I’m healthy so why’s my blood pressure high?
Every week Dr Martin Scurr, a top GP, answers your questions
CAN you explain why I have high blood pressure? I am 66, a size ten, don’t smoke, rarely drink and exercise regularly. I take 4mg of perindopril, but it isn’t effective enough. However, instead of looking for a reason as to why my blood pressure is high, my medication is going to be increased. Why aren’t more checks done about the cause when a patient is otherwise healthy?
Eleanor Gamble, by email.
GI vEN your situation, I can s ee why you are puzzled, and there are probably many readers in a similar position. Most people who have high blood pressure have no symptoms, so taking the one, two or even three medications they’ve been prescribed needs commitment, not least as they’ll have to do this long term and the pills may have sideeffects, such as gout or ankle swelling.
The obvious question, as you have put it, is why this has happened to you. What is needed is a careful explanation, though this isn’t always forthcoming, so this short tutorial may help.
A blood pressure r eading consists of two figures — the first i s the systolic pressure, the pressure in the arteries when the heart contracts. A normal reading is 120 or lower.
The second figure, the diastolic pressure, is when the heart relaxes — this should be 80 or lower.
If the reading is consistently above 140 over 90, this is known as hypertension. The diagnosis should not be made until blood pressure has been measured after three to six visits over some weeks. This is because it can be affected by f actors such as physical activity, and varies from minute to minute.
This i s why we sometimes arrange for ‘ ambulatory’ blood pressure monitoring, using an automatic system to record measurements every 30 minutes or so, day and night, as the patient goes about daily life.
Once diagnosed, it’s important to distinguish between primary, or ‘essential’ hypertension, where there is no identifiable cause, and secondary hypertension.
This is when there is an identifiable cause, such as kidney disease, oral contraceptives and some medicines (eg, non-steroid antiinflammatory drugs), hormonal disorders i ncluding t hyroid problems and obstructive sleep apnoea (a night-time breathing disorder that affects some overweight people).
Secondary hypertension is less common, but it must be excluded with blood tests and other investigations, not least because it is often ‘curable’. But 90 per cent of hypertension cases are unexplained, though we know there are many risk factors such as obesity, lack of physical activity, genetics (such as hypertension in one or both parents), a high salt intake and vitamin D deficiency.
Age is another factor — as we get older, blood pressure rises.
The reason it’s so important for hypertension to be detected, and treated effectively, is that the adverse effects are so serious.
It’s a major risk factor for heart disease, more so than smoking, high cholesterol or diabetes. It’s also the most important risk factor for stroke and kidney disease.
SO, WHEN a patient has been di agnosed with hypertension, i t’s vital we check for heart or kidney damage.
We also need to identify any potential curable causes; this mainly involves blood tests.
Once all this is done, the patient must be started on a suitable long-term treatment. This will i nclude r educing t heir salt intake, losing weight and regular exercise. If the systolic reading is consistently above 140 (150 for those over 60) and the diastolic is over 90, then it means starting on an anti-hypertensive drug.
The greater the reduction in pressure, the greater the reduction in heart attack or stroke risk.
You are taking 4mg of perindopril a day. This is an ACE inhibitor, which helps blood vessels relax. If this is ineffective, the dose can be increased up to 8mg.
Many patients need a second or even third drug to regulate their blood pressure, and if that’s the case, so be it.
Nothing matters more than achieving a steady level of suitably lowered blood pressure for the long term — you must work on it with your doctor. FOR 18 months I have suffered from cholinergic urticaria, which means I don’t sweat, but instead get a painful rash, affecting my back, chest, arms and ankles, which stops me doing sport.
The rash also appears for psychological reasons, such as pressure and embarrassment.
I’ve tried everything from rash creams to acupuncture and antihistamines prescribed by my GP, but nothing has worked. Are there any other treatments?
Mantas Stonkus, Medway, Kent. THE word urticaria is derived from the Latin word for stinging nettle, urtica, and is the term for a skin condition with different types and causes. It describes what looks like nettle rash, which is fiercely itchy.
Cholinergic urticaria is one of the so-called physical urticarias, when the rash or skin wheals are triggered by physical factors, such as pressure on the skin, f or instance from a watch.
It can also be triggered by a change in body temperature — referred to as generalised heat urticaria — caused by the patient’s emotional state, exercise or a hot bath or shower.
THE rash starts with an eruption of multiple tiny wheals typically on the body and neck; these start to itch and tingle.
The wheals can be anything from pinprick size to an area bigger than your hand, usually resolving within hours, though some people suffer from i t chronically for months or even years.
Antihistamines in high doses can work, and I’d suggest asking your GP i f you were given cetirizine at double the normal dose, ie, 10mg twice daily.
Another effective drug is the antihistamine ketotifen — the anti-allergy dose is 1mg, but this type of urticaria may need 4mg or more daily, though this can cause unacceptable sleepiness.
The steroid danazol and the monoclonal antibody drug, omalizumab, have also been shown to be useful. These would be prescribed under the guidance of a dermatologist or allergy expert. Your GP may agree to refer you.
The condition usually abates — 70 per cent of those affected have recovered by the tenth year. It’s not entirely good news, but reason for optimism.