I am a consultant cardiologist working in a busy city hospital. In my clinical work, I see many patients who have high blood pressure. Patients with high blood pressure can end up in hospital in two different ways. First, they may be admitted when they are acutely unwell with a heart attack, heart failure or stroke. This can be due to undiagnosed high blood pressure (hypertension) or because they have hypertension that needs to be controlled better. These patients can be extremely ill, especially if they have had a severe stroke, which is the most disabling complication of high blood pressure.
Second, patients with complex hypertension are referred to my clinic by their GPs. The GPs may have found it difficult to select the correct drug combination to control these patients’ blood pressure or the patients could be intolerant to medications. Sometimes young patients also need specialist investigations, just in case there is an underlying condition that is causing their high blood pressure.
Not everyone with high blood pressure ends up in hospital. For every person I see, there are many more people who have high blood pressure that goes undetected for months or even years. As high blood pressure seldom causes symptoms, an estimated 35 per cent of people with high blood pressure are unaware that they have it. This is why it’s important to get your blood pressure checked regularly – and it is even more important if you belong to a group of people who are at high risk of having high blood pressure; for example, those people who have a parent or other close relative with high blood pressure, or people who are heavy smokers, overweight or take no exercise.
Of course, hypertension is not restricted to those people and can affect anybody, which is all the more reason to make sure that your blood pressure is routinely monitored. If you discover that you do have high blood pressure, it is vital that your GP takes action to treat it to prevent the distressing complications it can cause. High blood pressure is one of the most preventable conditions, but it is also very treatable, with effective drug and lifestyle therapies that can prevent complications. However, to successfully manage high blood pressure, you need to take responsibility for it and be involved in your own treatment. This is not always understood or accepted, as those people diagnosed with high blood pressure may not feel that they are not ill as such, and may be reluctant to accept medical treatment. High blood pressure is a ‘silent’ condition and may not cause any symptoms for many years, so people need support and guidance from healthcare professionals to explain why it needs to be treated. Untreated high blood pressure can result in severe organ damage, including kidney failure, stroke or heart disease. Many people may not want to take medications that can have potential side effects, when they actually feel well. This means that some people do not take their medications regularly and find it difficult to persist with the healthy lifestyle changes recommended by their GPs. Persuading people to comply with treatment is a major challenge in the management of hypertension.
The aim of this book is to summarise, for the public, the current medical knowledge on the diagnosis and treatment of high blood pressure. I will discuss what high blood pressure means, how it is detected, what the risks associated with hypertension are, and best treatment options. Hopefully, by increasing public awareness of the problems and treatment of high blood pressure, we can reduce the substantial health problems that this condition causes.