People are often alarmed when they are told that they have high blood pressure and wonder why on earth that’s the case. And it’s still a very common thing for people to go for an ordinary check, a routine check with the practice nurse or pre-operatively when they’re feeling a bit tense and they come back to see a doctor within a day or two highly alarmed that they’ve got this condition called hypertension and they wonder why it hasn’t been spotted before and why they in particular have been singled out to have it.

Now as I’ve explained already a large proportion of the general public are on treatment for blood pressure because we check it regularly in most people these days. And quite a proportion of people have it without knowing it because it doesn’t cause symptoms. However once we’ve detected it we have to keep an eye on it to see what the natural variation of it is. And that’s why we do repeat testing at a doctor’s surgery or often in people’s homes these days to get an idea of what the overall level is. But once we’ve done that and established that it is high and that it needs treatment we don’t really go looking very far for causes because it’s usually something that’s simply innate in people. Therefore if you’ve got a family member whos got high blood pressure you’re just that little bit more likely to develop it later in life.

There are a few causes which we can identify and that’s why we usually run off a few basic tests in people whose blood pressure has been found to be high. One of those is a hormone produced near the kidneys and so we check kidney function with one or two chemical tests. We also make sure that we’re not causing high blood pressure in any sense by, for instance, using the oral contraceptive pill or one of the few medications, other medications that can cause raised blood pressure. But having done these basic screens we then tend to label blood pressure as what they used to call essential. Now that’s a silly word really because it’s not essential in any normal sense but it simply means that it’s it the essence of people and that we don’t know the cause.

Having said that once we’ve established blood pressure as being slightly too high we can look at factors in the lifestyle which can help to reduce it. What everybody tends to think of with this label of hypertension is that you’re a hypertense person and therefore you’ve got to relax more. Well that’s a nice thought and if you can do it good luck. But it’s not likely to have a huge effect on your blood pressure. Probably more important are factors such as exercise and salt intake and in people who drink heavily that can also be a factor. So those are things that people can address right from the start of the diagnosis. Being overweight also tends to be associated with a higher blood pressure and so once you’ve had this warning shot as it were of your blood pressure being discovered to be high it’s a kind of prompt to you to look at all of your lifestyle and make these changes because they’re all going to be good for you whether they reduce your blood pressure or not.

I’m 73 now and I probably was smoking for 60 years, and for the last 40 years I was smoking 40 cigarettes a day. It was a habit more than wanting them. I’d do a book fair and I’d find myself with a cigarette in my hand and one in the ashtray. Prior to that I was a driving examiner which involved a lot of stress. I was illegitimate according to everybody who failed their test; and you got abused, you got threatened – you were uptight. There were times, and every examiner will tell you the same, when you’d literally walk in the office and just beat your head against a wall. If you’ve had a terrible drive which you’ve had to abandon and then walk back you are like this and you’ve have to cancel the next test – you couldn’t go out because you couldn’t give a fair decision to that person. So I think that was probably one of the causes of it, and stress. I think if I had to really think about it I’d say stress is the biggest cause of high blood pressure.

I think theres a stereotypical image of the person who is stressed all the time, well I think there are several stereotypical images’ theres the organisation person, the white collar person, the person who wears a suit and is always on the go and having to sit in meetings and be there all the time and take work home and so on. I know theres also the person who is not necessarily a sort of a white collar worker and is perceived as being laid back, as theres all sorts of things inside which may be causing stress. The person isn’t doing that kind of ostensibly pressurised work where they sit at meetings and so on, and have to meet those kinds of deadlines, but just doing ordinary day to day activities like working in a shop or working in a factory. They’re worried about not earning enough money and whether they could pay for their mortgage or even pay to go on holiday, or do this, or get presents for their family at Christmas, or whatever; those sorts of people will have high blood pressure too. Then you have this other thing where people might have high blood pressure simply because it might not be only stress related, it could be other things, genetic things which they don’t seem to fully understand and I think doctors are beginning to appreciate that. I know even with me, at work people were surprised when they learnt I was in hospital and I had high blood pressure, because they thought I was stress free. Well that may have been the case, or give that impression, as it may be something else in here that’s causing the high blood pressure, it’s hard to say.

My mother had low blood pressure and she used to faint quite a bit of the time. My eldest sister had high blood pressure and she also had angina. My other sister at that time didn’t have high blood pressure, but eventually she did and now shes got a pace maker. Then my younger sister had high blood pressure and she eventually was told after a long, long, long time that she had bunch branch block – I don’t know, but I think the blood goes only one way, but that is very tough for her. Shes 60 years old. Finally my brother as well, so it all followed one after the other.

My parents have high blood pressure, my brother has and my sister also, so it’s something that runs in the family.

My mother had just died aged 69 of her third heart attack; but maybe at least the last 8 years of her life, she was very conscious of keeping fit, and swimming, and eating properly and not having more than one glass of wine. But also, all her sisters and brothers had died – she lasted the longest – they all died in their mid-sixties of heart attacks. They all smoked in their earlier days – John Players- really strong tobacco’ because nobody said actually smoking causes lung cancer and isn’t good for your arteries and so on, and things like that. They probably ate too much fatty stuff and in those days people weren’t so health conscious.

One of my sisters has got high blood pressure too; this also brought the whole thing together for me. I think these hereditary things are hereditary things’ if your family are all prone to something then it’s most likely you’ll be prone to it too. But for me it is incredibly helpful to have that little bit of family history because then I know where my vulnerabilities lie, my hereditary vulnerabilities lie. I think that is helpful because if I didn’t know then I would probably just keep pigging out on massive meals, and wouldn’t worry about my weight and being healthy and all these things. I wouldn’t be attempting to make an effort myself.

