Asthma is a condition that affects the smaller airways (bronchioles) of the lungs. From time to time the airways narrow (constrict) in people who have asthma. This causes the typical symptoms. The extent of the narrowing, and how long each episode lasts, can vary greatly.
Asthma can start at any age, but it most commonly starts in childhood. At least 1 in 10 children, and 1 in 20 adults, have asthma. Asthma runs in some families, but many people with asthma have no other family members affected.
The common symptoms are cough and wheeze. You may also become breathless, and develop a feeling of chest tightness. Symptoms can range from mild to severe between different people, and at different times in the same person. Each episode of symptoms may last just an hour or so, or persist for days or weeks unless treated.
You tend to develop mild symptoms from time to time. For example, you may develop a mild wheeze and a cough if you have a cold or a chest infection, or during the hay fever season, or when you exercise. For most of the time you have no symptoms. A child with mild asthma may have an irritating cough each night, but is often fine during the day.
You typically have episodes of wheezing and coughing from time to time. Sometimes you become breathless. You may have spells, sometimes long spells, without symptoms. However, you tend to be wheezy for some of the time on most days. Symptoms are often worse at night, or first thing in the morning. You may wake some nights coughing or with a tight chest. Young children may not have typical symptoms. It may be difficult to tell the difference between asthma and recurring chest infections in young children.
You become very wheezy, have a tight chest, and have difficulty in breathing. You may find it difficult to talk because you are so breathless. Severe symptoms may develop from time to time if you normally have moderate symptoms. Occasionally, severe symptoms develop suddenly in some people who usually just have mild symptoms.
Asthma is caused by inflammation in the airways. It is not known why the inflammation occurs. The inflammation irritates the muscles around the airways, and causes them to squeeze (constrict). This causes narrowing of the airways. It is then more difficult for air to get in and out of the lungs. This leads to wheezing and breathlessness. The inflammation also causes the lining of the airways to make extra mucus which causes cough and further obstruction to airflow.
The following diagram aims to illustrate how an episode of asthma develops.
Asthma symptoms may flare up from time to time. There is often no apparent reason why symptoms flare up. However, some people find that symptoms are triggered, or made worse, in certain situations. It may be possible to avoid certain triggers, which may help to reduce symptoms. Things that may trigger asthma symptoms include the following:
Some people only develop symptoms when exposed to a certain trigger - for example, exercise-induced asthma. As mentioned above, exercise can make symptoms worse for many people with asthma. But, some people only develop symptoms when they exercise, and are fine the rest of the time. Another example is that some people only develop symptoms when exposed to specific chemicals.
Sometimes symptoms are typical, and the diagnosis is easily made by a doctor. If there is doubt then some simple tests may be arranged. The two commonly used tests are called spirometry and assessment with a peak flow meter.
Spirometry is a test which measures how much air you can blow out into a machine called a spirometer. Two results are important:
Your age, height and sex affect your lung volume. So, your results are compared with the average predicted for your age, height and sex.
A value is calculated from the amount of air that you can blow out in one second divided by the total amount of air that you blow out in one breath (called FEV1:FVC ratio). A low value indicates that you have narrowed airways which are typical in asthma (but a low value can occur in other conditions too). Therefore, spirometry may be repeated after treatment. An improvement in the value after treatment to open up the airways is typical of asthma.
Note: spirometry may be normal in people with asthma who do not have any symptoms when the test is done. Remember, the symptoms of asthma typically come and go. Therefore, a normal result does not rule out asthma. But, if your symptoms suggest that you have asthma, ideally the test should be repeated when your symptoms are present. See separate leaflet called Spirometry for more details.
This is an alternative test. A peak flow meter is a small device that you blow into. A doctor or nurse will show you how. It measures the speed of air that you can blow out of your lungs. No matter how strong you are, if your airways are narrowed, your peak flow reading will be lower than expected for your age, size, and sex. If you have untreated asthma then you will normally have low and variable peak flow readings. Also, peak flow readings in the morning are usually lower than in the evening if you have asthma.
