High blood pressure (hypertension)

Blood pressure is a measure of the force that your heart uses to pump blood around your body. It is measured in millimetres of mercury (mmHg). Your reading will be given as 2 figures:

• systolic pressure – the pressure when your heart pushes blood out
• diastolic pressure – the pressure when your heart rests between beats

An ideal blood pressure is between 90/60mmHg and 120/80mmHg. Your blood pressure is low if it is less than 90/60mmHg and high if it is above 140/90mmHg.

With diabetes, you have high blood pressure if your reading is 140/80mmHg or higher (or an average of 135/75mmHg at home). If you have diabetes, the normal guidelines about blood pressure are different because of the way that the risks of diabetes and blood pressure combine together. If you’re younger or if you have complications, there is an additional long-term benefit from getting your blood pressure below 130/80 in order to avoid the damage that high blood pressure can cause.

 

A stethoscope, pump, arm cuff and dial are often used, but sensors and digital displays can also measure blood pressure. 

Your blood pressure is measured in millimetres of mercury (mmHg) and two figures are given:  Systolic pressure, which is the pressure when your heart pushes blood out.

Diastolic pressure, which is the pressure when your heart rests between beats.
So a reading of 140/90mmHg means you have a systolic pressure of 140mmHg and a diastolic pressure of 90mmHg.

Checking your blood pressure is high over time

Blood pressure can change throughout the day because of how we are feeling, so if you’re feeling stressed, it could be higher.

If you have a high reading, you may be asked to take some readings over a period of 24 hours, to see if it stays high during that whole time. This can be done using either a home blood pressure monitor or wearing a 24-hour monitor. This test is called 24-hour or ambulatory blood pressure monitoring (ABPM).

High blood pressure is one of several factors that increases your risk of developing type 2 diabetes. Other risk factors include family history, age, ethnicity and weight. If you have hypertension and are concerned about developing type two diabetes you can check your risk here.

If your risk is high, there is online support available on the Preventing Diabetes website. Patients who register will be able to see a personalised healthcare dashboard, displaying their latest blood results. The dashboard will offer advice on what is good, improving or getting worse in terms of health and prevention of type 2 diabetes.

For people with hypertension who are already living with diabetes, you can find support on our Know Diabetes website, which is already helping thousands of residents across North West London.  

Several medications help control high blood pressure, with many people taking a combination of different ones.

The medication you need depends on your age and ethnicity, but as a guide: If you’re aged under-55, which medication you take depends on your age. Your healthcare team can discuss this with you. This medication will reduce blood pressure by relaxing your blood vessels.

If you’re 55 or older, or of African or Caribbean origin and any age, you'll usually be offered a calcium channel blocker. These reduce blood pressure by widening your blood vessels.

You may need to always take blood pressure medication – but if your blood pressure stays under control for several years, you may be able to cut back or stop treatment. Most people don't have any side effects from these medications, but your GP will advise you on this.

Additional medicines to control blood pressure may be used, such as diuretics or beta blockers also called water pills.

Beta-blockers, which make your heart beat more slowly to reduce blood pressure, are not widely used because other medications give better results.

Making changes to your diet can often reduce blood pressure in just a few weeks.

Salt intake 

Eating too much salt may raise your blood pressure and increase your risk of developing heart and circulatory diseases.

There are small changes you can make to cut down the amount of salt you eat. Over time, this will help to keep your heart healthy.

What is salt and what is sodium?

When we use salt to season our food, we use table salt. Table salt is also called sodium chloride. When you see sodium on food labels, it’s just another way of talking about the amount of salt in the food.

Some sodium in our diet is good because it helps our kidneys to control the amount of water in our blood. If we eat too much sodium, water is pulled back into our bloodstream. The more water in our blood vessels, the higher our blood pressure gets.

How much salt should I eat per day?

The recommended daily salt intake for adults is less than 6 grams of salt per day. 6 grams of salt is about one level teaspoon.

