by Dr. Geoffrey B. Frankson

Hypertension is a serious cause for concern.  The higher an individual’s average blood pressure readings the greater the risk of stroke, heart disease, kidney disease, eye problems, etc.  When one in three adults can expect to have rising blood pressure a national programme of control is required.  “Treatment” is only part of the solution, and, at a national level, tablets are in any case less effective than preventative lifestyle changes in reducing the incidence of complications.

So where do we begin?  First of all by discarding the notion of high blood pressure as a sickness.  By and large, people with moderately raised blood pressure readings are not sick; they do not feel sick as a result of the high readings (although many are convinced that they do), and they are in no immediate danger of suffering from anything untoward unless there are other serious contributing factors.

What must be of primary concern is rising blood pressure readings over time.  People must know their average blood pressure in their twenties and follow that average over the years.  An individual, aged thirty, with blood pressure readings of 130/85 is at higher risk of developing complications than an individual, aged thirty, with readings of 120/80.  He must not wait until “the doctor says” he has hypertension to respond - which, in any case, is not likely to happen until the doctor finds readings higher than 140/90.

Average readings are what count.  A single blood pressure reading of 150/90 is utterly meaningless.  Many people experience a rise in blood pressure as soon as they walk into a doctor’s office; blood pressure readings are often different in the morning and afternoon, and can vary considerably from hour to hour.  Blood pressure has to be measured on several occasions in order to know what is really going on.

Hypertension is a condition that has to be managed - by the individual himself, not the doctor.  Blood pressure must be controlled by careful attention to several factors, and such control can only be established over time.  An individual who walks into a doctor’s office; is told that his pressure is “high”; is given some tablets and simply takes those tablets until they run out, has done nothing about his condition.  In fact, the tablets may not even be necessary.  Such an approach is a waste of time and money that may even make things worse by inducing a feeling of dependency and other negative effects of labelling.

(Labelling is what makes people describe themselves as "suffering" from high blood pressure. In a classic study of the effects of labelling, one group of workers with mildly elevated blood pressure readings was told that they had high blood pressure; another comparable group was not told and neither was treated.  Over the next year, the former took twice as much sick leave as the latter.)

The proper management of hypertension means that the individual himself takes responsibility for his progress.  He monitors his blood pressure at home; he stops smoking if he is a smoker; he loses weight if he is overweight; he takes much more exercise; he learns to manage stress, and he cuts down on his salt consumption.  But perhaps most important, he shows an interest in his overall health, recognising that high blood pressure is just one of several interrelated risk factors that can ultimately lead to very serious health problems.  Accordingly he checks his cholesterol level, his blood sugar, his body composition, his cardiovascular fitness, and he takes stock of his eating, drinking and other lifestyle factors.

In other words, he strives to be a healthier person with his blood pressure under control - which means that it is maintained at an acceptable level.  With such a "wellness" approach, many people can maintain their blood pressure at an acceptable level without tablets, but even if they do have to take medication to keep the pressure down, they do so with a clear understanding of what the medication is for and the certain knowledge that it is necessary.

By no stretch of the imagination can such an individual be said to be "suffering" from high blood pressure.  Indeed, such an individual will most likely live a longer and healthier life than an individual without hypertension who is fat, unfit and generally unhealthy (and who will no doubt have been told by his doctor that "nothing is wrong" with him).