
O'Shaughnessy pictured at the Unicorn Theatre in London
tvFiona O'Shaughnessy explains where she ends and her strange and wonderful character begins
Life and Style
Workers in Seattle are paid 100 times as much as workers in Bangladesh
fashionSeattle company lets customers create their own clothes, then click 'buy' and wait for delivery
Independent
Travel Shop
the manor
Up to 70% off luxury travel
on city breaks Find out more
santorini
Up to 70% off luxury travel
on chic beach resorts Find out more
sardina foodie
Up to 70% off luxury travel
on country retreats Find out more
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Data Analyst

    £30000 per annum: Ashdown Group: A highly reputable software house is looking ...

    Application Support Analyst / Junior SQL Server DBA

    £40000 - £45000 per annum: Ashdown Group: An established professional services...

    Commercial Litigation

    Highly Attractive Salary: Austen Lloyd: CITY - SENIOR COMMERCIAL LITIGATION SO...

    BI Developer - Sheffield - £35,000 ~ £40,000 DOE

    £35000 - £40000 per annum + competitive: Progressive Recruitment: My client is...

    Day In a Page

    A new Russian revolution: Cracks start to appear in Putin’s Kremlin power bloc

    A new Russian revolution

    Cracks start to appear in Putin’s Kremlin power bloc
    Eugene de Kock: Apartheid’s sadistic killer that his country cannot forgive

    Apartheid’s sadistic killer that his country cannot forgive

    The debate rages in South Africa over whether Eugene de Kock should ever be released from jail
    Standing my ground: If sitting is bad for your health, what happens when you stay on your feet for a whole month?

    Standing my ground

    If sitting is bad for your health, what happens when you stay on your feet for a whole month?
    Commonwealth Games 2014: Dai Greene prays for chance to rebuild after injury agony

    Greene prays for chance to rebuild after injury agony

    Welsh hurdler was World, European and Commonwealth champion, but then the injuries crept in
    Israel-Gaza conflict: Secret report helps Israelis to hide facts

    Patrick Cockburn: Secret report helps Israel to hide facts

    The slickness of Israel's spokesmen is rooted in directions set down by pollster Frank Luntz
    The man who dared to go on holiday

    The man who dared to go on holiday

    New York's mayor has taken a vacation - in a nation that has still to enforce paid leave, it caused quite a stir, reports Rupert Cornwell
    Best comedians: How the professionals go about their funny business, from Sarah Millican to Marcus Brigstocke

    Best comedians: How the professionals go about their funny business

    For all those wanting to know how stand-ups keep standing, here are some of the best moments
    The Guest List 2014: Forget the Man Booker longlist, Literary Editor Katy Guest offers her alternative picks

    The Guest List 2014

    Forget the Man Booker longlist, Literary Editor Katy Guest offers her alternative picks
    Jokes on Hollywood: 'With comedy film audiences shrinking, it’s time to move on'

    Jokes on Hollywood

    With comedy film audiences shrinking, it’s time to move on
    It's the best of British art... but not all is on display

    It's the best of British art... but not all is on display

    Voted for by the British public, the artworks on Art Everywhere posters may be the only place where they can be seen
    Critic claims 'I was the inspiration for Blanche DuBois'

    Critic claims 'I was the inspiration for Blanche DuBois'

    Blanche Marvin reveals how Tennessee Williams used her name and an off-the-cuff remark to create an iconic character
    Sometimes it's hard to be a literary novelist

    Sometimes it's hard to be a literary novelist

    Websites offering your ebooks for nothing is only the latest disrespect the modern writer is subjected to, says DJ Taylor
    Edinburgh Fringe 2014: The comedy highlights, from Bridget Christie to Jack Dee

    Edinburgh Fringe 2014

    The comedy highlights, from Bridget Christie to Jack Dee
    Dame Jenny Abramsky: 'We have to rethink. If not, museums and parks will close'

    Dame Jenny Abramsky: 'We have to rethink. If not, museums and parks will close'

    The woman stepping down as chair of the Heritage Lottery Fund is worried