Children should eat less salt than adults. The recommended daily intake of salt for babies and children depends on their age.

Some food labels call salt, sodium instead. Salt and sodium are measured slightly differently. The recommended daily sodium intake for adults is less than 2.5g per day.

The recommended daily intake of salt (or sodium) includes the amount already added it ready-made and processed foods, as well as the salt you add when you cook and eat.

How do I know how much salt I’m eating?

The labels on your food will usually have a nutritional information section. This section will show you how much of each nutrient is in the food, like the amount of salt. To see how much salt is in the packaged food, you can look at the ‘amount per serving’.

Some food labels have a traffic light system to help you see if the food has a low, medium or high amount of salt in it. If you reduce the amount of food you eat with medium (amber) and high (red) levels of salt, it will help you reduce your risk of developing high blood pressure. 

What foods are high in salt and sodium?

A lot of the food we eat already has salt in it. In fact, around three quarters of the salt we eat on a daily basis has already been added to our food before we buy it.

Most people know that microwave meals, takeaways and snacks like crisps are high in salt. You might be surprised to know a lot of other foods are also high in salt such as:

•    cheese
•    breakfast cereals
•    canned soups
•    bread, pastries and pizzas
•    biscuits, cookies and cakes
•    processed meats – sausages, bacon and ham
•    sauces – gravy, ketchup, mustard, brown sauce and soy sauce.

The amount of salt will vary between different brands and varieties. Check your food labels before you buy to help you choose healthier options.

It might feel tricky to have tasty food and watch how much salt you’re having. There are other ways to add flavour to food other than salt. Many people add flavour to their food by using:

•    chilli
•    lemon juice
•    black pepper
•    fresh and dried herbs
•    fresh and dried spices.
•    Reducing how much salt you eat can make you feel less thirsty, less dehydrated and have less headaches.

What foods are low in salt and sodium?

Even if the food we eat doesn’t taste salty, it might still be high in salt. But there are many foods that are naturally low in salt and sodium. You can reduce the number of salty foods you eat by swapping to less salty options. Trying new recipes and seasonings can also help you make your meals exciting and satisfying.

Are other types of salt healthier?
No, other types of salt still effect your blood pressure in the same way table salt does. They include:

•    pink salt
•    black salt
•    rock salt
•    crystal salt
•    salt flakes.

These types of salts are usually less refined (less processed) than table salt. But their amount of sodium and nutrients are similar to table salt. They can still put you at risk of developing heart and circulatory diseases.

Some supermarkets sell low salt alternatives like LoSalt and Saxa So-Low, or their own brands. These salt substitutes have less sodium than normal salt. They can help you reduce your sodium intake, but they won’t help you kick the habit of eating salty or ready-made foods. The low salt alternative brands usually contain potassium. 

High levels of potassium are not recommended for people with existing health conditions. If you have an existing health condition, you may want to talk to your doctor before using a salt substitute.

 

Balanced diet

A healthy diet can help reduce your risk of developing coronary heart disease and stop you gaining weight, reducing your risk of diabetes and high blood pressure.

It can also help lower your cholesterol levels and reduce your risk of some cancers. Even if you already have a heart condition, a healthy diet can benefit your heart.

We recognise this may be a worrying time for lots of people and we know that people tend turn to food as a way of coping with stress or other emotions. This is common, but when you’re feeling down it’s even more important to fuel your body and mind with nutritious, feel-good food. This isn’t always the easiest or most attractive option, but it will make you feel much better in the long run. 

The best way to understand it is to think of foods in food groups.
Try to eat:

•    plenty of fruit and vegetables
•    plenty of starchy foods such as bread, rice, potatoes and pasta. Choose wholegrain whenever you can
•    some milk and dairy products
•    some meat, fish, eggs, beans and other non-dairy sources of protein
•    only a small amount of foods and drinks high in fats and/or sugar.
•    Choose options that are lower in fat, salt and sugar.

