I’m Richard Lehman, a GP, who has been treating blood pressure as part of normal general practice for the last 30 years. High blood pressure is different from most of the other things that doctor’s treat in that it’s not an illness as such. it’s something that we detect that doesn’t usually cause any symptoms but that requires lifelong control if we are to avoid the long-term consequences of having high blood pressure over many years.

I think this is an important point to get over because the other word for high blood pressure is hypertension and a lot of people feel that once they’ve been labelled with hypertension they have been labelled as somebody who is abnormally tense or whos got something wrong with them. High blood pressure is not an illness. It is one of the things that can cause problems like heart attacks and strokes and kidney trouble and so we treat it as a matter of control over years, over decades, over the rest of a person’s life.

In all of us blood pressure varies from moment to moment from day to day and tends to rise as we get older. So that over the age of 65, for instance, a large proportion of the population need treatment for blood pressure. They don’t need it because it’s an abnormal state but because we want to keep them alive and well as long as possible.

So the definition of high blood pressure is an individual matter. There are overall guides to when to treat and when simply to monitor and when to simply advise lifestyle changes. But beyond a certain level treatment has to be with one or more of a range of different drugs that lower blood pressure and they have to be taken on a daily basis indefinitely. In some cases where there are other illnesses such as diabetes or a history of having had a stroke or a mini stroke we like to control blood pressure even more tightly than we do in people who haven’t had those conditions. So that again is an individual matter of tailoring treatment to the particular person.

Everybody should have their blood pressure checked regularly. In a person who is otherwise well that can be as seldom as every five years. In somebody who has got other conditions or in whom it’s borderline or who have many other risk factors in their lives then it’s probably better checked every year or more. And once you’re on treatment we tend to check blood pressure every six months or so once it’s stable. Of course it may need checking a lot more than that when we start treatment.

At the time I was 26 years old, I was pregnant with my daughter Gillian and I was told by the doctor that I had to go to bed. This was about 4 weeks before she was delivered and I couldn’t understand it at the time I must admit. However I did go to bed for 4 weeks before she was born. The doctor said he would sort it out afterwards.

When he came in to take my blood pressure he found that it had gone sky high and was very concerned. ‘If you don’t stay there [in bed],’ he said ‘you’ll have to go into hospital. So I stayed there and then she was born within 4 weeks after that but my blood pressure still stayed high.

So that was the first time I ever came in contact with blood pressure. On the two more occasions I was pregnant, again blood pressure had an affect. I had a miscarriage which I was told was caused by the blood pressure. And then I had a still birth when I was 38 weeks pregnant and I was told then that that was due to the blood pressure too. I just remember feeling very tired and lethargic and I can remember my heart beating very fast – it went a little bit mad on occasions. I just took the tablets and went every now and again to have the blood pressure checks which sometimes were okay and other times it was up and didn’t come down.

I was having my three yearly cervical smear and my blood pressure was taken at the same time as the smear. I think the nurse said it was higher than was quite right and I think at that point she made me another appointment to come back about the blood pressure. So, I went along and they put me in to see a different doctor who took my blood pressure and said ‘Oh yes this is too high. And he referred to this chart on the wall, and said ‘It’s not that it’s particularly desperate, but within the next 10 years you’ve got a between 20% and 30% chance of developing heart disease.

When I went for a check up for HRT, you have your blood pressure taken, and that’s when the doctor realised that it was up. I then went back to the GP for a second reading and then I actually did two 24 hour blood pressure tests at home. So the whole process probably took a couple of months to decide whether this was a problem and I needed to go on medication.

I went to visit my GP and, I think, just to have a general check up. I can’t remember what the issue was but I think perhaps I wasn’t feeling well or something like that. And, amongst other things, he took my blood pressure and noted that it was quite high, then asked me a series of questions. Then I was invited to come in again, I think the following week, and they checked my blood pressure a number of times. I was asked to attend the blood pressure clinic because it was obvious then that my blood pressure was much too high as far as they were concerned.

I was treated over a period of time, I went to the blood pressure clinic about once a fortnight and I was treated with a series of medications. It didn’t seem to affect the blood pressure as in it didn’t seem to lower it. So I was then referred to a consultant at the hospital. And over a period of about 7, 8 months the doctor seemed to be able to lower my blood pressure by trying out different medications and balancing them and experimenting with dosage, and so on, and it worked.

I think it was around 1995 in the summer. It all came about because at the time we were busy trying to buy a property, I needed the insurance, obviously. And up until then I felt fine, nothing at all actually. I suppose buying a new property makes you a bit hyper. I went along to the doctors, after the insurance was approved, to have a medical and he said ‘I think your blood pressure is a bit high.

I left the doctors, came away, filled the forms out, andabout 2 or 3 months later nothing happened. I went back to my GP, the practice, and the GP I saw previously wasn’t there. I saw another person and I said ‘Look I’ve been told that my pressure was high and I’m a bit concerned because nothing was actually done about it. He said ‘Okay well take it again’ and then he said ‘Oh, you are a bit high, I think were going to have look at some kind of medication. So I waited probably 3 months, just waiting for nothing at all. Then I thought,what would that mean to me, taking medication? I thought ‘Okay it’s just something that happens to I don’t know, I suppose a quarter of the population or something – it’s nothing, it’s no pain, it’s nothing, they’ll just put you on something.

Well, it started about 30 years ago I suppose. When I tried to apply for a life insurance they had to do the medical check-up and that’s when they discovered that I have high blood pressure.I forget what it was but obviously it was above normal. I was physically quite well and it was rather a surprise to find that when I applied for insurance they didn’t want to give it to me.