You may be asked to keep a diary over two weeks or so of peak flow readings. Typically, a person with asthma will usually have low and variable peak flow readings over several days. Peak flow readings improve when the narrowed airways are opened up with treatment. Regular peak flow readings can be used to help assess how well treatment is working. See separate leaflets called Asthma - Peak Flow Meter and Asthma - Peak Flow Diary for more details.
If the diagnosis remains in doubt then a specialist may perform further, more complex tests. But these are not needed in most cases.
For most people with asthma, the symptoms can be prevented most of the time with treatment. So, you are able to get on with normal life, school, work, sport, etc.
Most people with asthma are treated with inhalers. Inhalers deliver a small dose of medicine directly to the airways. The dose is enough to treat the airways. However, the amount of medicine that gets into the rest of your body is small so side-effects are unlikely, or minor. There are various inhaler devices made by different companies. Different ones suit different people. A doctor or nurse will advise on the different types. See separate leaflet called Inhalers for Asthma for more details.
Medicines delivered by inhalers can be grouped into relievers, preventers and long-acting bronchodilators:
Spacer devices are used with some types of inhaler. They are commonly used by children, but many adults also use them. A spacer is like a small plastic chamber that attaches to the inhaler. It holds the medicine like a reservoir when the inhaler is pressed. A valve at the mouth end ensures that the medicine is kept within the spacer until you breathe in. When you breathe out, the valve closes. So, you don't need to have good co-ordination to inhale the medicine if you use a spacer device. A face mask can be fitted on to some types of spacers, instead of a mouthpiece. This is sometimes done for young children and babies who can then use the inhaler simply by breathing in and out normally through the mask.
Most people do not need tablets, as inhalers usually work well. However, in some cases a tablet (or in liquid form for children) is prescribed in addition to inhalers if symptoms are not fully eased by inhalers alone. Various tablets may be used which aim to open up the airways. Some young children use liquid medication instead of inhalers.
A short course of steroid tablets (such as prednisolone) is sometimes needed to ease a severe or prolonged attack of asthma. Steroid tablets are good at reducing the inflammation in the airways. For example, a severe attack may occur if you have a cold or chest infection.
Some people worry about taking steroid tablets. However, a short course of steroid tablets (for a week or so) usually works very well, and is unlikely to cause side-effects. Most of the side-effects caused by steroid tablets occur if you take them for a long time (more than several months), or if you take frequent short courses of high doses.
Omalizumab is a medicine that is only used in a small number of people who have severe persistent allergic asthma that has not been controlled by other treatments. So, it is not a common treatment. It is given by injection. It works by interfering with the immune system to reduce inflammation in the airways which is present in asthma. Treatment with omalizumab can only be started by a specialist.
Everyone is different. The correct dose of a preventer inhaler is the lowest dose that prevents symptoms. A doctor may prescribe a high dose of a preventer inhaler at first, to 'get on top of symptoms' quickly. When symptoms have gone, the dose may then be reduced by a little every few weeks. The aim is to find the lowest regular dose that keeps symptoms away.
Some people with asthma put up with symptoms. They may think that it is normal still to have some symptoms even when they are on treatment. A common example is a night-time cough which can cause disturbed sleep. But, if this occurs and your symptoms are not fully controlled - tell your doctor or nurse. Symptoms can often be prevented - for example, by adjusting the dose of your preventer inhaler, or by adding in a long-acting bronchodilator.
A common treatment plan for a typical person with moderate asthma is:
At first, adjusting doses of inhalers is usually done on the advice of a doctor or nurse. In time, you may agree an asthma action plan with your doctor or nurse.
An asthma action plan is a plan agreed by you with your doctor or nurse. The plan enables you to make adjustments to the dose of your inhalers, depending on your symptoms and/or peak flow readings. The plan is tailored to individual circumstances. The plan is written down, usually on a standard form, so you can refer to it at any time. Research studies suggest that people who complete personal asthma action plans find it easier to manage their asthma symptoms and that their plan helps them to go about their lives as normal. Asthma UK provides asthma action plans which you can download from www.asthma.org.uk/advice-personal-action-plan.