Fruit and vegetables

A well-balanced diet should include at least 5 portions of fruit and veg a day. Try to vary the types of fruit and veg you eat.

They can be fresh, frozen, dried or tinned. Pure unsweetened fruit juice, pulses and beans count as a portion, but they only make up a maximum of one of your five a day, however much you eat in one day.

Fats

To help look after your heart health it is important to make sure you choose the right type of fats.

So to help keep your heart healthy:

• Replace saturated fats with small amounts of mono and polyunsaturated fats
• Cut down on foods containing trans fats
• It's also important to remember that all fats and oils are high in calories, so even the unsaturated fats should only be used in small amounts.

Saturated fat

Too much saturated fat can increase the amount of cholesterol in the blood, which can increase the risk of developing coronary heart disease.

Unsaturated fats

Unsaturated fats, which can be monounsaturated fats (for example olive oil, rapeseed oil, almonds, unsalted cashews and avocado) or polyunsaturated fats (including sunflower oil and vegetable oil, walnuts, sunflower seeds and oily fish) are a healthier choice.

Trans fats

Another type of fat, known as trans-fat, can also raise the amount of cholesterol in the blood.

Physical activity can help reduce your risk of heart and circulatory disease. It can also help you control your weight, reduce blood pressure and cholesterol and improve your mental health – helping you to look and feel great.

Working out at home is on the rise! A great first step to moving more, which will help you manage your diabetes. Find out how to get fit at home, for free.

Many people are turning to home workouts because you can fit in your exercise when it suits you, it’s mostly free and it’s so easy to find something you like online or via a fitness app.

Being more active at home can have a positive effect on your blood pressure, it’s well reported that moving more gives us the feel-good factor and more energy as we become fitter.

9 ways to get more active

1. Start small - Try breaking down your exercise into short sessions throughout the day and build up from there. You could start by taking a 30 minute walk every day. Or why not try our 10 minute workout? You can do it from the comfort of your own living room.
2. Be realistic about your goals - Set yourself realistic goals that are specific and achievable. For example, set a goal to do a short walk outside every day or try our 10-minute workout (see above) which can be done indoors.
3. Make exercise part of your day - Plan a time to do some physical activity that fits in with the rest of your day and try keeping an activity diary to help monitor your progress and success. You could walk or cycle instead of driving. If you miss a day, don't worry - just make sure you start again the next day.
4. Keep moving - Remember, everyday activities count, so look out for opportunities to be active during the day while you're in or outdoors.
5. You don't have to go it alone - Involve friends and family by going for walks with them, or join an exercise class together to make activities more fun, sociable and enjoyable.
6. Make sure you get plenty of variety - Make a list of enjoyable activities you can do such as dancing and yoga, and place them in a jar. Pick a different activity to do each week. By varying your activities, you are less likely to get bored and lose interest.
7. Set reminders where you can see them - Prompt yourself to be more physically active by setting reminders. Put Post-it notes on the fridge door or by the kettle, or set daily reminders on your phone.
8. Keep an eye on your progress - You may have a phone or watch that can count the number of steps you walk each day. 
9. Reward yourself - Recognise when you achieve your goals. Think of things that you could reward yourself with, like a copy of your favourite magazine, a new pair of trainers or a massage.

The British Heart Foundation video below says you don't need fancy gym gear or a lot of space to get active– just a few minutes and a positive attitude. Read our safe not scared page for tips on how to stay safe when exercising.

Click on some workouts you can try at home: BHF home-workout video: YouTube

Drinking more than the recommended amount of alcohol can have a harmful effect on your heart and general health.

This is a stressful and scary time for many people, and the temptation to drink alcohol may be strong during this period. For your health, it's important to try to stay within the recommended guidelines for alcohol consumption.

Alcohol can cause abnormal heart rhythms, high blood pressure, damage to your heart muscle and other diseases such as stroke, liver problems and some cancers.

