nhsmanagers.net | Briefing | 24 March 2018 Medicine for Managers Dr Paul Lambden BSc MB BS BDS FDSRCSEng MRCS LRCP DRCOG MHSM FRSM For most people a blood pressure of 135/85 millimetres of mercury or better is desirable. The ideal is 120/80. NICE defines high blood pressure as a figure in excess of 140/90. Blood pressure varies normally, higher during the day and when exercising and lower during the hours of sleep. When the blood pressure is persistently raised it is called hypertension and it affects about sixteen million people in the United Kingdom. The existence of abnormalities in the blood vessels has been known since the time of the Chinese Emperors, Hippocrates and Galen. Known as ‘hard pulse disease’ it was treated by bloodletting using a knife-like instrument or leeches. The first real understanding of the existence of blood pressure to achieve circulation was made by William Harvey (1578-1657) who explained the circulation of blood in his book “De motu cordis et sanguinis in animalibus” (The action of the heart and blood in animals). The first measurement of blood pressure was made in 1733 by the clergyman, Stephen Hales. Hypertension was first properly established with the invention of the sphygmomanometer blood pressure cuff in 1896. Blood pressure, elevated without a known cause, became known as essential hypertension in 1911 and physicians in the Mayo Clinic in America defined very high blood pressure in 1928 using the term malignant hypertension. In the period from the 1930s to the 1950s, the significance of raised blood pressure was not recognised and physicians of the time said that modest hypertension was not harmful and should not be treated. Subsequently, evidence accumulated that raised blood pressure that what was previously believed to be ‘benign hypertension’ was in fact harmful and, as the blood pressure rose, the risk of complications rose with it. The circulation is a closed system. The heart is the pump and the blood vessels form the pipework which circulates it. The arteries are thick walled, elastic vessels and blood within them is under pressure because the muscles exert force tending to Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use. Raised Blood Pressure – Does It Matter? Blood pressure is the force exerted by the blood on the walls of the arteries when the heart beats. When the heart beats, the blood forced from the heart as it contracts enters the arteries and the pressure in them rises. This pressure (systolic) is the highest pressure in the system. When the heart relaxes the pressure in the arteries falls and the lowest pressure is called the diastolic.
Transcript
nhsmanagers.net | Briefing | 24 March 2018
Medicine for Managers
Dr Paul Lambden BSc MB BS BDS FDSRCSEng MRCS LRCP DRCOG MHSM FRSM
For most people a blood pressure of 135/85 millimetres of mercury or better is desirable. The ideal is 120/80. NICE defines high blood pressure as a figure in excess of 140/90.
Blood pressure varies normally, higher during the day and when exercising and lower during the hours of sleep. When the blood pressure is persistently raised it is called hypertension and it affects about sixteen million people in the United Kingdom.
The existence of abnormalities in the blood vessels has been known since the time of the Chinese Emperors, Hippocrates and Galen. Known as ‘hard pulse disease’ it was treated by bloodletting using a knife-like instrument or leeches.
The first real understanding of the existence of blood pressure to achieve circulation was made by William Harvey (1578-1657) who explained the circulation of blood in his book “De motu cordis et sanguinis in animalibus” (The action of the heart and blood in animals). The first measurement of blood pressure was made in 1733 by the clergyman, Stephen Hales.
Hypertension was first properly established with the invention of the sphygmomanometer blood pressure cuff in 1896.
Blood pressure, elevated without a known cause, became known as essential hypertension in 1911 and physicians in the Mayo Clinic in America defined very high blood pressure in 1928 using the term malignant hypertension.
In the period from the 1930s to the 1950s, the significance of raised blood pressure was not recognised and physicians of the time said that modest hypertension was not harmful and should not be treated.
Subsequently, evidence accumulated that raised blood pressure that what was previously believed to be ‘benign hypertension’ was in fact harmful and, as the blood pressure rose, the risk of complications rose with it.
The circulation is a closed system. The heart is the pump and the blood vessels form the pipework which circulates it. The arteries are thick walled, elastic vessels and blood within them is under pressure because the muscles exert force tending to
Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.
Raised Blood Pressure – Does It Matter? Blood pressure is the force exerted by the blood on the walls of the arteries when the heart beats. When the heart beats, the blood forced from the heart as it contracts enters the arteries and the pressure in them rises. This pressure (systolic) is the highest pressure in the system. When the heart relaxes the pressure in the arteries falls and the lowest pressure is called the diastolic.
reduce the size of the blood vessel lumen. The pressure is dissipated as the blood reaches the capillaries and there is no pressure at all in the veins taking the blood back to the heart.