There is no once-and-for-all cure. However, about half of the children who develop asthma grow out of it by the time they are adults.
For many adults, asthma is variable with some good spells and some spells that are not so good. Some people are worse in the winter months, and some worse in the hay fever season. Although not curable, asthma is treatable. Stepping up the treatment for a while during bad spells will often control symptoms.
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Type 2 diabetes occurs mainly in people aged over 40. The first-line treatment is diet, weight control and physical activity. If the blood sugar (glucose) level remains high despite these measures then tablets to reduce the blood glucose level are usually advised. Insulin injections are needed in some cases. Other treatments include reducing blood pressure if it is high, lowering high cholesterol levels and also other measures to reduce the risk of complications.
Diabetes mellitus (just called diabetes from now on) occurs when the level of sugar (glucose) in the blood becomes higher than normal. There are two main types of diabetes - type 1 diabetes and type 2 diabetes.
With type 2 diabetes, the illness and symptoms tend to develop gradually (over weeks or months). This is because in type 2 diabetes you still make insulin (unlike in type 1 diabetes). However, you develop diabetes because:
Type 2 diabetes is much more common than type 1 diabetes.
In type 1 diabetes the beta cells in the pancreas stop making insulin. The illness and symptoms develop quickly (over days or weeks) because the level of insulin in the bloodstream becomes very low. Type 1 diabetes used to be known as juvenile, early-onset, or insulin-dependent diabetes. It usually first develops in children or in young adults. Type 1 diabetes is treated with insulin injections and diet.
After you eat, various foods are broken down in your gut (intestine) into sugars. The main sugar is called glucose which passes through your gut wall into your bloodstream. However, to remain healthy, your blood glucose level should not go too high or too low.
So, when your blood glucose level begins to rise (after you eat), the level of a hormone called insulin should also rise. Insulin works on the cells of your body and makes them take in glucose from the bloodstream. Some of the glucose is used by the cells for energy, and some is converted into stores of energy (glycogen or fat). When the blood glucose level begins to fall (between meals), the level of insulin falls. Some glycogen or fat is then converted back into glucose which is released from the cells into the bloodstream.
Insulin is a hormone that is made by cells called beta cells. These are part of little islands of cells (islets) within the pancreas. Hormones are chemicals that are released into the bloodstream and work on various parts of the body.
The rest of this leaflet deals only with type 2 diabetes. There is a separate leaflet called Type 1 Diabetes.
Type 2 diabetes used to be known as maturity-onset, or non-insulin-dependent diabetes. It develops mainly in people older than the age of 40 (but can also occur in younger people). In the UK about one in 20 people aged over 65 and around one in five people aged over 85 have diabetes. Type 2 diabetes is now becoming more common in children and in young people.
The number of people with type 2 diabetes is increasing in the UK, as it is more common in people who are overweight or obese. It also tends to run in families. It is around five times more common in South Asian and African-Caribbean people (often developing before the age of 40 in this group). It is estimated that there are around 750,000 people in the UK with type 2 diabetes who have not yet been diagnosed with the condition.
Other risk factors for type 2 diabetes include:
As already mentioned, the symptoms of type 2 diabetes often come on gradually and can be quite vague at first. Many people have diabetes for a long period of time before their diagnosis is made.
The four common symptoms are:
The reason why you make a lot of urine and become thirsty is because glucose leaks into your urine, which pulls out extra water through the kidneys.
As the symptoms may develop gradually, you can become used to being thirsty and tired and you may not recognise that you are ill for some time. Some people also develop blurred vision and frequent infections, such as recurring thrush. However, some people with type 2 diabetes do not have any symptoms if the blood sugar (glucose) level is not too high. But, even if you do not have symptoms, you should still have treatment to reduce the risk of developing complications.