Alcohol is also high in calories so it can lead to weight gain.  It also lowers your inhibitions which might mean you find it harder to stick to your healthy eating plans when you have been drinking.

If you are trying to lose weight, cut down on alcohol.

How much can I drink?

If you drink alcohol it is important to keep within the guidelines:

Men and women should not drink more than 14 units of alcohol each week. You should have several alcohol-free days each week. These guidelines apply whether you drink regularly, or only occasionally.

Most people don’t drink alcohol every day - but if you do, you should aim to have some days off. Just make sure you don’t increase the amount you drink on the other days. If you do drink as much as 14 units per week, spread this our evenly over three days or more.

Drinking large amounts of alcohol in one go can cause additional damage to your body, so avoid heavy or ‘binge’ drinking – you can’t save up your units!  If you drink too much, avoid alcohol for 48 hours to allow your body time to recover.​​​​​​

How much is one unit of alcohol?

A unit is a measure of alcohol.  The number of units is based on the size of the drink and its alcohol strength (ABV).  The ABV (alcohol by volume) figure is the percentage of alcohol in the drink.

A single pub measure (25mls) of spirits (40% ABV) contains one unit of alcohol.

A glass (50 ml) of liqueur, sherry or other fortified wine (20% ABV) contains one unit of alcohol.
Half a pint (about 300mls) of normal strength (4% ABV) lager, cider or beer contains 1.1 unit of alcohol - be aware that many beers and ciders are stronger and have a higher volume than this.

A standard 175ml glass of wine (13% ABV) would be 2.3 units - be aware that many wines have a higher alcohol content and the size of glasses may be bigger.

Is it true alcohol can be good for your heart?

There may be some heart health benefits for women over the age of 55 as long as they have no more than five units in a week. However, we would not advise you to start drinking if you don't already. There are safer and healthier ways to protect your heart.

It is more important to start doing more physical activity, eat a healthy, balanced diet and to stop smoking.

Low carb alcoholic drinks

Know what’s in your drink, so you can choose the best type for you. For instance, low-carb options include:

•    dry red or white wines
•    sparkling white wines like champagne cava and prosecco
•    pure spirits like whiskey, gin and vodka
•    cocktails like a dry martini
•    High-carb drinks include:
•    beer
•    cider
•    sugary cocktails
•    alcopops

Some beers and ciders contain much more carbs, which will increase your blood sugar levels further. Also avoid beers and cider (sometimes called diabetic drinks) that may have less sugar because they could have more alcohol in them. Just one pint of a low-sugar beer can bring you above the legal limit.

The risk of developing serious problems that damage your eyes, feet, legs and kidneys doubles if you smoke and have diabetes.

Smoking narrows your blood vessels, which is a huge problem for people with diabetes as it can cause serious complications that lead to loss of sight and limbs.

Smoking doubles your risk of heart disease and stroke, and causes many different types of cancer.  So let’s focus on the benefits of quitting here.

The cost of smoking: your money or your life?

Being smoke free can prevent 15 different types of cancer. Smoking is bad for our health and costs lots of money, but if you think the risks are worth it, here are some hard facts:

On average, smokers die 10 years younger than non-smokers.

Smoking burns a hole in your pocket that just keeps getting bigger. For instance, if you smoke 10 cigs a day in 2019, you’re spending about £28.00 per week, which is nearly £14,000 over 10 years – and could be much higher as the cost keeps going up.

Teenage smokers get more asthma and chest problems than non-smokers, they also have poorer health and are less fit.

Smoking ages you – smokers get wrinkles much earlier than non-smokers and you're more likely to go grey and lose your hair.

It’s not just about you, though, as you could be harming your loved ones: passive smoking damages the health of those who are close to you.

There are no benefits to smoking

People often say that smoking is relaxing, but smoking actually stresses you out more because the nicotine in cigarettes is a stimulant so it can’t calm you down. OK, you may feel more relaxed as you’re smoking, but that’s because in that moment you’re feeding your itch for nicotine.