My father did die of heart disease. He was 72 and he hadn’t been well for quite a long time. I can’t go back beyond that because my parents came from China in the 30s so in fact I only have immediate family in this country. So as far as I know theres no history in the family apart from my father having died perhaps slightly young. But you know I don’t have anything else to go on.

WifeEssential hypertension has always run in my mother’s family. My grandfather had it and various of her brothers and sisters have it and my mother has it. Well she was diagnosed probably about forty years ago with it.
Interesting enough, my sister who is almost 8 years younger than me, she seemed for a long time to escape, then suddenly last year her blood pressure was giving problems. I think she went on a course of drugs for a bit. But since then for whatever reason her blood pressure has returned to normal and she is off them again.

Well there wasn’t any family history of hypertension that I knew about at all. My father died at the age of 65 from a heart attack, and I have an older brother who had a heart attack when he was about 35 years old, so I have been rather conscious of family history of heart problems. But I think having said that, I really was quite busy putting it out of mind. I am the kind of doctor who really is fairly cynical about medicine up to a point and certainly I tend not to think about these things as they apply to myself.

We do have quite a strong family history of high blood pressure but I’d never thought of it as something that I might inherit. My father had his first stroke when he was 56 and I’ve subsequently found out that my grandfather had a stroke when he was 53. But I think we all thought that my father had a stroke at 56 because of pressure of work and stress and so on. And although my mother did vaguely mention that my grandfather had had a stroke at the same age, it never occurred to me that this could be a hereditary problem that I might get. Although as soon as my doctor said ‘Your blood pressure is up’, I said ‘Well I think we do have a family history of this.

I went through all these various blood pressure tests to find out whether it was a problem that I need medication for. During that time, I was having about 2 months off work, so when I went to see the GP and she said ‘There is a problem and you’re going to be on medication for the rest of your life,’ it did come as a real shock. I thought, and actually said to her, ‘I have absolutely no reason to have high blood pressure. I have no stress or worry in my life, I’m not even working, I’m having a lovely time at home,’ and she just said ‘I’m afraid it’s your genetics.

My sister has high blood pressure as well, which shes discovered. Shes older than me but shes discovered that shes got high blood pressure and my mother suffered before she died with high blood pressure. I think my mother’s was more due to worry and tension and things like that.

My mother died at the age of 57 from heart failure. Just suddenly, she had a heart attack one day. Very slim woman – never been fat in her life – always working – always energetic. So she had this had this heart attack and then a week later she died.

She only had one kidney and she had this congestive heart failure.

Then when I got talking at her funeral to all my aunts and uncles on her side in Scotland I found that she had 18 brothers and sisters of which only five are still alive and all the rest had died of heart failure. So it didn’t come as a surprise to me that there was a history of heart disease but rather than genetic I think it was due to poor nutrition and diet in childhood itself. My grandmother’s idea of diet was big lumps of fat thrown into a stew point of lentils and barley and potatoes. Potatoes with everything. So the diet nutritionally was very very poor. And you can imagine with 18 children there was probably not sufficient either.

I do feel that I am a sort of hypertensive character. A type ‘A. I am quite hyperactive and quite compulsive. I am a finisher. I like doing things. I do see myself very much as a type of person who is likely to get hypertension. I am a little bit obsessive – probably my friends would say I am very obsessive.

I am very emotional that’s true, I am easily stressed and I tend to worry. I tend to worry about nothing – that’s my composition, my physical and emotional status – I get very easily upset. Very silly things upset me, maybe it is something to do with high blood pressure. Theres one thing I must here mention; that all my worries, all my excitements and negative symptoms in that sense are very short lasting. Maybe it’s important, maybe not, but I never really loose a night’s sleep because of a worry. I would be worried that somebody is passing while I sleep – I have to get up and say ‘Who is this?’, but in a matter of a second I’m alright, no problem. So maybe that’s why my sons say to me, ‘Why haven’t you got any white hair?. Because I’m very peaceful inside.

I am rather hyperactive. I don’t sit down very often and if I do I usually am up in a few minutes. My son always says ‘Oh Mother for goodness sake sit down!. I must admit I thought that that would be the cause of it, me jumping up and down like a yo yo and rushing about going to shops and, because I don’t just walk there, I fly there, my feet just go fast. I’ve had to slow down now because I keep falling.

I would like to know more about high blood pressure, I’ve got a wonderful doctor – it isn’t that he wouldn’t tell me – he would if he had the time, but he hasn’t got the time and I know that.

When I’m in there I’m going to see him for some reason or other, I always end up by saying ‘Well I won’t keep you any longer’, and he says something like ‘That’s alright,’ I say ‘Well I don’t want to hold you up,’ ‘You’re not holding me up. But I think it is in my nature, I’ve got to be off again, I don’t want to hold anybody up. So, I don’t really know whether that causes it or not, I haven’t got a clue.

I have my own theory about why I got struck with it so early which is I had a period of fairly extreme anorexia in my early 20s. And I know that when the anorexia first began I had normal blood pressure because my mother began to worry about why I was suddenly getting thin and she took me to the doctor. I can remember my blood pressure, it was the first time I had ever had it taken and it was 110 on 80, so that was alright. Two or three years later I went for the medical and it had gone wrong and by then I was quite severely anorexic and I know that can damage cardiovascular systems. So that’s the only thing I’ve been able to think of. I’m not anorexic any more but you can do that sort of damage.