A simple dipstick test may detect sugar (glucose) in a sample of urine. However, this is not sufficient to diagnose diabetes definitely. Therefore, a blood test is needed to make the diagnosis. The blood test detects the level of glucose in your blood. If the blood glucose level is high then it will confirm that you have diabetes. Some people have to have two samples of blood taken and may be asked to fast (this means having nothing to eat or drink, other than water, from midnight before the blood test is performed).
It is now recommended that the blood test for HbA1c can also be used as a test to diagnose diabetes. An HbA1c value of 48 mmol/mol (6.5%) or above is recommended as the blood level for diagnosing diabetes.
In many cases diabetes is diagnosed during a routine medical or when tests are done for an unrelated medical condition.
This is not common with type 2 diabetes. It is more common in untreated type 1 diabetes when a very high level of glucose can develop quickly. However, a very high glucose level develops in some people with untreated type 2 diabetes. A very high blood level of glucose can cause lack of fluid in the body (dehydration), drowsiness and serious illness which can be life-threatening.
If your blood glucose level is higher than normal over a long period of time, it can gradually damage your blood vessels. This can occur even if the glucose level is not very high above the normal level. This may lead to some of the following complications (often years after you first develop diabetes):
The type and severity of long-term complications vary from case to case. You may not develop any at all. In general, the nearer your blood glucose level is to normal, the less your risk of developing complications. Your risk of developing complications is also reduced if you deal with any other risk factors that you may have, such as high blood pressure.
Hypoglycaemia (which is often called a 'hypo') occurs when the level of glucose becomes too low, usually under 4 mmol/L. People with diabetes who take insulin and/or certain diabetes tablets are at risk of having a hypo. A hypo may occur if you have too much diabetes medication, have delayed or missed a meal or snack, or have taken part in unplanned exercise or physical activity.
Symptoms of hypoglycaemia include: trembling, sweating, anxiety, blurred vision, tingling lips, paleness, mood change, vagueness or confusion. To treat hypoglycaemia you should take a sugary drink or some sweets. Then eat a starchy snack such as a sandwich.
Note: hypoglycaemia cannot occur if you are treated with diet alone.
Although diabetes cannot be cured, it can be treated successfully. If a high blood sugar (glucose) level is brought down to a normal or near-normal level, your symptoms will ease and you are likely to feel well again. You still have some risk of complications in the long term if your blood glucose level remains even mildly high - even if you have no symptoms in the short term. However, studies have shown that people who have better glucose control have fewer complications (such as heart disease or eye problems) compared with those people who have poorer control of their glucose level.
Therefore, the main aims of treatment are:
The blood test that is mainly used to keep a check on your blood glucose level is called the HbA1c test. This test is commonly done every 2-6 months by your doctor or nurse.
The HbA1c test measures a part of the red blood cells. Glucose in the blood attaches to part of the red blood cells. This part can be measured and gives a good indication of your average blood glucose level over the preceding 1-3 months.
Treatment aims to lower your HbA1c to below a target level. Ideally, it is best to maintain HbA1c to less than 48 mmol/mol (6.5%). However, this may not always be possible to achieve and your target level of HbA1c should be agreed between you and your doctor. If your HbA1c is above your target level then you may be advised to step up treatment (for example, to increase a dose of medication) to keep your blood glucose level down.
Some people with diabetes check their actual blood glucose level regularly with a blood glucose monitor. If you are advised to do this then your doctor or nurse will give you instructions on how to do it.
Lifestyle changes are an essential part of treatment for all people with type 2 diabetes, regardless of whether or not they take medication.
You can usually reduce the level of your blood glucose and HbA1c if you:
Many people with type 2 diabetes can reduce their blood glucose (and HbA1c) to a target level by the above measures. However, if the blood glucose (or HbA1c) level remains too high after a trial of these measures for a few months, then medication is usually advised.
There are various medicines that can reduce the blood glucose level. Different ones suit different people. It is fairly common to need a combination of medicines to control your blood glucose level. Some medicines work by helping insulin to work better on the body's cells. Others work by boosting the amount of insulin made by the pancreas. Another type works by slowing down the absorption of glucose from the gut. There is also a type which suppresses a hormone called glucagon, which is released into the bloodstream by the pancreas and stops insulin from working.
