How to beat the invisible killer

High blood pressure is common, mostly symptomless, and potentially lethal. Known as the silent killer, it is a direct cause of more than 100,000 strokes each year (two thirds of the total). It also increases the risk of heart disease, kidney problems and blindness. A quarter of adults have high blood pressure, and among those over 60 the proportion rises to half. But many people don't know they have it. An estimated 18 per cent of men and 13 per cent of women with high blood pressure are not receiving treatment that could protect them from an early death.

High blood pressure is not just a problem for older people. Blood pressure can rise at any age. One in 10 men aged 25-34 years have high blood pressure compared with approximately two in five men aged 35-44 years, according to the Blood Pressure Association. Fewer women are affected at a young age, but one in 10 women in their twenties are affected.

Has thinking about blood pressure changed?

Dramatically. The old view was that high blood pressure was necessary in older people in order to pump the blood through furred arteries, which had been narrowed by fatty deposits. In the 1930s there was huge controversy over whether it would be safe to attempt to lower blood pressure. When the first trials of blood pressure- lowering medicines were carried out in the 1960s, only patients with extreme raised pressure were entered into them, because of what were perceived to be the risks. The results showed rapidly and unequivocally that lowering the pressure saved lives.

Is the problem getting worse?

Yes – because we are an ageing population and our arteries get stiffer as we get older. Modern Western lifestyles are also making high blood pressure increasingly common. It is almost unknown in parts of the world such as rural Africa, where factors such as poor diet, lack of exercise, excess salt and too little fruit and vegetables don't apply. This is so even though Africans have an underlying genetic propensity to high blood pressure. The problem is now so widespread in the West, with half the over- sixties affected, that high blood pressure has come to represent normality.

What is high blood pressure?

As the heart pumps the blood around the body it exerts pressure on the artery walls. If you have high blood pressure, it means your heart is having to work harder to pump the blood. This can weaken the heart or damage the artery walls, resulting in a blockage or a rupture of the walls (haemorrhage). High blood pressure is defined as a sustained pressure of 140/90mm Hg or over.

What does that mean?

Blood pressure is measured in millimetres of mercury (Hg). Two measures are used, to record the maximum and minimum pressures during a single beat of the heart. The first figure – 140 – is called the systolic pressure, which is the maximum pressure as the heart contracts, pumping the blood round the body. The second figure – 90 – is the diastolic pressure, or the minimum pressure as the heart relaxes while the ventricles (chambers) of the heart fill with blood before it pumps again.

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