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Hypertension: Diagnosis and treatment

Dr Alister McNeish explains diagnosis and treatment of high blood pressure, which is major risk factor for cardiovascular disease.
So how is blood pressure detected? Well actually, most of us have probably had this done at the doctor’s. It’s done using a device called a sphygmomanometer. And what this device does is it measures blood pressure on a scale called millimetres of mercury, or sometimes referred to as the mercury scale. Essentially, the device has a cuff that can be inflated with air. And you inflate the cuff until the blood flow is completely stopped, normally in the main artery of the arm. Once this happens, the pressure is slowly relieved from the cuff, and the doctor or medical practitioner can listen to the heartbeat. So you would get two values. The first value is called a systolic blood pressure.
This is the blood pressure when the heart is contracting and pumping blood out. The second value is normally a lower number, and it’s called diastolic blood pressure. This is the value when the heart is resting in between heartbeats. So what is normal and high blood pressure, or hypertension? Well, normal blood pressure is considered to be a systolic blood pressure of less than 120 millimetres of mercury, and a diastolic pressure of less than 80 millimetres of mercury. Clinically defined, hypertension or high blood pressure is a systolic blood pressure of greater than 140 millimetres of mercury, or a diastolic pressure of greater than 90 millimetres of mercury, whichever is higher.
Now here at Reading School of Pharmacy, we teach that people who have blood pressure values in between the normal and hypertensive values do not require treatment, but should be offered lifestyle advice, such as changing their diet or increasing exercise to keep their blood pressure within normal ranges. People who have been diagnosed with hypertension will require lifestyle advice, but will also require medication. So for people with newly diagnosed hypertension in the UK, there’s a strict treatment regime called the ACD strategy. The ACD refer to drugs that you’ll be treated with. Normally people will receive either an ACE inhibitor - that’s A– or a calcium channel blocker - C - as a first line treatment.
And this treatment is based on your age and your racial background, as well as other underlying medical conditions. If this still fails to control your blood pressure, then you will also be given a diuretic drug - D. If you’re unsure about this information, you can ask your GP or your pharmacist for further information. They can give advice on the medications used to treat high blood pressure, and also give you advice on lifestyle changes you can make to control your blood pressure.

Dr Alister McNeish continues to look at hypertension explaining how blood pressure is measured, values that are considered normal, and what can be done to regulate it.

The ACD strategy

In the UK, hypertension in adults is normally treated by applying the National Institute for Health Care and Excellence (NICE) ACD strategy (part of Clinical Guidance 127). The ACD strategy defines an approach for using different medications: ACE inhibitor (A), a calcium channel blocker (C) and a diuretic (D – normally a thiazide-like diuretic) either separately or in combination.

The ACD strategy can be broken down into three steps:

Step 1: A
Step 2: A+C
Step 3: A+C+D
Step 4: for resistant hypertension, in addition to A+C+D, another diuretic, an alpha blocker or a beta blocker would be considered, in addition to obtaining help from a specialist.

You can download the Week 3 supplement, which contains additional images and descriptions to help you understand the topics covered in this video.

British Heart Foundation resources

Find out more in the following, optional, video High blood pressure and heart disease; one of a series, produced by the British Heart Foundation Risking it: Fighting against risk factors in coronary heart disease.

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Heart Health: A Beginner's Guide to Cardiovascular Disease

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