Medication is not used instead of a healthy diet, weight control and physical activity - you should still do these things as well as take medication. See separate leaflet called Treatments for Type 2 Diabetes for more details.
You are less likely to develop complications of diabetes if you reduce any other risk factors. These are briefly mentioned below - see separate leaflet called Preventing Cardiovascular Diseases for more details. Although everyone should aim to cut out preventable risk factors, people with diabetes have even more of a reason to do so.
It is very important to have your blood pressure checked regularly. The combination of high blood pressure and diabetes is a particularly high risk factor for complications. Even mildly raised blood pressure should be treated if you have diabetes. Medication, often with two or even three different medicines, may be needed to keep your blood pressure down. See separate leaflet called Diabetes and High Blood Pressure for more details.
Smoking is a high risk factor for complications. You should see your practice nurse or attend a smoking cessation clinic if you have difficulty stopping smoking. If necessary, medication or nicotine replacement therapy (nicotine gum, etc) may help you to stop.
You will usually be advised to take a medicine to lower your cholesterol level. This will help to lower the risk of developing some complications such as heart disease, peripheral vascular disease and stroke.
Most GP surgeries and hospitals have special diabetes clinics. Doctors, nurses, dieticians, specialists in foot care (chiropodists), specialists in eye health (optometrists) and other healthcare workers all play a role in giving advice and checking on progress. Regular checks may include:
It is important to have regular checks, as some complications, particularly if detected early, can be treated or prevented from getting worse.
You should be immunised against flu (each autumn) and also against pneumococcal germs (bacteria) (just given once). These infections can be particularly unpleasant if you have diabetes.
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Some people with diabetes develop foot ulcers. A foot ulcer is prone to infection, which may become severe. This leaflet aims to explain why foot ulcers sometimes develop, what you can do to help prevent them, and typical treatments if one does occur.
A skin ulcer is where an area of skin has broken down and you can see the underlying tissue. Most skin ulcers occur on the lower legs or feet. The skin normally heals quickly if it is cut. However, in some people with diabetes the skin on the feet does not heal so well and is prone to developing an ulcer. This can be even after a mild injury such as stepping on a small stone in your bare feet.
Foot ulcers are more common if you have diabetes because one or both of the following complications develop in some people with diabetes:
Your nerves may not work as well as normal because even a slightly high blood sugar level can, over time, damage some of your nerves. This is a complication of diabetes, called peripheral neuropathy of diabetes.
The nerves that take messages of sensation and pain from the feet are commonly affected. If you lose sensation in parts of your feet, you may not know if you damage your feet. For example, if you tread on something sharp or develop a blister due to a tight shoe. This means that you are also more prone to problems such as minor cuts, bruises or blisters. Also, if you cannot feel pain so well from the foot, you do not protect these small wounds by not walking on them. Therefore, they can quickly become worse and develop into ulcers.
If you have diabetes you have an increased risk of developing narrowing of the arteries (peripheral arterial disease). This is caused by fatty deposits called atheroma that build up on the inside lining of arteries (sometimes called furring of the arteries). This can reduce the blood flow to various parts of the body.
The arteries in the legs are quite commonly affected. This can cause a reduced blood supply (poor circulation) to the feet. Skin with a poor blood supply does not heal as well as normal and is more likely to be damaged. Therefore, if you get a minor cut or injury, it may take longer to heal and be prone to becoming worse and developing into an ulcer. In particular, if you also have reduced sensation and cannot feel the wound.
Although foot ulcers can be serious, they usually respond well to treatment. However, foot ulcers can get worse and can take a long time to heal if you have diabetes, particularly if your circulation is not so good. In addition, having diabetes means you are more likely to have infections and an infection in the ulcer can occur. Occasionally, more serious problems can develop, such as tissue death (gangrene).
