Know Your Numbers! Week: Rising to the Challenge of High Blood Pressure | Imperial News

Professor of Clinical Pharmacology and Therapeutics, Peter Sebbah, explains the importance of blood pressure self-management and the latest research.

It's well known that high blood pressure increases the risk of heart attack and stroke, the two leading causes of death and disability worldwide. Despite the importance of managing your blood pressure, many people in the UK are unaware of their blood pressure levels or don't receive the treatment they need.

“When patients take control of their own blood pressure management, their blood pressure is better controlled.”

To address this,Let's learn numbers! Week' will take place from September 2-8 and aims to encourage individuals to get their blood pressure checked.

we Professor Peter SebbahProfessor of Clinical Pharmacology and Therapeutics at Imperial National Heart and Lung Institute (NHLI)Find out the risks associated with high blood pressure and what the latest research reveals.

What causes elevated blood pressure and what are the associated risks?

The heart pumps blood through a system of different tubes and blood vessels. Increased pressure in the system is usually caused by vascular disease and is primarily linked to an increased long-term risk of heart attack and stroke. That's why we're particularly concerned about high blood pressure. Heart attacks and strokes constitute one of the biggest causes of death and disability worldwide.

Traditionally, high systolic blood pressure (upper limit 140 mm Hg or higher) indicates high risk and requires treatment. Diastolic blood pressure (lower limit 90 mm Hg or higher) is also abnormal. In recent years, there has been increasing evidence that in some high-risk patients, intervention should be considered at slightly lower levels of pressure, around 130 mm Hg systolic blood pressure.

What factors influence an individual's blood pressure levels, and what measures can be taken to manage these factors?

Blood pressure levels result from a complex interaction of genetic and environmental factors. Blood pressure is known to run in families, and genetic studies have shown that blood pressure is likely around 50% heritable. However, unlike traditional genetic diseases, there are over 100 genes involved in blood pressure, each with a small effect, making it difficult to pinpoint a specific genetic cause except in a very small number of cases.

Environmental factors play an important role in how these genes are expressed. Even if you have “bad” genes, if you eliminate environmental influences, your blood pressure may not increase. Important environmental factors include diet, especially the higher-than-necessary salt intake in the Western diet. Being overweight, excessive alcohol consumption, lack of exercise, and environmental stressors can all contribute to elevated blood pressure.

When seeing a patient with a systolic blood pressure of 160, not only do we consider drug treatment, but we also need to develop a lifestyle plan, which includes diet, regular exercise, reducing alcohol and salt intake, and dealing with environmental stressors, but from a practical point of view, this is often very difficult.

How often should you check your blood pressure?

It depends on your blood pressure level. If you're 50 and your blood pressure is 120/80, you probably won't need to have it checked again for a year. But if your blood pressure is 150, regardless of age, you should check it again in a few weeks to see if it's real. If your blood pressure remains high, you need treatment. Once you start treatment, you should check your blood pressure at home at least once every month or two. You can extend the interval to two or three months or more, depending on how well your blood pressure is controlled.

While traditional blood pressure measurements are important in assessing cardiovascular health, blood pressure variability is also emerging as an important factor. Can you explain what blood pressure variability is and why it is important?

Traditionally, concerns about blood pressure were based on measurements taken in a clinic, but more recently, systolic and diastolic blood pressure have been measured once at home, and based on that measurement, a doctor can determine whether your blood pressure is high, normal, or low.

But we've studied blood pressure variability. There are two types of blood pressure variability. The first is short-term variability, where blood pressure fluctuates throughout the 24-hour period. The higher this variability, the higher the long-term risk of heart attack or stroke. The second is long-term variability, which is measured over weeks, months, or even years. Again, the higher the variability, the higher the risk of heart attack or stroke. Long-term variability is more important for prognosis, but it has not yet been fully incorporated into assessment and treatment guidelines.

Our Recent ASCOT trial articlesA study published in the European Heart Journal found that hypertensive patients who are on treatment and whose blood pressure appears to be well controlled, but who have high blood pressure variability, are still at very high risk. This has never been demonstrated before, and our data, based on 20 years of follow-up and 3,000 cardiovascular events, are very convincing. Currently, these patients are being ignored, but this needs to change, and we want to highlight this in the next guidelines.

There is also evidence to suggest that certain medications are more effective than others at reducing blood pressure fluctuations, and recommendations are currently being made based on this evidence.

How can individuals track and manage fluctuations in their blood pressure?

That's a great question. We're currently investigating it. Most of the published data on blood pressure variability is based on measurements made in clinics over weeks or months. From a practical standpoint, if a patient asks about blood pressure variability, or if their doctor says they need to measure it, they can't wait weeks or months for an answer.

We are exploring alternative ways to assess blood pressure variability. One study underway at NHLI is looking at home blood pressure recording. In this study, we ask patients to measure their blood pressure every morning and evening for a week, and we can calculate blood pressure variability from these measurements. When we compare these home measurements to the variability obtained from a traditional series of clinic measurements, we have seen a striking correlation so far. This suggests that home monitoring may be a viable way to assess blood pressure variability.

Why do you think we need blood pressure awareness campaigns?

We have known for some time that high blood pressure is a common cause of premature death and disability. In most cases, high blood pressure is easily treatable. Everyone should monitor their blood pressure, and if their blood pressure is high they should be re-examined and re-see their doctor. People who know they have high blood pressure should receive treatment, and if their blood pressure is not well controlled their treatment should be adjusted.

Patients are much better able to control their blood pressure when they take control of it themselves. There is a great need for education programs that shift blood pressure management from the doctor to the patient.