The reality is that as soon as you put out a cigarette your stress levels go up to where they were before.  

Smoking doesn’t stop you from putting weight on and you won’t put on weight just because you stop smoking.

And don’t think that just a few cigarettes won’t do you any harm. Not smoking much or only smoking for a short time does matter because even your first cigarette hurts your body.  Every cigarette you have puts gases and chemicals that cause cancer and other diseases into your body. Your health improves the moment you stop.

Kicking the smoking habit

The good news is that you can get help if you want to kick the habit today. Don’t be afraid to tell your healthcare team that you smoke, as they’ve helped hundreds of people like you before.
Ask your GP about stop smoking programmes in North West London or search for stopping smoking programmes in your area now.

The NHS national programme, called “Smokefree” is a website and an app that has helped millions of people quit. Both are free and give you a personal plan on how to stop, including a way to calculate how much money you save and how your health improves the longer you’ve stopped. 

Extra Resources:

• https://www.nhs.uk/better-health/quit-smoking/
• https://www.nhs.uk/live-well/quit-smoking/10-self-help-tips-to-stop-smoking/

 

What about shisha pipes? 

Shisha pipes use tobacco sweetened with fruit and fruit flavouring. Wood, coal, or charcoal is burned in the shisha pipe to heat the tobacco and create the smoke because the fruit syrup or sugar makes the tobacco damp.

When you smoke shisha, you are breathing in smoke which releases toxins including carbon monoxide and heavy metals –reducing your body’s ability to carry oxygen around in your blood.
Shisha tobacco contains tobacco, nicotine, tar, carbon monoxide and heavy metals, such as arsenic and lead. As a result, shisha smokers are at risk of the same kinds of diseases as cigarette smokers, such as heart disease, cancer, respiratory disease and problems during pregnancy.

The average shisha-smoking session lasts an hour and research has shown that in this time you can inhale the same amount of smoke as from more than 100 cigarettes.

Are you feeling worried, anxious or low in mood? Free programmes are available across North West London.

NHS psychological therapies service

Free talking therapies are available from the NHS in your local area to help with your emotional wellbeing and coping with Hypertension. 

NHS Talking Therapies

It’s good to talk, it's free, and it's confidential 
Talking Therapies services are part of a national NHS programme and thousands of people in North West London have already accessed this free service.

People can be seen individually or in groups in locations close to your home, or even online. This is a free and confidential service, offering a range of therapies.

Programme inclusion criteria: 18 years or older for people with or without hypertension.

Living with a long-term condition like hypertension can bring many ups and downs, and may be difficult or overwhelming. Life stresses and other health issues may also affect your Hypertension.

Talking therapies can help you to manage feelings of stress, worry or sadness, and can help you to manage your Hypertension better.

There are eight IAPT services across North West London, one for each borough. They see people aged 18 upwards who are not already being seen by other mental health services.

Are Talking Therapies right for me?

Our services offer talking therapies tailored specifically for people with long term conditions. This may include online courses, with a therapist who has received additional training in working with people with a long-term health condition.

We also offer guided self-help for particular difficulties like low mood, worry or panic attacks, and one to one Cognitive Behavioural Therapy (CBT) or counselling for difficulties like post-traumatic stress disorder, social anxiety or for support with bereavement.

Talking therapies - get help with IAPT Video

How do I access this service?

Your GP or other health professional can refer you or you can refer yourself via this page. Some of the main problems that IAPT services work with are low mood, worry, panic, social anxiety, obsessive compulsive disorder (OCD) and Post Traumatic Stress Disorder (PTSD).

You will most likely be offered an initial assessment appointment over the telephone to find out more about your difficulties and needs.

Following this you will be offered the most appropriate service for you.

• Harrow
• Hillingdon
• Westminster
• Kensington & Chelsea
• Ealing
• Hammersmith & Fulham
• Hounslow