High blood pressure causes no symptoms and is diagnosed from readings taken away from the clinic, not from one measurement in a room. Treatment is chosen by age and ethnicity and adjusted every 4 to 6 weeks until it reaches target. A 30 minute consultation is £150.
Message the clinic and a doctor replies within 24 hours.
Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.
Blood pressure is the pressure inside the arteries, written as the peak during a heartbeat over the pressure between beats. It is called high when readings away from the clinic average 135 over 85 or above, which is a lower threshold than the clinic figure people usually quote.NICE NG136, 2023
It causes nothing until it causes something. There are no reliable symptoms, headaches and nosebleeds are not a guide, and the first sign for many people is the stroke or heart attack it produced.NICE NG128, 2022
In most adults no single cause is found and the drivers are age, weight, salt, alcohol, inactivity and inheritance. Around 1 in 10 has a specific cause, most often kidney disease or a hormonal condition, and that proportion is higher in people diagnosed under 40.European Heart Journal ESC guideline, 2024
White coat effect is real and common. A reading taken in a clinic is on average higher than the same person’s reading at home, which is why the diagnosis is not made on it.NICE NG136, 2023
Send us what you are seeing and we will tell you what it is likely to be.
A raised clinic reading starts the process rather than finishing it. Diagnosis is confirmed with home readings over 7 days or with 24 hour monitoring, because treating a white coat reading commits somebody to a lifetime of tablets they do not need.NICE NG136, 2023
Once confirmed, the assessment looks for damage already done and for a treatable cause. Kidney function, urine for protein, HbA1c, lipids, and an examination that includes the pulse for an irregular rhythm.European Heart Journal ESC guideline, 2024
An irregular pulse is followed up rather than noted. Atrial fibrillation often runs alongside raised blood pressure, it raises stroke risk substantially, and its treatment is different from everything else here.NICE NG196, 2021
The 10 year cardiovascular risk is calculated at the same visit, because blood pressure is treated as part of overall risk rather than as an isolated number.The BMJ Hippisley Cox, 2017
Salt, weight, alcohol and activity
Reducing salt, losing weight where there is weight to lose, cutting alcohol and regular activity each lower blood pressure measurably. Together they are worth roughly as much as a first medication for many people.European Heart Journal ESC guideline, 2021
Home monitoring instead of treatment, for a while
For readings just above threshold with low overall risk, monitoring and change is a reasonable first plan with a date to review it rather than an open ended wait.NICE NG136, 2023
A first line medication chosen by age and ethnicity
Which class is started first depends on your age and ethnic background rather than preference, because the classes work differently in different groups.NICE NG136, 2023
Combination treatment
Two medicines at moderate dose usually lower pressure more, and cause fewer side effects, than one at maximum dose. Combining early rather than pushing a single drug is what reaches target faster.European Heart Journal ESC guideline, 2024
Investigation for a secondary cause
For anyone diagnosed under 40, for resistant pressure on three medicines, or where potassium is low. Finding one changes the treatment entirely.European Heart Journal ESC guideline, 2024
Treating the lipids at the same time
Blood pressure is one of several inputs to the same risk. Where the calculated risk is high, lowering cholesterol alongside is often worth more than tightening the pressure further.NICE NG238, 2023
Most medications reach their full effect within 4 weeks, which is why the dose is reviewed at 4 to 6 week intervals rather than at 6 months. Reaching target usually takes 2 or 3 adjustments, and stopping after the first one is the commonest reason people stay above target for years.NICE NG136, 2023
The inconvenient half. A large randomised trial found that treating to a systolic target of 120 rather than 140 reduced cardiovascular events and death, and also produced more episodes of low blood pressure, fainting, electrolyte disturbance and acute kidney injury. Tighter control is better on average and it costs something, and which side of that you sit on is a conversation rather than a protocol.New England Journal of Medicine Wright, 2015
Do a 7 day home series before the appointment and bring the numbers. Sitting, back supported, feet flat, arm at heart height, twice each morning and twice each evening, and throw away day one. The average of days 2 to 7 is what the diagnosis is made on.NICE NG136, 2023
Buy a validated upper arm monitor rather than a wrist device. Wrist monitors are less accurate at the pressures that matter, and the cuff has to fit your arm, because a cuff that is too small reads high and produces a diagnosis you do not have.European Heart Journal ESC guideline, 2024
Look at your salt for one week. Most salt comes from bread, processed meat, sauces and eating out rather than from the cellar on the table, and reading the labels for a week is what makes that visible.European Heart Journal ESC guideline, 2021
Do not buy a private echocardiogram or a kidney scan on the strength of one high reading. Confirm the diagnosis with home readings first, because a proportion of people who do that turn out not to have high blood pressure at all.NICE NG136, 2023
Do not buy a wrist blood pressure monitor. It costs less and it measures the wrong thing at the wrong place, so the money is wasted twice, once on the device and once on the decisions made from it.European Heart Journal ESC guideline, 2024
Step 1
Seven days of home readings, or 24 hour monitoring, before anybody is told they have high blood pressure.
Step 2
Kidneys, urine, blood sugar, lipids and rhythm, with the 10 year risk calculated at the same visit.
Step 3
Adjusted until the numbers are where they should be rather than started and left. Most people need 2 or 3 adjustments.
Ask before you book if you are not sure this is the right appointment.
Away from the clinic, an average of 135 over 85 or above is treated as high blood pressure. Clinic readings run higher, which is why a single raised reading in a room starts the process rather than finishing it. Above 180 over 120 needs to be seen the same day.
Usually, though not always. Where weight, alcohol or inactivity were the drivers and those change for good, medication can sometimes be reduced or stopped under supervision. Stopping on your own is the version that goes wrong, because there are no symptoms to warn you.
Because clinic readings average higher than home readings in the same person, and treating that difference commits somebody to lifelong medication they do not need. Day one is discarded because it reads high, and the average of days 2 to 7 is what counts.
A 30 minute consultation with examination and risk calculation is £150. The Core blood panel covering kidneys, sugar and lipids is £350. Titration reviews by telephone are £59 each, and most people need 2 or 3. Medication is dispensed and priced by the pharmacy.
Not at the levels most people have. Headaches and nosebleeds are not a reliable guide and waiting for a symptom is what allows years of untreated pressure. The only way to know is to measure it, which is the whole argument for the 7 day series.
A validated upper arm monitor with a cuff that fits your arm. Wrist devices are less accurate at the pressures that matter, and a cuff that is too small reads falsely high. Bring your monitor to the appointment and it can be checked against ours.
The chance of a specific underlying cause is higher, so the assessment goes further. Kidney function, potassium and hormonal causes are looked for rather than assumed absent, because finding one changes the treatment completely.
This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.
European Heart Journal, European Society of Cardiology
Guidelines on cardiovascular disease prevention in clinical practiceESC guideline, 2021
European Heart Journal, European Society of Cardiology
Guidelines for the management of elevated blood pressure and hypertensionESC guideline, 2024
New England Journal of Medicine
A randomised trial of intensive versus standard blood pressure control, SPRINTWright, 2015
NICE
NICE
Stroke and transient ischaemic attack in over 16s, diagnosis and initial managementNG128, 2022
NICE
NICE
Cardiovascular disease, risk assessment and reduction, including lipid modificationNG238, 2023
The BMJ
Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular diseaseHippisley Cox, 2017
Written by the clinical team at The Wellness. Awaiting clinical sign off.
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