High blood pressure

Get help straight away if

These are uncommon, but they need same-day care — go to an emergency department, do not wait for an appointment.

• Sudden weakness or numbness on one side, drooping of the face, or trouble speaking or understandingCall 911. This is a stroke until proven otherwise, whatever your blood pressure reading is.
• Chest pain or pressure, or sudden severe breathlessnessCall 911.
• A sudden severe headache unlike your usual, with confusion, vision loss or vomitingGo to an emergency department.

Contact us promptly if

Not an emergency, but worth being seen sooner rather than waiting it out.

• Home readings staying very high over several days, even without symptoms
• Side effects that are making you consider stopping treatmentTell us rather than stopping — there are usually alternatives that suit you better.

What usually happens

You cannot feel your blood pressure. Headaches, flushing and feeling tense do not reliably track it, and the commonest harm we see is someone taking their tablets only when they feel unwell. It works precisely by being taken on days you feel fine.

One high reading is not a diagnosis. Blood pressure moves constantly and rises for many people simply by being measured in a clinic, so we usually want readings taken at home over a week, or a monitor worn for a day, before deciding anything.

The target is not about making a number look tidy. It is chosen from your overall risk — age, kidneys, diabetes, cholesterol, whether you have had a cardiac event — which is why two people can be treated to different numbers quite deliberately.

Lifestyle genuinely moves the number rather than nominally: salt, alcohol, weight, activity and untreated sleep apnoea all have measurable effects, and for some people that is enough on its own.

If a medication does not suit you, say so. There are several classes that lower blood pressure by different routes, and swapping is normal — stopping without telling anyone is what causes harm.

At your appointment

We will usually ask for readings taken outside the clinic — a week of home readings, or a 24-hour monitor — because those predict risk better than the one we take while you sit here.

Bring your own machine and cuff if you have one, so we can check it against ours and make sure the cuff size is right for your arm. An ill-fitting cuff is a common cause of misleading readings.

We will look at your kidneys, your heart and your overall cardiovascular risk rather than the blood pressure alone, because the decision to treat depends on the whole picture.

If you are on treatment, we will ask directly about side effects and about doses you have missed. Neither is a telling-off; both change what we should prescribe.

Worth asking

• —What number are we aiming for in my case, and why that one?
• —How and when should I take my readings at home?
• —Is my risk driven mainly by blood pressure, or by other things as well?
• —What should I do if I miss a dose, or run out?