Most people with diabetes are reviewed at least once a year by a doctor and other health professionals. Part of this review is to examine the feet to look for problems such as reduced sensation or poor circulation. If any problems are detected then more frequent feet examinations will usually be recommended.
As a rule, the better the control of your diabetes, the less likely you are to develop complications such as foot ulcers. Also, where appropriate, treatment of high blood pressure, high cholesterol level and reducing any other risk factors will reduce your risk of diabetic complications. In particular, if you smoke, you are strongly advised to stop smoking.
Research has shown that people with diabetes who take good care of their feet and protect their feet from injury, are much less likely to develop foot ulcers.
Good foot care includes:
You should tell your doctor or a person qualified to diagnose and treat foot disorders (a podiatrist - previously called a chiropodist) straightaway if you suspect an ulcer has formed. Treatment aims to dress and protect the ulcer, to prevent or treat any infection and also to help your skin to heal.
Many foot ulcers will heal with the above measures. However, they can take a long time to heal.
In some cases, the ulcer becomes worse, badly infected and does not heal. Sometimes infection spreads to nearby bones or joints, which can be difficult to clear, even with a long course of antibiotics. Occasionally, the tissue in parts of the foot cannot survive and the only solution then is to surgically remove (amputate) the affected part.
If you have a diabetic foot problem, you will be able to get most of the treatment you need from your GP or other health professionals working in the community. However, there are some problems which may require you to go into hospital for treatment. The National Institute for Health and Care Excellence (NICE) has released some guidance as to what you can expect if this should happen:
High blood pressure (hypertension) is a risk factor that can increase your chance of developing heart disease, a stroke, and other serious conditions. As a rule, the higher the blood pressure, the greater the risk. Treatment includes a change in lifestyle risk factors where these can be improved. For example, losing weight if you are overweight, regular physical activity, a healthy diet, cutting back if you drink a lot of alcohol, stopping smoking, and a low salt and caffeine intake. If needed, medication can lower blood pressure.
Blood pressure is the pressure of blood in your blood vessels (arteries). Blood pressure is measured in millimetres of mercury (mm Hg). Your blood pressure is recorded as two figures. For example, 150/95 mm Hg. This is said as 150 over 95.
Clinic/GP surgery blood pressure readings: these are readings taken by a doctor or nurse in a clinic or GP surgery using a standard blood pressure machine.
Home blood pressure readings: these are readings taken by a person whilst seated and at rest at home using a standard blood pressure machine.
Ambulatory blood pressure readings: these are readings taken at regular intervals whilst you go about your normal activities. A small machine that is attached to your arm takes and records the readings, usually over a 24-hour period.
As a rule, an average of the ambulatory blood pressure readings gives the most true account of your usual blood pressure. Home blood pressure readings are a good substitute if an ambulatory machine is not available. Ambulatory and home readings are often a bit lower than clinic or GP surgery readings. Sometimes they are a lot lower. This is because people are often much more relaxed and less stressed at home than in a formal clinic or surgery situation.
High blood pressure is a blood pressure that is 140/90 mm Hg or above each time it is taken at the GP surgery (or home or ambulatory readings always more than 135/85 mm Hg). That is, it is sustained at this level. High blood pressure can also be:
However, it is not quite as simple as this. Depending on various factors, the level at which blood pressure is considered high enough to be treated with medication can vary from person to person.
If your blood pressure is always in this range you will normally be offered treatment to bring the pressure down, particularly if you have:
For most people this level is fine. However, current UK guidelines suggest that this level is too high for certain groups of people. Treatment to lower your blood pressure if it is 130/80 mm Hg or higher may be considered if you:
A one-off blood pressure reading that is high does not mean that you have 'high blood pressure'. Your blood pressure varies throughout the day. It may be high for a short time if you are anxious, stressed, or have just been exercising.
You have high blood pressure if you have several blood pressure readings that are high, and which are taken on different occasions, and when you are relaxed.
If one reading is found to be high, it is usual for your doctor or nurse to advise a time of observation. This means several blood pressure checks at intervals over time. The length of the observation period varies depending on the initial reading, and if you have other health risk factors.