High blood pressure may exist for many years without any clue to its presence, because it produces no symptoms in the vast majority. However, the increased pressure in the system causes damage to the heart and blood vessels. In general, the risks of high blood pressure are
A few people with raised blood pressure may experience headaches, nose bleeds or breathlessness but these symptoms are non-specific and they don’t generally appear until it has reached a severe stage.
Overall one in four of people in England have high blood pressure and it is the third largest cause of premature death. High blood pressure is slowly progressive. 10% of people are hypertensive in their 30s. Most people are hypertensive in old age. For every ten people who are diagnosed with high blood pressure a further seven remain undiagnosed. The UK.Gov website emphasises the importance of treatment. A 10 mm reduction in blood pressure will result in:
• 17% reduction in coronary heart disease
• 27% reduction in stroke • 28% reduction in heart failure • 13% reduction in all cause mortality
No cause for hypertension is found in over 90% of patients and the raised pressure is
normally identified on routine blood pressure check. It is called essential hypertension. For the remaining 10% there are a variety of factors which may be responsible. They include factors such as kidney disease, thyroid disease, hormonal abnormalities or drugs such as the oral contraceptive pill. Obstructive sleep apnoea and illegal drugs such as cocaine and amphetamine may also cause the disorder.
The risk factors for raised blood pressure include
• Age. Risk increases with age. It is more commonly raised in young and middle-aged men and women are more likely to be hypertensive after age 65.
• Race. Blood pressure rises earlier and more commonly in black men. The common complications are also more common in black people.
• Family History. Hypertension runs in families
• Obesity increases the risk • Inactivity increases the risk • Alcohol and chronic overuse
increases the risk. • High salt diets • Smoking increases the risk • Stress is recognised as a major
culprit but it can be very difficult to avoid.
These days an increasing number of younger people are having a blood pressure check every 2-5 years.
Indeed, blood pressure machines are now available cheaply in pharmacies to enable individuals to do their own.
There may be some limitations with public machines and those bought in
Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.
shops because the wrong size of cuff may result in an inaccurate reading.
If raised blood pressure is suspected an ambulatory blood pressure monitor is used to establish whether the blood pressure is raised (and on occasion whether treatment is effective).
The technique eliminates any undue influences such as white coat syndrome (where blood pressure rises because it is being taken by the doctor).
The ambulatory monitor device consists of a cuff which is fitted round the upper arm connected to a small pump and monitoring device usually fitted to a waist belt.
The device automatically measures the blood pressure every 15-30 minutes during the day and every 30-60 minutes during the night for 24 hours. The patient should carry out all normal activities (except bathing or showering).
The device is removed after 24 hours and the results are analysed by the computer. The technique gives reliable blood pressure readings and the variances.
Reducing the Blood Pressure
Reduce the factors known to increase it!
1. Lower salt by reducing processed foods
2. Reduce weight
3. Increase exercise 4. Reduce alcohol 5. Stop smoking 6. Try to reduce stress 7. [Stop aging but this is
difficult]
Medication It may be necessary to take medication to reduce the blood pressure. There are a number of different classes of blood pressure lowering drugs:
a. Diuretics act by helping the body to remove water and salt. They make the patient pass more urine and are therefore taken in the morning. Examples are indapamide and bendroflumethiazide
b. Beta-blocking drugs. They have been around for half a century or more. They slow the heart by blocking adrenaline and they open blood vessels. Examples are atenolol and bisoprolol
c. ACE Inhibitors. Very popular since the early 1980s, they block the formation of angiotensin which is a hormone that raises blood pressure. They open blood vessels. Examples are ramipril, enalapril, lisinopril
d. ARBs These angiotensin receptor blockers act similarly to ACE inhibitors but in a different part of the system, for example losartan, candesartan and irbesartan
e. Calcium Channel Blockers such as amlodipine, felodipine and nifedipine open blood vessels by a direct action.
Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.
f. Alpha-blockers block the alpha effects of adrenaline, for example doxazosin
g. Other diuretics such as amiloride and spironolactone.
For those of us old enough to remember rows of hospital beds occupied by patients recovering from strokes, modern management of hypertension has made a major contribution to reducing those numbers.
However, any adult who has not had his or her blood pressure taken in the last year or two should do so.
Medicine for Managers articles are not intended to be a source of medical advice. Their purpose is to familiarise the non-medical reader about current key medical disorders. Any medical or medicinal products mentioned by name are examples only and should not be regarded as an endorsement of their use.
