- In most people who have high blood pressure, there are no warning signs
   (symptoms) to tell them that they have a high blood pressure until it’s too
    late.
-  This is why hypertension is often called the ‘silent killer’.
- There is only one way to find out if you have high blood pressure, and that is to visit
    your doctor, clinical sister or pharmacist and have your blood pressure
    measured

- The measurement of the blood pressure is made by PLACING A CUFF AROUND
   YOUR ARM, PUMPING IT UP and then RECORDING SOUNDS (turbulence) in the
   artery when RELEASING THE CUFF.
- It is a VERY RELIABLE INDIRECT MEASUREMENT of the pressure in your blood.
- This technique has been IN USE FOR OVER 100 YEARS. It has stood the test of
   time.

- An INCREASED PRESSURE in the blood circulating through the body will DAMAGE THE VESSELS (ARTERIES) AND HEART.
     + You may liken this to what you notice happens to a hose-pipe with time.
     + After a long period of time it eventually wears out and springs a few leaks
     + If the tap that you use runs water very fast (and hence generates a high
         pressure), the hose will wear out much faster than normal unless you use a
         hose that has a wide diameter (which keeps the pressure low).
- If the DIAMETER OF THE ARTERY IS NOT WIDE ENOUGH, HIGH PRESSURES will
   occur and damage the wall of the artery and the heart.
- The DAMAGED VESSELS AND HEART may CAUSE A STROKE (BRAIN ATTACK),
   HEART ATTACK, HEART FAILURE AND KIDNEY FAILURE as well as other less
   common diseases of vessels

- High blood pressure affects 1 in 5 adults and hence is a very common disease.
- You should look around you the next time you go shopping or visit a crowded place
   and realize that 1 in every 5 adults that you walk past has hypertension. You are not
  alone.
- You should also notice that many of the people you see are living happy and
   productive lives whilst living with a high blood pressure. This is thanks to modern
    medicine and research into hypertension.

High blood pressure is caused by a combination of factors which include your genetic background (you will often find that it runs in families) and a number of behaviors that define the way we live in modern urban societies.

We often can’t escape these behaviors.

The best example of how our lifestyles contribute to a high blood pressure is that in people who still live hunter-gatherer existences, hypertension is almost non-existent.

What do we do in the modern world that causes our blood pressure to increase?

In a nutshell we:
- live stressful lifestyles which we often can’t avoid,
- do too little exercise (often because of time constraints) which makes us fat,
- eat too much processed food which contains a lot of salt (sodium), and
- eat too much processed food which contains too many calories (sugar, starch and
   bad fat) which makes us fat.

We eat like we do because we live in a society that takes advantage of a consumer market which depends on “comfort eating”, usually in front of the television (which limits our time for exercise).

Age is also the strongest risk factor for hypertension.

Just as your hose-pipe wears out with age, your chances of getting hypertension also increase with age.

Hypertension is CAUSED BY:
 - genetic factors
- the unhealthy way we live
- aging

Although you CAN’T CHANGE YOUR GENES OR STOP GETTING OLD, you CAN CHANGE THE WAY IN WHICH YOU LIVE.

The good news is that the genetic and aging effects on blood pressure largely depend on the presence of the “unhealthy” lifestyle factors.
- CHANGE YOUR LIFESTYLE AND YOUR BLOOD PRESSURE WILL DROP.
- CHANGING YOUR LIFESTYLE ALONE HOWEVER, MAY NOT ELIMINATE YOUR
  HYPERTENSION as it is years of “unhealthy” living which increases blood pressure
  (the arteries change their structure over long periods of time), and hence it may take
   years of “healthy living” again to return your blood pressures to normal.

1.            LOSE WEIGHT USING DIET AND EXERCISE.
                Discuss the best method of weight reduction with your doctor or nurse.
  
 2.            DECREASE TOTAL SALT (SODIUM) INTAKE and do this in consultation
                with your doctor or nurse. 
                Besides table salt, high sodium levels are found in:
               •             packet soups, stock cubes, gravies, processed cheese, many
                             breakfast cereals, bread, salty snacks, tinned food, ham, bacon,
                             tongue, corned beef, and salami.
               •            To improve the taste of your food use lemon juice, herbs and spices
                            as alternative seasoning.  
 3.            LIMIT ALCOHOL INTAKE to a maximum of:
                •             2 standard drinks per day for men.
                •             1 standard drink per day for women and small men.
                               A standard drink is 25 ml spirits, 125 ml wine, 340 ml beer, 60 ml
                              sherry, or 25 ml liqueur.  

4.            CHANGE YOUR DIET to one:
                •             which is LOW IN TOTAL FAT.
                •             with HIGH INTAKE OF FRUIT AND VEGETABLES (5 portions per
                              day)
                •             containing regular use of LOW-FAT DAIRY PRODUCTS.
                •             with HIGH INTAKE OF HIGH-FIBRE WHOLE-GRAIN FOODS.
                •             containing FISH rather than red meat.
                •             containing PRODUCTS LOW IN SATURATED FAT.
                •             with SPARING use of sugar and sugar-containing foods. 

5.            AVOID intake of beverages with HIGH CAFFEINE levels, but the modest use
               (1 - 2 cups per day) of coffee will not increase BP.  

6.            START REGULAR MODERATE-INTENSITY EXERCISE for AT LEAST 30
                MINUTES on MOST DAYS OF THE WEEK.
               •             Moderate levels of exercise can be achieved by brisk walking.
               •             Patients with uncontrolled hypertension should embark on exercise
                             training only after evaluation and initiation of therapy. 

7.            STOP THE USE OF ALL TOBACCO PRODUCTS. Nicotine replacement
               therapy should be used for patients with hypertension while under medical
               supervision.

- Pills are NOT THE ONLY ANSWER to your management.
- If your BLOOD PRESSURE is higher than normal, but NOT DANGEROUSLY HIGH,
   your doctor or nurse may ask you to CHANGE YOUR LIFESTYLE and determine
   what this alone does to your blood pressure.
- However, this may NOT ALWAYS LOWER YOUR BLOOD PRESSURE TO NORMAL
  LEVELS and THEN YOU NEED PILLS to control your blood pressure.

·         You may be lucky and find that changing your lifestyle is all that you need to
          control your blood pressure.
·         If you are highly motivated and manage to completely change your “unhealthy
          lifestyle” this often happens, and then you should rejoice and shout to the
           heavens: “I am cured”.
 ·         However, often your blood pressure may be increased because of years of
          “unhealthy” living and then a change in your lifestyle isn’t going to be the only
           thing that you need.
·         Your doctor may then ask you to start taking pills to control it.
·         If this is the case, the pills are usually for life and are aimed at preventing your
          high blood pressure from causing a major cardiovascular problem (stroke, heart
          attack, heart failure, kidney failure).

 - ONE type of tablet will ALWAYS lower your blood pressure, but it will SELDOM
    control it to normal levels.
 - Nevertheless, to monitor for side effects, when doctors and clinical sisters start you
   on medication they will usually only start you on one type of medication.
 - When they next see you, if your blood pressure is still higher than it should be they
    will increase the dose or add another tablet rather than change your medication.
   They will keep increasing the dose and adding new types of tablets until your blood
   pressure is normal

 -  You should never see yourself as someone in whom the treatment does not work if
     you end up taking a lot of different types of tablets.
 - Although ONE type of tablet will always lower your blood pressure, it will seldom
   control it to normal levels.
 - Therefore more types of tablets may be necessary.
 -  All that counts is that the blood pressure ultimately reaches normal values, even if
   this means having to take a lot of tablets.
 - Obviously the higher your blood pressure is at the beginning, the more tablets you
   will end up having to take.

This rarely occurs, but it may take your doctor some time to find the right combination of types of tablets to lower your blood pressure to normal.

 - All of the tablets used to treat your high blood pressure do so by relaxing the
   muscles in the wall of your arteries.
 - This will increase the diameter of the arteries.
 - Just as when you use a hose-pipe with a wide diameter, the hose-pipe lasts longer
    because the pressure on the wall is reduced, if the arteries have a wide diameter
    this will also decrease your blood pressure and allow the walls of the arteries to last
    longer.  
 - In some instances you may be told that you are receiving “water tablets”.
 - These tablets will make you urinate a little bit more than normal and hence will
    reduce the amount of blood inside the artery.
 - Just as if you run less water through a hose-pipe the pressure inside the hose-pipe
   decreases (and hence not much water comes out the other end), so reducing the
   amount of blood inside an artery will also reduce the pressure in an artery.
-  “Water tablets” will also increase the diameter of an artery and hence lower the
   blood pressure in this way.  

 -  The successful medical treatment of high blood pressure usually means that once
    your doctor has started you on tablets, you will need to take the medication for the
    rest of your life.
 -   This is what will prevent you from having a stroke, heart attack, or developing heart
    failure or kidney failure.
 -  Because it takes years of “unhealthy” living to cause the increase in blood pressure
    to begin with, the tablets take years to reverse this.
 -  This does not mean that you should see yourself as being sick for your whole life.
 -  In fact if your blood pressure is normal on the tablets you should see yourself as
    perfectly healthy, able to do everything that others do, and able to live to a “ripe” old
    age.
 -  Phew!! Thank goodness for modern medicine.

 - The types of blood pressure tablets recommended by the experts today seldom
   cause side effects.
 - In fact blood pressure medications are some of the safest medicines in use today,
   often safer than medications you may purchase over the counter at pharmacies
   such as cough and cold medications.
 - If when starting your tablets you don’t feel well, you should tell your doctor,
   pharmacist or clinical sister who will quickly identify whether the problem is a side
   effect and stop the medication before it can cause permanent damage.
 - If you are worried ask your doctor to describe the possible side effects before you
   start the medication. The package inserts supplied with the tablets also list the
   possible side effects

 - If you are not being treated for a high blood pressure, even if the last time you had
   your blood pressure taken it was normal, as you get older it may increase.
 - Hence, all adults should have blood pressure checks once a year, especially if they
    have stressful occupations or a family history of hypertension.
 - Once you have been told that you have a high blood pressure you should have
    regular blood pressure checks as directed by your doctor or clinical sister.
 - If your blood pressure is only modestly raised, your doctor or sister will probably
   want to see you at 1 to 3 month intervals until your blood pressure is controlled.
 - If you have very severe hypertension your doctor will probably ask you to come
   along every 1-2 weeks until your blood pressure has stabilized.
 - Thereafter, you will need to see your doctor once a year or more frequently if you
  are elderly or if there are complications.

If you are being treated for other medical conditions, you should always tell your doctor OR pharmacist.
They can advise you on the safety of taking treatments for these conditions together with blood pressure tablets.
However, always remember that blood pressure medicines are some of the safest tablets in use today.

As a general rule, ask your doctor or pharmacist before taking any other medication.
It is nevertheless very important that you realize that many over the counter products can increase your blood pressure. Indeed, many medications for coughs and colds and stimulants which contain caffeine will increase your blood pressure.