Some 18 million people — a third of the UK’s adult population — have a blood pressure (BP) higher than their doctors would like. Two thirds of over-65s have a blood pressure high enough for doctors to think that it needs treatment.

When researchers checked people without any symptoms, they found that a third of those with high blood pressure — also known as hypertension — were not aware that they had it.

A third of those in whom high blood pressure has been diagnosed are still not being treated — and even if they are, the treatment is not always adequate. Some therefore remain at increased risk of a stroke, heart attack, heart failure or kidney disease. These patients are not being treated with the best available medication in the right doses.

Our reader’s question is important for all those with a blood pressure over 140/90, whatever their age. Blood pressure should be kept even lower if there are other causes of increased cardiovascular risk. The question is also timely, as it coincides with the publication of new guidelines on high blood pressure drawn up by the National Institute for Health and Clinical Excellence (NICE), the government organisation that largely determines British prescribing habits, after consultation with the British Hypertension Society (BHS). The other relevant body is the Blood Pressure Association (BPA), which is concerned with communicating with the public.

Professor Graham MacGregor, chairman of the BPA, says that the guidelines will result in much better control of a patient’s blood pressure. Those who follow them will be less likely to have a stroke, heart attack, heart failure or renal failure, and also less likely to suffer such adverse side-effects as a higher incidence of diabetes and raised cholesterol levels.

Persistent high blood pressure (the reader’s 190/100 is too high if it is a constant finding) always needs treatment. Many doctors who confirm its presence recommend that a patient should buy, beg or borrow a home blood pressure machine that allows them to take their BP at times of day when they are relaxed. It is important to follow the machines’ instructions carefully and record all readings along with the times of day at which they were taken.

The NICE/BHS recommendations are complex and depend on age, race and the patient’s response. A white patient under 55 is advised to start by taking an ACE inhibitor or angiotensin receptor blocker. If they are over 55 or black they should begin with a calcium channel blocker or a diuretic. If the initial treatment fails to control BP adequately, both groups should change their medication either to an ACE inhibitor or angiotensin receptor blocker plus a calcium channel blocker, or to an ACE inhibitor or angiotensin receptor blocker and a diuretic.

If the BP remains unacceptably high, they move to step three and have an ACE inhibitor or angiotensin receptor blocker plus a calcium channel blocker, plus a diuretic. If it is still too high, step four is to increase the dose of diuretics or to prescribe an alpha or beta blocker.

The new guidelines are of special importance to those currently taking beta blockers, though on no account should anyone give up taking their beta blockers before they have discussed a different regime with their doctor. Beta blockers will in any event remain included in the treatment of choice for many patients who have angina or heart failure, or who have had a heart attack. They may also be prescribed for women of childbearing age with high BP.

Does it all matter? Yes. Blood pressure is one of the greatest threats to health in the developed world. Controlling it will save more than 50,000 deaths from stroke and 100,000 from heart disease a year in the UK. The need for treatment is not lessened because a patient is young or old, male or female, or because of their general health.

Patients with high BP don’t only need medication. They should restrict their weight (above all, their waistline), take brisk but not violent exercise, stop smoking, reduce their daily salt intake to under 6g and avoid too much alcohol.

For written information on the new guidelines, telephone the BPA on 0870 7700600; or visit www.bpassoc.org.uk

ASK DR STUTTAFORD

Send Dr Thomas Stuttaford your questions on blood pressure and hypertension here

Send your questions on other topics to drstuttaford@thetimes.co.uk or to times2, The Times, 1 Pennington Street, London E98 1TT. Please include the following: the symptoms (and how long they have been present), the person’s age, sex and marital status. Dr Stuttaford’s replies cannot apply to individual cases and should be taken in a general context.

Readers are always advised to consult their GP, as only he/she will be fully conversant with the background. We regret that Dr Stuttaford cannot enter into personal correspondence.