What is normal blood pressure?
For those under 80 years of age, your average blood pressure when monitoring at home should be below 135/85 mmHg. A reading of 134/84 mmHg is acceptable, but 135/85 mmHg is not. If either the top number (systolic) or the bottom number (diastolic) is high, it indicates high blood pressure, medically known as hypertension.
For individuals 80 years and older, a higher systolic pressure is allowed, with the target average being below 145/85 mmHg.
In a health professional’s clinic, the target blood pressure readings are slightly higher than those for home monitoring.
Did you know?
As you age, you are more likely to develop hypertension. In fact, 60% of people aged 60 and over have been diagnosed with high blood pressure. Because of this, we recommend purchasing a home blood pressure monitor and checking your readings regularly. If you do this, bear in mind that if your upper arm circumference is large, you’ll need a monitor with a large cuff. Using a normal-sized cuff on a larger arm can overestimate your blood pressure readings.
Why is blood pressure important?
High blood pressure is a major risk factor for heart attacks and strokes. It can also cause kidney damage and eyesight problems. The key to preventing these issues is to treat hypertension early, as many of these complications develop over years.
Does high blood pressure cause symptoms?
Usually, no, which is why hypertension is often referred to as the “silent killer.” However, in very rare cases, if blood pressure rises rapidly or reaches extremely high levels, it can cause symptoms such as headaches, chest pain, and vision problems.
Should I worry if I get a very high reading at home?
Severe hypertension is defined as a blood pressure reading greater than 180/120 mmHg (either number). People with severe hypertension have been found with readings in excess of 300/190 mmHg, which is extremely dangerous.
If you get a high reading like this, try to relax and repeat the measurement several times. If it remains severe, contact us immediately to start or modify treatment that same day. If you also feel unwell with symptoms such as a headache, chest pain, or visual disturbances, you should go to the Emergency Department immediately.
DO I NEED AND ANTIBIOTIC FOR MY CHEST?
Most commonly infections of the nose, throat, sinuses, ears and chest are caused by viruses - THIS IS ESTIMATED TO BE AROUND 90%. Antibiotics do not kill viruses, they only kill bacteria.
It can take up to 10 days to "turn the corner" and start feeling better from a viral cold. Antibiotics may make you feel worse. It is quite normal for a cough from a chest cold to take 3-4 weeks to settle. This is due to irritation of the respiratory tubes taking longer to settle after the bug has gone. Antibiotics will not clear the cough any quicker.
The single biggest determinant as to whether an antibiotic will work is how generally unwell you feel (e.g. feeling totally wiped out, stuck in bed, not eating or drinking). Definite shortness of breath and chest pain are also symptoms you should contact us about.
Antibiotics may have side effects that include: stomach upsets, diarrhoea, rashes and thrush. The more antibiotics you take, the less effective they become at fighting more serious infections, as your body's bacteria build up a resistance against them. They also destroy your guts natural microbiome which is thought to be important for maintaining a strong functioning immune system.
It is good medical practice to examine a patient before deciding whether to issue an antibiotic. That said that we will occasionally issue one over the phone, particularly if you already suffer from a respiratory condition, are older or have weakened immune system.
Another option is to ask your community pharmacist for advice. Studies show for common conditions, symptoms often respond better to simple treatments eg taking Paracetamol to reduce temperature, aches and pains. Advice can also be given for specific symptoms such as sore throats, runny/stuffed nose, coughs.
SHOULD I TAKE A STATIN?
Statin drugs such as atorvastatin have been shown to reduce atherosclerotic cardiovascular diseases such as heart attacks, strokes, blocked arteries in the legs, and vascular dementia. They do this by lowering cholesterol. The plaques that block arteries contain cholesterol. By reducing the level of cholesterol in the blood, the rate at which blocked arteries develop is also reduced. This process takes years, so statins are taken long-term and not just for a course.
Do they have side effects, and can they be dangerous?
Common side effects of statins are:
1. Muscle Pain (Myalgia): This is the most frequently reported side effect and can range from mild discomfort to severe pain.
2. Digestive Problems: These can include nausea, constipation, diarrhea, and indigestion.
3. Increased Blood Sugar Levels: Statins can lead to higher blood sugar levels, which may increase the risk of developing type 2 diabetes in some people. This small risk is offset by the benefits when considering the reduced risk of atherosclerotic cardiovascular disease.
4. Liver Damage: Statins can cause elevated liver enzymes, which are typically monitored through blood tests. We suggest having a liver blood test 3 months after starting and then annually thereafter. Severe liver damage is rare.
There is a rare but severe side effect called rhabdomyolysis. This is a serious condition involving the breakdown of muscle tissue, leading to the release of muscle fiber contents into the bloodstream. This can cause kidney damage and other severe complications. It makes you very ill and is not linked to the mild aches you may have as a common side effect. The risk of developing rhabdomyolysis from statin use is very low, estimated at approximately 1-2 patients per year for every 10,000 patients taking it, or about 0.01% to 0.02%. While the risk of rhabdomyolysis is minimal, it is important for patients on statins to be aware of the symptoms, such as severe muscle pain combined with weakness and/or dark urine, and to seek medical attention promptly if they occur.
How does a doctor decide who would benefit from taking a statin?
Rather than use the actual cholesterol result, doctors now use a risk prediction calculator called the QRISK3 score. This is evidence-based and uses lots of information such as age, blood pressure, diabetes, smoking, as well as the ratio of total cholesterol (the bad cholesterol) to HDL (the good cholesterol). For every patient aged 40-85, we can determine the risk-benefit ratio, i.e., whether a statin would do more harm than good. Interestingly, using this prediction risk score, everyone benefits from a statin regardless of what their cholesterol is by simply age alone. Men in their late 60s and women in their early 70s tend to cross the threshold where benefits outweigh risks even when they have “good” cholesterol levels. This has divided opinion amongst medical professionals, with some saying we shouldn’t medicalize normal society and others saying the evidence shows that statins can benefit all.
So, to answer the original question, the decision to take one should ideally be assessed after someone has had their lipid profile blood test taken and their blood pressure checked. The doctor, looking at the result, will then use the QRISK3 score to determine whether a statin would be beneficial and leave a note to this effect when the patient phones in for the results.
We recommend having a lipid profile blood test when you reach 40 years of age and then every 3-5 years thereafter. You can make an appointment with our nurse to have this done without having to discuss it with a doctor.
Why does the doctor not just advise a low cholesterol diet?
We do! But while a good diet can lower your cholesterol by around 12%, a statin can do it by around 33%. A statin should not be used as a substitute for a bad diet.