For example, say a first reading was mildly high at 145/89 mm Hg. If you are otherwise well, then a period of several weeks of observation may be advised. This may involve several blood pressure measurements over the next few weeks. You may be given a machine to monitor blood pressure while you are going about doing your everyday activities (ambulatory monitoring). You may be given (or asked to buy) a machine to measure your blood pressure at home (home monitoring). One reason this may be advised is because some people become anxious in medical clinics. This can can cause the blood pressure to rise. (This is often called white coat hypertension.) Home or ambulatory monitoring of blood pressure may show that the blood pressure is normal when you are relaxed.
The observation period is also a good time to change any lifestyle factors that can reduce blood pressure (see below). If the blood pressure readings remain high after an observation period then medication may be advised, depending on your risk factors (see below).
However, if you have diabetes, or have recently had a heart attack or stroke, you may be advised to have blood pressure checks fairly often over the next week or so. Also, treatment with medication is usually considered at an earlier stage if the readings remain high.
This is called essential hypertension. The pressure in the blood vessels (arteries) depends on how hard the heart pumps, and how much resistance there is in the arteries. It is thought that slight narrowing of the arteries increases the resistance to blood flow, which increases the blood pressure. The cause of the slight narrowing of the arteries is not clear. Various factors probably contribute.
It is then called secondary hypertension. For example, certain kidney or hormone problems can cause high blood pressure.
In the UK, about half of people aged over 65, and about 1 in 4 middle-aged adults, have high blood pressure. It is less common in younger adults. Most cases are mildly high (up to 160/100 mm Hg). However, at least 1 in 20 adults have blood pressure of 160/100 mm Hg or above. High blood pressure is more common in people:
High blood pressure (hypertension) usually causes no symptoms. You will not know if you have high blood pressure unless you have your blood pressure checked. Therefore, everyone should have regular blood pressure checks at least every five years. The check should be more often (at least once a year) in:
High blood pressure is a risk factor for developing a cardiovascular disease (such as a heart attack or stroke), and kidney damage, sometime in the future. If you have high blood pressure, over the years it may do some damage to your blood vessels (arteries) and put a strain on your heart. In general, the higher your blood pressure, the greater the health risk. But, high blood pressure is just one of several possible risk factors for developing a cardiovascular disease.
Cardiovascular diseases are diseases of the heart (cardiac muscle) or blood vessels (vasculature). However, in practice, when doctors use the term cardiovascular disease they usually mean diseases of the heart or blood vessels that are caused by atheroma. Patches of atheroma are like small fatty lumps that develop within the inside lining of blood vessels (arteries). Atheroma is also known as atherosclerosis and hardening of the arteries.
Cardiovascular diseases that can be caused by atheroma include:
In the UK, cardiovascular diseases are a major cause of poor health and the biggest cause of death.
Everybody has some risk of developing atheroma which may cause one or more cardiovascular diseases. However, certain risk factors increase the risk. These include:
However, if you have a fixed risk factor, you may want to make extra effort to tackle any lifestyle risk factors that can be changed.
Note: some risk factors are more risky than others. For example, smoking and high blood pressure probably cause a greater risk to health than obesity. Also, risk factors interact. So, if you have two or more risk factors, your health risk is much more increased than if you just have one. For example, a middle-aged male smoker who takes no exercise and has high blood pressure has a high risk of developing a cardiovascular disease such as a heart attack before the age of 60.
Therefore, the benefit of lowering a high blood pressure is to reduce the risk of developing a cardiovascular disease in the future.
For example, it is estimated that reducing a high diastolic blood pressure by 6 mm Hg reduces your relative risk of having a stroke in the future by about 35-40%, and reduces your relative risk of developing heart disease by about 20-25%. Larger reductions in blood pressure provide greater benefits.
A risk factor calculator is often used by doctors and nurses to predict the health risk for an individual. A score is calculated which takes into account all your risk factors, such as age, sex, smoking status, blood pressure, blood cholesterol level, etc. If you want to know your score, see your practice nurse or GP.
