DO I NEED TO WORRY ABOUT MY SLIGHTLY HIGH BLOOD PRESSURE?

Hypertension, also known as high blood pressure, impacts around one in three people in the UK, according to Blood Pressure UK. Due to its lack of symptoms, it is known as the ‘silent killer’ – it significantly increases the risk of cardiovascular disease, stroke, kidney disease and heart failure – but is asymptomatic until a medical event is triggered.

“High blood pressure is a bit like a drippy pipe in a home,” explains Dr Iqbal Malik, consultant cardiologist. “Over the course of a week, that drip doesn’t do anything, but if you leave it for years, the whole wall might fall down. 

“In general a good blood pressure reading is between 90/60mmHg and 120/80mmHg. It is hypertension when it is 140/90mmHg or higher.

“If the blood pressure is even five millimetres higher, than it should be then your heart is beating against that 70 times a minute, and over the course of a number of years that will have an effect on the engine.”

For this reason, the NHS screens blood pressure in adults from 40 and above at least every five years. If your blood pressure is consistently 140 over 90 when checked by a healthcare professional, you would be considered hypertensive.

What counts as ‘slightly high’?

But the line between needing treatment and not needing treatment is actually very marginal, explains Professor Ian Wilkinson, chair of the British and Irish Hypertension Society and director of therapeutics at Cambridge Cardiovascular.

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“There’s a continuous relationship between blood pressure and risk: even if your blood pressure is 130 and below the threshold, you would still have less risk of heart attack and stroke if it was 120. Our current threshold of 140/90 was chosen based on a level of risk that people thought was worthwhile treating, and trials showing that treating people above that level saved lives.”

But what about if you are just above or just below that reading? One is treated by medical professionals but the other is, even though the level of risk between the two is pretty similar.

When do I need to panic?

“If you’re in that grey zone where your blood pressure is between 130 and 140 and it’s been creeping up (say 10 years ago it was 120),” says Dr Malik, “then that’s when you should dial that back before it becomes a problem.” Which is to say, you do not need to panic but you should not ignore it.

If you are in this range then treatment will very rarely mean medication – only if you’ve got lots of risk factors like kidney disease or diabetes. “In an otherwise healthy person where the GP finds it’s 135 and sometimes 140, that’s where lifestyle is important,” he adds.

The two most important lifestyle factors are your weight and your salt intake. The bigger you are physically, the more your heart has to work to keep your blood pumping, while salt increases the amount of urinary protein, which is a major risk factor for developing kidney or cardiovascular disease.

Try the Mediterranean diet

For both, Dr Malik recommends the Dietary Approaches to Stop Hypertension (Dash) diet or the Mediterranean diet. “You eat much more fruit, vegetables, fibre, and much less saturated fat, as well as reducing your added salt intake. Even if your weight hasn’t changed, your blood pressure will still go down. The healthiness of the food that you actually eat will have an impact on blood pressure.”

On top of this, Professor Wilkinson sums it up as follows: “Don’t smoke, don’t drink much, eat well, move and avoid licorice. It puts your blood pressure up as it makes you retain salt, so an occasional Bertie Bassett is OK but don’t overdo it. All of that may well bring that blood pressure back to below 130.”

When to start medication

If you’ve made all of these changes and your blood pressure is still at the threshold, it’s perhaps time to consider medication. But Dr Malik cautions against jumping into it without properly monitoring your blood pressure for an extended period of time.

“I would definitely not be starting medication until I’ve run a 24-hour blood pressure monitor which is a much better average reading than even doing it at home. Even though I’m not a stressful guy, when I talk to my patients their blood pressure is always so much higher with me than at home. It’s called the white coat effect.”

Whether you manage to lower your blood pressure yourself, or are still considered to be in the grey zone, the most important thing is to continue to get your blood pressure checked at least every year.

“If you look at people’s blood pressure as a function of age, it goes up for most of us relentlessly throughout life,” Professor Wilkinson. “So it is very likely that if you’re just below now, in the next five years you’ll be just over. And the sooner you know, the sooner you can start preventing the damage.”

2025-06-10T05:21:34Z