Heart Conditions — Risk Factors
High Blood
Pressure
Hypertension is one of the most significant and preventable causes of heart attack and stroke worldwide — yet it typically causes no symptoms until serious damage has already occurred. Early detection and treatment are essential.
The Silent Risk Factor
Why Blood Pressure Matters
Hypertension is a major cause of death worldwide and one of the most treatable. It is called the silent killer because it produces no warning symptoms while steadily damaging arteries, the heart, kidneys, and brain.
Elevated blood pressure damages arteries through atherosclerosis — the accumulation of cholesterol and calcium that narrows vessels. When plaque eventually ruptures, the resulting clot can trigger a heart attack or stroke.
Long-term hypertension also causes the heart muscle to thicken, reducing pumping efficiency and leading to breathlessness and ankle swelling — the signs of early heart failure. It raises the risk of atrial fibrillation and silently damages the sensitive arteries supplying the kidneys, potentially leading to renal failure requiring dialysis.
Reading Your Results
Understanding the Numbers
Blood pressure is expressed as two numbers — both are important and both require treatment when persistently elevated.
Systolic (Upper Number)
The pressure in your arteries when the heart contracts and pumps blood out. This reflects the peak force on artery walls with each heartbeat.
Diastolic (Lower Number)
The pressure when the heart relaxes and refills between beats. Diastolic hypertension causes similar long-term damage and warrants treatment.
Hypertension is diagnosed at 140/90 mmHg or above in a clinical setting, or 135/85 mmHg or above on ambulatory (home) monitoring. Younger patients are ideally treated to below 130/80 mmHg.
Why Does It Develop?
Causes of Hypertension
In the majority of patients there is no single identifiable cause — this is called essential or primary hypertension, and genetic factors play a significant role. In a minority, a specific underlying cause can be found and corrected.
Secondary Causes
In patients under 30 it is important to exclude thyroid disorders, cortisol abnormalities (Cushing's syndrome), kidney disease, or narrowing of the aorta — all of which raise blood pressure and can be corrected.
Contributing Factors
High salt intake, excessive alcohol, shift work with altered hormone levels, workplace stress, and certain medications including NSAIDs and oral contraceptives all raise blood pressure over time.
Genetic & Essential
The most common type — no single cause is identified. A family history of hypertension significantly increases lifetime risk, and blood pressure tends to rise with age as artery walls stiffen.
How It Is Confirmed
Accurate Diagnosis
A single elevated reading in a clinic does not confirm hypertension. White-coat hypertension — artificially elevated readings caused by the anxiety of a medical appointment — is common and can lead to unnecessary treatment.
For home monitoring, take three readings in succession; ignore the first and record the average of the remaining two. Repeat at least twice daily for seven days. This gives a far more accurate picture than a single clinic measurement.
The gold standard is a 24-hour ambulatory blood pressure monitor (ABPM) — a small device worn on the arm that records 40–50 readings automatically throughout the day and night, revealing patterns that a single reading cannot capture.
Investigations may also include an ECG, echocardiogram, urine and blood tests to assess kidney function, and an eye examination to check for hypertensive changes in retinal vessels.
First-Line Approach
Lifestyle Modifications
Lifestyle change is the foundation of blood pressure management. Even modest improvements can reduce readings by amounts comparable to a single medication.
Exercise
10–20 minutes of moderate daily activity encourages blood vessels to remain pliable and promotes the development of new muscle capillaries, reducing peripheral resistance and blood pressure over time.
Weight Management
A sustained reduction of 10 kg in body weight can lower blood pressure by 5–10 mmHg — equivalent to the effect of a single antihypertensive medication.
Salt Reduction
Aim for under 5g of salt daily. Avoid adding table salt and reduce processed foods, which contain the majority of hidden dietary sodium. Even small reductions have meaningful effects.
Diet Quality
Increase fresh vegetables and reduce red meat. Replace saturated fats with unsaturated options — avocados, olive oil, and oily fish such as salmon and mackerel are particularly beneficial for vascular health.
Alcohol
Alcohol raises blood pressure directly. Recommended limits are no more than 3–4 units daily for men and 2–3 for women, with regular alcohol-free days each week.
Stress Management
Workplace stress and shift work alter cortisol levels and sustain blood pressure elevation. Mindfulness, adequate sleep, and structured recovery time all contribute to cardiovascular health.
When Medications Are Needed
Blood Pressure Medications
Medications are prescribed when lifestyle changes prove insufficient — particularly when there is evidence of kidney or heart damage — or when readings are significantly elevated. Patients with a prior heart attack or stroke may need immediate medication alongside lifestyle changes.
Treatment targets are below 140/90 mmHg in most patients, and ideally below 130/80 mmHg in younger patients. Combination therapy using two or more medications at lower doses is often more effective and better tolerated than maximising a single drug.
- ACE Inhibitors / ARBs — ramipril, perindopril, candesartan. First-line in most patients, particularly those with diabetes or kidney disease.
- Calcium Channel Blockers — amlodipine, felodipine. Relax artery walls. Common first-line choice, especially in older patients.
- Thiazide Diuretics — indapamide, bendroflumethiazide. Reduce fluid volume. Often added as a third agent.
- Beta-Blockers — bisoprolol, carvedilol. Used where there is also a heart rate or heart failure indication.
- Aldosterone Antagonists — spironolactone. Useful in resistant hypertension not controlled by first-line agents.
Related Conditions
Further Reading
Concerned about your blood pressure?
Dr Nijjer offers comprehensive hypertension assessment and management at 68 Harley Street, including ambulatory blood pressure monitoring, echocardiography, and tailored treatment plans.