Michelle Berriedale-Johnson - High Blood Pressure - Natural Self-help for Hypertension, including 60 recipes

hyperparathyroidism, due to overactivity of the four parathyroid glands in the neck which, if not treated, raises blood calcium levels and can damage the kidneys.

Several drugs – both those available on prescription and those bought over the counter – can put your blood pressure up while they are being taken. These include:

nasal decongestants (e.g. ephedrine), taken to relieve a blocked nose

non-steroidal anti-inflammatory drugs (e.g. ibuprofen), taken to relieve aches and pains in the muscles and joints which – can raise BP by 5–10 mm Hg

oral corticosteroids, taken for severe inflammatory conditions such as asthma or rheumatoid arthritis

the combined oral contraceptive pill (containing both oestrogen and progestogen hormones), which can raise BP after several years’ use – recent research suggests that the average increase in BP is around 2.8/1.9 mmHg. In some women, however, rapid and more severe rises in BP can occur

monoamine-oxidase inhibitors – drugs sometimes used to treat severe depression – can cause sudden rises in BP if you eat cheese or other foods containing tyramine while on medication

carbenoxolone – a synthetic version of liquorice, sometimes used to treat stomach ulcers – can put BP up as it can trigger retention of sodium and water; a similar effect can also occur if you eat too much liquorice which has not been deglycerrizhinated.

If your doctor finds your blood pressure is raised, you will probably have the following examinations:

checking your blood pressure at least twice during the first visit

feeling your pulse to see how regular and strong it is

checking pulses in your groin, feet and ankles to make sure your peripheral circulation is intact – pressing on the skin of your lower legs and then letting go will show how quickly blood flows back into the blanched area

feeling your chest to see where the tip of your beating heart is detectable – this gives a good indication of whether or not your heart is enlarged

listening to your heart with a stethoscope to check for heart murmurs and to listen to your heart beat rhythm

listening to your lungs to check for signs of fluid build-up on the chest

listening to your neck and abdomen with a stethoscope to detect any noises due to turbulent blood flow through damaged carotid or renal arteries

examining the backs of your eyes to look for any signs of arterial damage ( see below ).

If your blood pressure remains consistently raised, you may have the following routine investigations:

chest x-ray – to check the size and shape of the heart and to look for evidence of congestive heart failure with fluid build-up on the lungs

ECG – heart tracing to look for signs of left-ventricular thickening, irregular heartbeat or evidence that the heart muscle is struggling

analysis of a urine sample – to look for protein and sugar, which would suggest blood vessels in the kidney are damaged

blood test for urea and electrolytes – to check kidney function and your salt balance

blood test for fasting blood lipids – to see if your blood cholesterol or other fat levels are raised.

If your doctor suspects your blood pressure is due to an underlying cause, you may have one or more of the following tests carried out:

If your potassium level is low, and you are not on diuretic treatment, you may have a hormone problem leading to high blood pressure. You will therefore have blood tests taken to check levels of other hormones such as aldosterone, cortisol and renin.

Blood tests to assess kidney function (creatinine clearance rate).

An intravenous urogram – a substance that shows up on x-ray is injected into your blood stream and a series of x-rays taken. This shows any narrowing of your renal arteries, how well your kidneys concentrate the dye in the urine, and outlines your urinary system to show up anatomical abnormalities or shrinkage of the kidneys.

Ultrasound of your kidneys.

Blood tests to measure catecholamine levels or measurement of urinary vanillylmandelic acid if phaeochromocytoma (tumour of the adrenal gland) is suspected.

If acromegaly is suspected from changes to your facial features and the fact that your tongue, jaw, hands and feet are getting bigger, you will have your blood levels of growth hormone measured.

High blood pressure damages small arteries throughout your body. Those in the back of the eye have the advantage of being visible using an ophthalmoscope and they show the state of arterioles throughout your system, including your brain. Early changes due to hypertension include thickening of retinal blood vessel walls. If hypertension becomes long-standing or severe, the blood vessels leak and little haemorrhages form. Other changes are probably due to obstruction of vessels and reduced blood circulation.

Your doctor will regularly check the back of your eyes for signs of damage if your blood pressure has been high. This is performed in a darkened room using an ophthalmoscope, which contains a number of lenses and a light source. Sometimes you may have one eye dilated first with drops to make the task easier. The doctor is looking for various abnormalities known as Keith-Wagener retinal changes. These are divided into four stages of severity:

Grade 1 – retinal arteries are more tortuous i.e. less straight. Because they are thickened and bulging under pressure, they also reflect light from the ophthalmoscope more than usual. This gives them an appearance known as silver wiring.

Grade 2 – as in grade 1, plus evidence that the thickened, bulging arteries are compressing the veins where they cross over them (arterio-venous nipping).