About a year and a half ago, I was cycling and had really bad pains in my arms. I went to my doctor and this is how it was discovered that I had high blood pressure. I think I had had it for about two years before this, slightly high blood pressure, that is. But I think my doctor had thought ‘well she seems so healthy in every other way, it’s probably just shes a bit nervous when shes in the surgery. So unless it went obviously dangerously high I think we hadn’t really worried about it.

I came out of the army in 1982, then I could run about 20 miles. Physically fit. So to me it came as an absolute shock to suddenly find myself with hypertension. And at the same time an x-ray showed that my heart was actually enlarged. I managed to get over that particular episode, and they tried different drugs while I was in hospital until eventually they got my blood pressure down to within the near normal range 13090.

The ECGs they did while I was in the hospital showed a slight flattening of the p waves but nothing else. The exercise tolerance test I passed absolutely fine. It was a normal ECG except for this just slight flattening. So therefore it was diagnosed as unspecific. They didn’t know why I had hypertension. My cholesterol levels were low, were very low and the triglyceride levels also were in normal range. So as for the blood chemistry there was no particular reason why I should have hypertension.

I thought my blood pressure being down just must be a fluke thing – something that is freaky and all that, because I didn’t feel bad. I felt absolutely fine. Full of energy, full of life. I just totally ignored what the doctors were saying.

I went and got another job and carried on working. But the nature of the job I had was travelling all over the country in a car, stopping at service stations, drinking cans of coke, Yorkie bars, pork pies, things like this. And before I realised it my weight had blossomed up to about 17 stone. And then I had another episode where I passed out, or was nearly passing out driving my car down the motorway. I managed to brake and pull in over the side where I slumped and obviously somebody must have spotted me because the next thing I knew the police were knocking and once again I was rushed to hospital. Blood pressure up, once again. This time it was about 240 over about 170, so they then said to my family that it was very doubtful if I would live the night.

Then in 92, I came here to London to work and I went to work in the British Museum as an internal security warden. Which was a very demanding job, where you had to be very fit. But by this time my blood pressure had gone down I thought to myself ‘I don’t need this tablet, come off it’ and of course I was very fit. Then one night I was walking along the roof of the British Museum supervising contractors who were working, when I tripped and damaged my ankle which seemed to be all right after a short while. And then when I had to go down some vertical ladders, when you had to turn round backwards, I put my foot on the first rung and had screeching pain. The shock of it made me let go and I fell backwards onto my head.

Two weeks after that I had epileptic fits and was admitted to a hospital. It was a nightmare. My blood pressure went up immediately. I told her about it and straight away I was put back onto the tablets again, back onto innovace. The diabetes had come back with vengeance. They had me on two drugs then, two diabetic drugs because it is weight related and late onset diabetes. And then the British Museum retired me because I had diabetes, hypertension and epilepsy.
Being at home, not being able to work again by order of the doctors, I then started to put weight on. I promptly went up to 16 stone. My blood pressure rapidly went up again. Today I am now on three different tablets for the hypertension.

I was doing a book fair and I had what I thought was indigestion. I got somebody to go out and get me some indigestion tablets, but they had no effect whatsoever. I went along to see a doctor next morning and he said ‘From the symptoms I think you’ve had a heart attack. I want you to go out to the hospital and have an ECG, a blood test and an xray. The results come back and nothing. He said ‘I’m not satisfied I’d like you to go to another hospital. I went there, saw the cardiologist, he asked various questions and he said ‘May we do an angiogram?’ which they did. I went into hospital, they did the angiogram and he said ‘You’ve got one blocked artery, you can either stay on tablets or have an angioplasty. I had the angioplasty. That covered 2 days roughly, I came out and had to go back about once a month to see the cardiologist.

That was when they realised the blood pressure was extremely high; it was running up around 190 over about 100. They tried various tablets and things, they couldn’t get it down, couldn’t find any reason so they asked me to go and see one of the professors there. He sorted out tablets for me and I’m fine. I can do 90% of what I’d done before except that I get extremely short of breath, but again that could have been from 40 years of smoking and that was smoking 40 cigarettes a day. But on reflection, thinking back 20 years, theres a couple of occasions when I was in restaurants, had a good meal, it was hot and I fainted. Thinking about it that could be high blood pressure, I don’t know.

I actually found out that I had high blood pressure completely coincidentally. It was about 10 years ago, I was lecturing in Blackpool to the Health Visitors Association and there was a huge great exhibition of medical equipment and all sorts of

things and there was this – I say now wretched- stand, because I really wish I hadn’t done this, but there was this stand where they had these automatic blood pressure measuring machines. Where the machine sort of pumps up your blood pressure and measures it. So I thought ‘oh well it’s fun I’ll just try this out’ And I tried it out and it was something absolutely appalling like 180 over 120.

And I couldn’t believe it. At first I was convinced that it was a machine that wasn’t working. So I tried a couple more times. I didn’t actually tell the people on the stand what it was, I kept it to myself and sort of rushed off with this knowledge that I obviously did have hypertension and I strongly objected to the fact of having the knowledge- – – I mean I would much rather not have known about it in a funny kind of way. There is a kind of dilemma in that. Once one does know about it one has to do something about it. Especially being a doctor. But I would rather not have found out. I think I would be able to live much more happily not having found out.

However, having found out, when I got back I went to see my General Practitioner and talked to him about it and he took my blood pressure again. And yes, there did seem to be a problem.

I had a number of alternatives, and I knew these alternatives. I could lose weight, I could try and give up salt, I could take lots of exercise and see if that had any effect on my blood pressure. So I did what I could only it wasn’t much when it came down to it.

I probably could have tried harder. It finally became obvious that I would need to go on tablets. My blood pressure had stayed up. I mean I think that at the best it was about say 160 over 110 or something and it was apparent from the medical literature that I had read and from what I knew that it probably would be a good idea if I actually accepted some treatment.