Hypertension (how to lower)

What is blood pressure?

Blood pressure is the pressure of your blood pushing on the walls of your arteries as your heart pumps blood around your body. It is measured and described with 2 numbers (for example, 130/90mmHg).

The pressure is measured in mmHg, which is short for ‘millimetres of mercury’.

• Systolic pressure is the higher number and is the pressure of your heart contracting and forcing blood through your arteries.
• Diastolic pressure is the lower number and is the pressure in the arteries between heart beats (when the heart is resting and filling with blood).

Blood pressure measurements are commonly referred to as the systolic pressure ‘over’ the diastolic pressure. For example, 120/80mmHg would be referred to as ‘120 over 80’.

How do I know if I have high blood pressure (hypertension)?

High blood pressure, which is also called hypertension, doesn’t usually cause symptoms. So you won’t know if you have high blood pressure without it being measured by a health professional.

Some people may experience headaches, nosebleeds or feel short of breath, but these symptoms usually only occur when blood pressure is dangerously high.

Untreated high blood pressure raises your risk of heart disease, stroke and chronic kidney disease.

Around 1 in 3 Australians have been diagnosed with hypertension.

How is blood pressure measured?

Sphygmomanometer

Your doctor can measure your blood pressure using an instrument called a sphygmomanometer. An inflatable cuff wraps around your upper arm and is connected to a device that measures the blood pressure.

When the cuff is inflated until it feels tight, the pressure temporarily stops blood flow to the arm. As the cuff is slowly deflated blood flow is restored. Two measurements are taken at different points to give the systolic and diastolic pressure readings.

24-hour ambulatory monitoring

Blood pressure can also be measured using 24-hour ambulatory monitoring. You wear a cuff and device for 24 hours and your blood pressure is recorded through the day and night.

This is useful for people who have what’s referred to as, ‘white-coat hypertension’, where their blood pressure rises in the doctor’s surgery but is lower when measured in other situations. This type of monitoring can also show what happens to a person’s blood pressure when they are asleep.

Home blood pressure monitoring

Your doctor may recommend you take measurements yourself while at home. This may help them understand how your blood pressure changes throughout the day or how it’s responding to treatment.

What is considered high blood pressure (hypertension)?

Blood pressure changes naturally throughout the day. This depends on many factors, including whether you are sitting, standing, exercising or sleeping, and upon how much fluid is in your body.

High blood pressure (hypertension) is when a person’s blood pressure is persistently higher than it should be: usually 140/90mmHg or higher. Your doctor will need to take several measurements at different times before they can diagnose high blood pressure.

The decision to treat high blood pressure doesn’t just depend on your measurements; it also depends on your other risk factors for heart disease and blood vessel disease.

The Australian guidelines for classifying blood pressure ranges are:

How often should I have my blood pressure checked?

It’s recommended that Australian adults have their blood pressure checked by their doctor at least every 2 years. Some people may be advised to have more frequent checks — for example, people who have been diagnosed with high blood pressure.

People with diabetes should have their blood pressure checked at least every 6 months if it’s normal and every 3 months if they have high blood pressure.

All Australians aged 45 and over — and 30 and over for those of Aboriginal or Torres Strait Islander descent — are eligible for a regular, 20-minute heart health check with their GP or nurse. This checks your blood pressure, cholesterol and blood sugar levels. Your health professional will be able to assess your risk of having a heart attack or stroke in the next 5 years.

Heart health checks are covered by Medicare and free at practices that bulk bill this service.

What risks are increased by high blood pressure (hypertension)?

High blood pressure increases your risk of heart disease, stroke and chronic kidney disease. If you have diabetes, high blood pressure also puts you at higher risk of complications such as nerve and eye damage.

How can I lower my blood pressure?

High blood pressure can be treated through lifestyle changes and medicines. Everyone with high blood pressure, regardless of whether they’re on medication, should follow the lifestyle recommendations (see below). Some people will find lifestyle improvements mean they don’t need blood pressure medicines or they can take a lower dosage.

These are the Australian recommendations for lifestyle changes to lower blood pressure. If you are an older Australian or have a chronic condition (for example, arthritis), your doctor will tell you which lifestyle changes are suitable for you.

Do regular physical activity

Regular aerobic exercise reduces blood pressure. The reductions are greater for people who start with higher blood pressure. Even relatively small increases in physical activity have been shown to lower blood pressure.

• • People aged 18-64 years should do a total of 2.5 to 5 hours of moderate-intensity activity or 1.25 to 2.5 hours of vigorous activity every week. You can achieve this in shorter periods of activity. Moderate-intensity activity includes brisk walking, golf, swimming and mowing the lawn. Vigorous activity includes jogging, aerobics, soccer, netball or fast cycling.

• • People aged 18-64 years should also do muscle strengthening (or resistance) exercises at least 2 days per week, such as squats, lunges, pull-ups, push-ups, lifting weights, carrying things or digging. When doing resistance exercises, it’s important to breathe normally and not hold your breath since this raises blood pressure.

• People aged 65 and older should aim for some physical activity every week — preferably 30 minutes of moderate intensity on most days. Any activity is better than none, and you can gradually build up to the target total.

If you experience any chest pain, palpitations or unexpected breathlessness during exercise, stop the activity and seek medical advice.

Maintain a healthy weight

If you are overweight, even a modest reduction in weight can reduce blood pressure. For example, losing 5 kilograms has been shown to reduce systolic blood pressure by around 7mmHg.

• Keep your body mass index (BMI) in the healthy weight range.
• Your waist circumference should be less than 94 centimetres (cm) for men, less than 90cm for Asian men, and less than 80cm for women.

Follow a healthy diet

A healthy diet with a variety of nutritious foods, in line with the Australian Dietary Guidelines, will help keep blood pressure under control — as well as your cholesterol and weight.

• Eat 5 serves of vegetables and 2 serves of fruit every day.
• Limit your fat intake to 20 to 35% of your total energy intake. Consume healthy unsaturated fats instead of saturated fats.
• Reduce your salt intake to fewer than 4 grams per day (equivalent to 1600 milligrams per day of sodium) if you have high blood pressure. This is less than one teaspoon of salt. Salt contains sodium, which is linked to high blood pressure.

Quit smoking and limit your alcohol intake

Not smoking has been shown to reduce blood pressure and the risk of heart disease, diabetes and stroke. The benefits of quitting smoking start immediately.

Drinking more than 1 standard drink per day for women, and 2 for men, increases the risk of developing high blood pressure. You can read more about how alcohol affects your health here.

Which medicines are prescribed for high blood pressure (hypertension)?

Some people will find that lifestyle changes alone won’t be enough to control their blood pressure and so they’ll need to take medicines. Often, 2 types of medicines that work in different ways will be needed; sometimes more than 2 are necessary.

Blood pressure medicines (known as anti-hypertensives) are typically taken every day. Many people will need to take them for the rest of their lives. The most commonly used blood pressure medicines are ACE inhibitors, angiotensin-receptor blockers, beta blockers, diuretics and calcium channel blockers.

Your doctor will choose the most appropriate medicine for you based on your blood pressure measurements, your overall risk of heart and blood vessel disease, and any other medical conditions you have or medicines that you take. Your doctor may set a target blood pressure.

Your doctor will probably start you on a low dosage of one medicine and review your progress a few weeks later. If you experience any side effects, tell your doctor straight away.