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.