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Hypertension is when overall blood pressure is consistently high, even when resting.

How common is hypertension?

National Institute for Health and Care Excellence (NICE) guidance on diagnosing and managing hypertension, updated in March 2022, says it is one of the most treatable causes of premature morbidity and mortality in the world. ‘In 2015, it was reported that high blood pressure affected more than one in four adults in England (31% of men; 26% of women) – around 13.5 million people – and contributed to 75,000 deaths,’ it states.

The clinical management of high blood pressure accounts for 12% of visits to primary care and up to £2.1 billion of annual healthcare expenditure in England alone. However, the picture is improving.

‘Between 2010 and 2020, progress has been made to improve the diagnosis and management of hypertension: the population average blood pressure in England has fallen by about 3mmHg systolic and the proportion of adults with untreated high blood pressure has decreased,’ says NICE.

What are the signs, symptoms and risk factors?

Hypertension rarely has noticeable symptoms, although they can include blurred vision, nosebleeds, shortness of breath, chest pain, dizziness and headaches, says the British Heart Foundation (BHF).

Most people develop hypertension because of their diet, lifestyle or a medical condition, says the charity. High BP also runs in families and can worsen with age. It is more common in people of black African or black Caribbean descent. Risk also increases with the following: excess alcohol use or salt intake, smoking, being overweight and insufficient exercise.

Hypertension is a major risk factor for stroke, myocardial infarction, heart failure, chronic kidney disease, cognitive decline and premature death, says NICE. Around 50% of heart attacks and strokes are associated with high BP, according to the BHF.

What is the treatment?

NICE has produced a patient decision aid on treatment options for hypertension to support discussions on the various alternatives. Medications used to treat hypertension include:

Regular home blood pressure monitoring can help encourage lifestyle changes

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What do all nurses need to know about BP and hypertension?

Knowing how to take a patient’s BP accurately is crucial, says BHF senior cardiac nurse Sindy Jodar.

‘Make sure the patient is as relaxed as possible with their feet flat on the floor, sitting upright in a chair,’ she says. ‘It’s important to use the right cuff size for their arm. You should be able to fit two fingers underneath the cuff. If it’s too loose or too tight, it will affect the measurement.’ If the person’s BP is higher than 140/90mmHg, wait a few minutes for the blood flow in their arm to return to normal, then take it again. If the second measurement is substantially different, take a third. The lowest two measurements are the patient’s clinic BP.

Ambulatory blood pressure monitoring (ABPM) should be offered to those whose BP is between 140/90mmHg and 180/120mmHg, says Ms Jodar. This involves wearing a BP cuff attached to a monitor for 24-48 hours. For those who find this uncomfortable, offer home blood pressure monitoring (HBPM) to confirm a diagnosis of hypertension. ‘You should also be aware of the “white coat effect” when there is a difference of more than 20/10mmHg between clinic and ABPM or HBPM. This is because some patients feel more anxious at the doctor’s or in a hospital setting.’

How can non-specialist nurses support patients?

Nurses can help patients understand that hypertension is a condition that can be managed, says Ms Jodar. ‘Patients can’t take in all the information about a new diagnosis in one go, so we give them booklets to take away with them.’

It is vital that patients understand the importance of managing their BP using a combination of medication and lifestyle changes. ‘Remind them that medication should be taken at the same time every day and if they miss a dose, take it as soon as possible. Also encourage patients to quit smoking, reduce their alcohol intake, eat a healthy balanced diet low in salt, and increase physical activity.’

Ms Jodar suggests patients monitor their own BP at home. ‘That way they can see the improvement in their blood pressure numbers as they start taking medication and making lifestyle changes.’

Further information

NICE (2022) Hypertension in adults nice.org.uk/guidance/ng136

BHF: High blood pressure tinyurl.com/blood-pressure-BHF