enough to increase the distance you can walk before calf pain starts by up to 30 per cent in three months (see Chapter 19).
A severely narrowed artery in the leg can be overcome with a bypass graft to open up an alternative circulatory route. If there are only one or two main sites of blockage, these can sometimes be overcome by passing a balloon catheter into the artery and expanding it at the site of blockage to locally dilate the vessel in that area.
Treatment of High Blood Pressure
Early diagnosis and treatment can control your blood pressure before it harms your health. You will have your blood pressure measured several times before your doctor will decide to prescribe any anti-hypertensive drugs. This is to make sure your blood pressure remains consistently high and is not just going up as a result of visiting the surgery. The aim of blood-pressure treatment is to reduce diastolic BP to below 85 mmHg and/or systolic BP to below 140 mmHg (thresholds may be different in some groups of people such as the very elderly). Sometimes two or even three different types of drug are needed to achieve this goal.
The aim of treatment is to lower your blood pressure gradually. Your doctor will start you off on a low dose of tablets to see how your blood pressure responds. If this is not enough, your dose may be increased, other drugs may be added in, or your medication may be completely changed. In some cases, more than one drug may be needed to achieve an acceptable BP. It may seem annoying to have to take one, two or even three different kinds of drugs when you feel perfectly well. But by prescribing treatment to keep your blood pressure within normal limits, your doctor is helping you to avoid the complications of uncontrolled hypertension – heart attack, stroke, peripheral vascular disease, kidney failure and even blindness.
It is important to take your blood pressure tablets regularly as prescribed. Some tablets only need only to be taken once a day, but others may need to be taken two or more times daily. This depends on how long each dose of medicine works in your body, and on how bad your blood pressure is.
When most forms of anti-hypertensive treatment are stopped, blood pressure only climbs up only slowly over several days or even weeks. With some forms of treatment, however, a rebound effect can occur so your blood pressure shoots back up.
Don’t stop taking your blood pressure treatment without first consulting your doctor. If you notice something that may be a side-effect, such as a rash, dizziness or sexual problems, always tell your doctor immediately so your dose can be altered or your treatment changed to one that suits you better.
Research shows that controlling hypertension can:
GUIDELINES FOR DOCTORS
Doctors have been given guidelines to help them decide which patients with high blood pressure need treatment and which don’t. Basically, if your BP is consistently found to be above a certain level, it is important to bring it down to normal to reduce your risk of future complications such as coronary heart disease, kidney failure, eye problems (hypertensive retinopathy) or stroke. If complications (target organ damage) are already in evidence, the management of your condition will be stepped up.
These guidelines are based on extensive studies and trials that confirm the health benefits of treatment. In some cases, where blood pressure is borderline, and research does not show clear benefits of treatment, your doctor will monitor you regularly to make sure your BP does not go up. In these cases, diet and lifestyle changes are often enough to control your BP so you don’t need to take drug treatment at all.
You might find it interesting to read the guidelines given to doctors. These are as follows:
Measurement
Baseline BP is established by taking two to three BP readings per visit (while the patient is sitting) on up to four occasions.
Aims of Treatment
To reduce diastolic BP to less than 85 mmHg and to reduce systolic BP to less than 140 mmHg, but the optimal target in people with diabetes or kidney disease is lower. In the elderly, the threshold for treatment is usually higher, as research only shows consistent benefits in treating a BP that is persistently raised to 160/90 or greater.
Target Organ Damage
This is defined as left ventricle of heart enlarged; angina; transient ischaemia attacks (TIAs); stroke; peripheral vascular disease; heart attack; kidney function impaired.
DRUGS USED TO TREAT HYPERTENSION
At present, six classes of drug are available to lower high blood pressure:
