If I could offer just one piece of medical advice to help people live longer and healthier lives, it would be this: know your blood pressure and keep it under control.
That guidance applies to everyone, but it is particularly important for women in their 40s and 50s as they approach and move through menopause.
The message is straightforward, but its impact can be enormous: have your blood pressure checked regularly and take action if it is too high.
Few measures offer a clearer warning of future heart attack or stroke risk. When blood repeatedly pushes too hard against artery walls, it places added strain on the heart and substantially raises the danger of a serious, potentially fatal cardiovascular event.
Most people recognise a blood pressure reading as two figures, measured in millimetres of mercury. The first records the pressure as the heart contracts, while the second measures the pressure between heartbeats. A reading below 120 over 80 is generally regarded as ideal.
What is less widely understood is that each additional 20 points above 120 can double the risk of a heart attack or stroke. Put simply, lowering high blood pressure by 20mm may cut that risk roughly in half — a trade-off many patients consider well worth making.
A recent British Medical Journal study highlighted the scale of the problem. It estimated that more than one in three adults in England has high blood pressure, while about 60 per cent of those affected — almost 10 million people — do not know it. In many cases, hypertension produces no warning signs until serious damage has occurred, earning it the name “silent killer.”
So which people are living with high blood pressure without being diagnosed?
A British Medical Journal study found that more than one in three adults in England has high blood pressure, yet around 60 per cent of those people — nearly 10 million adults — are unaware of it
In my experience, hypertension is most often identified in people with familiar risk factors. They may be men — despite the mistaken belief that high blood pressure is exclusively a men’s health issue — and may also be living with obesity, inactivity, smoking or excessive alcohol use. Others are already receiving care for high cholesterol, heart disease or kidney problems.
But many women in middle age do not fit that traditional profile and are therefore being overlooked. Some are also reluctant to believe anything has changed, telling me: “I was tested years ago and my blood pressure was fine.”
The important point is that women generally do have lower blood pressure than men — but that advantage typically lasts only until menopause.
After menopause, women’s blood pressure can rise sharply. By around age 70, it reaches levels comparable with men’s, and beyond that point women are more likely than men to have hypertension.
That steep later-life increase helps explain why women are ultimately more likely than men to die from cardiovascular disease.
The rise may happen gradually, driven by factors that can seem relatively minor on their own: gaining a little weight, drinking slightly more alcohol than recommended, living with persistent stress or regularly missing out on sleep.
The encouraging news is that high blood pressure is often treatable. Common medicines, including ACE inhibitors and calcium channel blockers, offer safe and effective options for many patients and are frequently inexpensive.
If monitoring blood pressure is one of the most effective ways to improve the odds of enjoying many additional healthy years, then the solution should be simple: make an appointment with your GP and have it measured.
Dr Tomas Bothe says high blood pressure is most often discovered in patients who have the clearest recognised risk factors
The answer is both yes and no. A single test can offer an immediate reading, but blood pressure is influenced by a range of factors, making the result more complicated than it may first appear.
The process is familiar: a cuff is wrapped around the upper arm and inflated, briefly restricting blood flow through an artery. As circulation resumes, the device measures the pressure created by the returning flow.
But has the cuff been calibrated in the past year? And is it on the correct arm (most cuffs are designed to fit on the left)?
Then there’s time: doctors and nurses are always in a hurry. Yet to conduct a half-way meaningful measurement, the patient needs to sit absolutely still for five minutes beforehand.
And for the patient, drinking coffee, smoking, sitting with their legs crossed, having a full bladder – these all bump up the reading. The well-known phenomenon of white coat hypertension also comes into play: some patients are so anxious about seeing the doctor that their blood pressure jumps. But the opposite can also be true: some patients are so comfortable with their doctor, their blood pressure drops!
Having just eaten a big meal can also produce a different reading, while recent exercise, heat or cold can also skew the results.
All of these factors can send the measurements haywire, which is no good: when you’re making crucial medical decisions for a patient, you need certainty.
To get around this, a patient might be asked to use a blood pressure monitor at home and take a series of measurements over the course of a week – two in the morning, two in the evening.
This is the system recommended by the NHS for home blood pressure monitoring, using a device ratified by the British Heart Foundation.
Sadly, half of patients don’t manage to complete the whole week of measurements, while others – this happens more often than you might imagine – simply make up the numbers.
Nonetheless, if it’s carried out accurately and conscientiously, week in week out, it will definitely produce useful measurements that can help a doctor work out if their patient is at risk of a deadly heart attack or stroke.
These days, however, technology has improved. There are now wearable devices that can measure your blood pressure at all times, which means patients don’t need to remember to check themselves (and reduces the risk of them making up the numbers).
As it happens, as well as being a medical doctor, blood pressure expert and physiologist, I’m also Chief Medical Officer for the firm Hilo by Aktiia, which makes a medical device called Hilo – a band that fits around the wrist to provide blood pressure monitoring. The initial cost is £200 – plus a £10 a month subscription after the first year.
Obviously, I believe this is the optimal system to provide continuous blood pressure monitoring which is effortless and accurate.
However, my central point remains this: there are plenty of effective treatments available for high blood pressure.
And because the damage caused by undiagnosed hypertension is compounded over the years, it’s important to do everything possible to catch it early.
So checking your blood pressure regularly really is the best way to aim for additional years of healthy life. Every year without a stroke or heart attack counts, for you and your loved ones. Don’t put it off.