Current UK guidelines advise that if your score gives you a 2 in 10 risk or more of developing a cardiovascular disease within the next 10 years, then treatment is advised.
Treatments may include:
If you are diagnosed as having high blood pressure (hypertension) then you are likely to be examined by your doctor and have some routine tests which include:
The purpose of the examination and tests is to:
There are two ways in which blood pressure can be lowered:
Losing some excess weight can make a big difference. Blood pressure can fall by up to 2.5/1.5 mm Hg for each excess kilogram which is lost. Losing excess weight has other health benefits too.
If possible, aim to do some physical activity on five or more days of the week, for at least 30 minutes. For example, brisk walking, swimming, cycling, dancing, etc. Regular physical activity can lower blood pressure in addition to giving other health benefits. If you previously did little physical activity, and change to doing regular physical activity five times a week, it can reduce systolic blood pressure by 2-10 mm Hg. You should seek medical advice before undertaking exercise if you have high blood pressure.
Briefly, this means:
A healthy diet provides benefits in different ways. For example, it can lower cholesterol, help control your weight, and has plenty of vitamins, fibre, and other nutrients which help to prevent certain diseases. Some aspects of a healthy diet also directly affect blood pressure. For example, if you have a poor diet and change to a diet which is low-fat, low-salt, and high in fruit and vegetables, it can lower systolic blood pressure by up to 11 mm Hg.
The amount of salt that we eat can have an effect on our blood pressure. Government guidelines recommend that we should have no more than 5-6 grams of salt per day. (Most people currently have more than this.) Tips on how to reduce salt include:
Caffeine is thought to have a modest effect on blood pressure. It is advised that you restrict your coffee consumption (and other caffeine-rich drinks) to fewer than five cups per day.
Too much alcohol can be harmful and can lead to an increase in blood pressure. You should not drink more than the recommended amount. That is, men should drink no more than 21 units of alcohol per week, no more than four units in any one day, and have at least two alcohol-free days a week. Women should drink no more than 14 units of alcohol per week, no more than three units in any one day, and have at least two alcohol-free days a week. Pregnant women should not drink at all. One unit is in about half a pint of normal-strength beer, or two thirds of a small glass of wine, or one small pub measure of spirits.
Cutting back on heavy drinking improves health in various ways. It can also have a direct effect on blood pressure. For example, if you are drinking heavily, cutting back to the recommended limits can lower a high systolic blood pressure by up to 10 mm Hg.
It is estimated that dietary and exercise interventions discussed above can reduce blood pressure by at least 10 mm Hg in about 1 in 4 people with high blood pressure.
Medication to lower blood pressure is usually advised for:
If you are taking medication to lower high blood pressure:
Your GP or practice nurse will advise you what your target blood pressure is.
There are several medicines that can lower blood pressure. The one chosen depends on such things as:
Some medicines work well in some people, and not so well in others. One or two medicines may be tried before one is found to suit.
One medicine reduces high blood pressure to the target level in less than half of cases. It is common to need two or more different medicines to reduce high blood pressure to a target level. In about a third of cases, three medicines or more are needed to get blood pressure to the target level. In some cases, despite treatment, the target level is not reached. However, although to reach a target level is ideal, you will benefit from any reduction in blood pressure.
See separate leaflet called Medicines for High Blood Pressure for more details.
In most cases, medication is needed for life. However, in some people whose blood pressure has been well controlled for three years or more, medication may be able to be stopped. In particular, in people who have made significant changes to lifestyle (such as having lost a lot of weight, or stopped heavy drinking, etc). Your doctor can advise you.
If you stop medication, you should have regular blood pressure checks. In some cases the blood pressure remains normal. However, in others it starts to rise again. If this happens, medication can then be started again.
Smoking does not directly affect the level of your blood pressure. However, smoking greatly adds to your health risk if you already have high blood pressure. You should make every effort to stop smoking. If you smoke and are having difficulty in stopping, then see your practice nurse for help and advice.
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