Nooooooooovember

[El Gordo]

Poor fellow; the more so, for when my father practised as a GP (he retired in the 70s), surviving a coronary was unusual. Now, death is rare.
I used to have an Excel template for recording BP, I think by the British Hypertension Society. Can't see it on their site anymore, but if anyone wants a copy, I still have one. You will find any number of tools, including some slightly frightening risk-predictors, and recommendations on monitors. The best thing anyone can do is stop smoking. I stopped on 15 August 1984.
I've been on a succession of anti-hypertensives, currently amlodipine. They all have side-effects, but even in my glummest moments, I realise they're better than being dead

Not sure if you're a subscriber to The Times, Tom, but my suspicions are that you may not be. This article is in today's edition:

http://www.thetimes.co.uk/tto/life/article3591005.ece

How to stop your blood pressure rising every time you see a white coat. You could get your own blood pressure monitor

Millions of people are taking unnecessary medication for high blood pressure, according to new research. About 12 million people in the UK are thought to have high blood pressure (hypertension) but studies show that doctors and nurses have been getting the diagnosis wrong in as many as 1-in-4 cases. Might you be one of them?

The confusion is largely because of “white coat hypertension”. Put simply, lots of people’s blood pressure rises whenever a doctor or nurse measures it. So, if you base the diagnosis on a series of artificially inflated readings in a clinic using the 140/90mmHg standard cut-off, you risk falsely labelling a quarter of your patients and starting them on treatment they don’t require.

And, to compound the problem, even when the diagnosis is correct, there is no convincing evidence that treating the most common, milder form of high blood pressure confers any benefit. A review by the respected Cochrane Hypertension Group, published in the summer, found no convincing evidence that treating people with readings under 160/100mmHg protected them against heart attack, stroke or an early death. (Those with pre-existing heart disease were excluded from the review and may well benefit).

White coat hypertension is now widely accepted to be a much bigger problem than initially thought and the National Institute for Health and Clinical Excellence (NICE) has taken this into consideration in its new guidance on how to measure blood pressure. Anyone with clinic readings averaging more than 140/90mmHg should now be offered ambulatory blood pressure monitoring — an automated machine which takes at least 14 readings throughout the day to get around the white coat effect.

But this requires specialist equipment and access to it is still restricted, so many GPs are turning to home blood pressure monitoring as a simpler, albeit cruder alternative. Surgeries either loan out machines, or ask patients to use their own, approved, model. The upper threshold for “normal” in the clinic setting remains 140/90, but NICE advises a lower cut-off for ambulatory and home readings of 135/85. So, if you were diagnosed as having high blood pressure without being offered either of these options — and most people will not have been — you could talk to your GP or nurse about reconsidering the diagnosis, particularly if your readings are borderline (though never stop treatment without seeking medical advice first).

The next conundrum is what to do if you are confirmed as having high blood pressure, but you fall into the milder end of the spectrum (140/90 — 160/100) where pills may not confer any benefit. There is no doubt that high blood pressure is bad for you — each 2mmHg rise in the upper figure is associated with a 10 per cent increase in the risk of dying from a stroke. What the Cochrane review questions is whether pills are the answer.

Critics have pointed out that the review contained research using older medicines that have now fallen out of favour, and that we really need a bigger study using the latest drugs to be sure that pills don’t protect people with mildly raised blood pressure. But there is a growing realisation that, until we have such evidence, we should think twice before starting medication, and concentrate much more on proven interventions such as stopping smoking, increasing exercise levels and dietary changes (particularly the low-salt and/or Mediterranean approach).

It is a lot to take in if you are one of the millions of people on treatment for high blood pressure. There is no need to rush to see your doctor or practice nurse — it is probably safer to be on unnecessary medication than to miss out on treatment you need — but you should discuss any concerns you have at your next review, and ask them to spell out what you can be doing to help yourself. At the very least, think seriously about investing in your own blood pressure monitor.

• Monitor your blood pressure at home
  
• Only use an approved home monitor (see the list at bloodpressureuk.org) that uses a cuff on the upper arm. Prices vary, but you don’t need to buy anything too fancy — most doctors use types that can be bought for less than £60.
  
• Take three sets of readings across the day. Sit down quietly for five minutes and then check your blood pressure twice, recording the lower of the two readings.
  If your average is above 135/85 then you should talk to your doctor or practice nurse. If it is below 135/85 then put the monitor away for at least six months.