Pressure You Can't Feel

Read This First

High blood pressure does most of its damage while you feel completely well. For a lot of people, the first thing they ever feel from it is a stroke. This book is here so that yours shows up on a cuff first.

Who this book is for

• You've been told your blood pressure is "a bit high", and nobody said what that means or what happens next.
• A parent or grandparent had a stroke, kidney failure or heart failure, and you've started to wonder about your own numbers.
• You were given tablets and stopped them because you felt fine, felt worse, or ran out. Or you've never had your pressure checked at all.

What this book will and will not do

It will show you how to get real numbers, taken properly. It explains what years of quiet high pressure do to your brain, kidneys, eyes and heart. It covers why people stop their tablets and what happens when they do, and which everyday products push your pressure up. And it gives you a plan you can take to a clinician.

It will not diagnose you, choose your medicine or set your target. It is general health information, not medical advice, and it does not replace an assessment by a clinician who can examine you. Nothing in it is a reason to stop, cut down or swap a blood-pressure medicine on your own. Where a decision belongs to you and your prescriber together, the book gives you the exact question to ask.

Call your local emergency number now if you have:

• a very high reading together with chest pain, breathlessness, a severe headache, a change in your vision, confusion, or weakness or numbness
• sudden face drooping, arm weakness, slurred or strange speech, sudden loss of balance or sudden vision loss (stroke signs: note the time)
• severe headache, vision changes, or sudden swelling of the face or hands while pregnant or in the weeks after giving birth
• sudden, severe pain in the chest or back: sharp, stabbing or tearing

Emergency numbers: Kenya 999 or 112 · US 911 · UK 999 or 112.

The full list is on the Go Now card at the back of this book. Find it now, before you need it.

How to read it

Chapters 1 and 2 are for everyone: why you can't feel high blood pressure, and how to measure it so the numbers mean something. Read those first.

After that, go where you need to. Chapter 3 covers causes, including the hidden ones worth testing for if you're young. Chapters 4 to 6 cover what pressure does to your brain, kidneys, eyes and heart. Chapter 7 is about pregnancy. Chapter 8 is about stopping tablets and Chapter 9 about the products that raise your pressure. Chapter 10 explains why high blood pressure often starts earlier in people of African descent. Chapter 11 brings it all together.

Every chapter ends with one action. The book ends with your Pressure Plan: a two-week home-reading log, your target as agreed with your clinician, your medicines and questions, and the things that push your own numbers up.

Stories in this book

Some stories are composites; names and details are changed. Where a story is a real, published case, it is cited, and the details come from that published source. No composite carries a real person's quote, a real clinic's name or a precise statistic.

About this book

This book is educational. It is not medical advice, and it is not a substitute for a clinician who knows your history. If you have warning signs now, use the Go Now card or call your local emergency number. For everything else, take the questions in this book to a doctor, nurse or pharmacist.

Your first action

Turn to the Go Now card at the back. Take a photo of it on your phone now.

The Silent Killer in Young Adults

You walk past it every week. The blood-pressure machine by the door of the chemist, or the one in the supermarket next to the scales. Sometimes there's a nurse at a table outside a church or a mall, offering free checks. You think about it for half a second. Then you think: I feel fine. I don't have time. That's for old people. And you keep walking.

Sound familiar?

• You haven't had your blood pressure checked in years, and you're not sure you ever have.
• Someone once said your reading was "a bit high", and you put it down to the stairs, the traffic or the coffee.
• You figure you'd know if something was wrong: headaches, a red face, nosebleeds.
• You've had headaches, and blamed them on screens, stress or not drinking enough water.
• One of your parents takes "pressure tablets", and you've never asked what that means for you.
• You think of stroke as something that happens to grandparents.

Here is the problem with every one of those. High blood pressure almost never causes symptoms. Feeling fine tells you nothing about your pressure. Only a cuff reading does. That is why it is called the silent killer, and it is why so many people meet it for the first time in an emergency department.

Jon, 39

Jon was 39, a father of two young children in Lancashire, in the north of England. He was overweight, didn't exercise, worked away from home a lot and, in his own words, didn't look after himself. He had never really had his blood pressure checked.

On 15 December 2014, ten days before Christmas, he had a stroke at work. It was caused by high blood pressure.

Jon was lucky in the way that matters most with a stroke: his workplace was about two minutes from the local hospital, so he was treated fast. He spent a week in hospital and six months off work. He made a full recovery, and his pressure is now controlled. He tells his story so other people get checked.

Here is what Jon did not know, and what this chapter is about. His high blood pressure had probably been there for years. A cuff would have found it on any ordinary day. Nothing he felt would have.

Why you can't feel it

Your blood pressure is the force of blood pushing against the walls of your arteries, the tubes that carry blood from your heart to every part of your body. Every heartbeat sends a surge through them. Between beats, the pressure drops but never to zero.

Hypertension is the medical word for blood pressure that stays too high, day after day. Not one high reading after you ran for a bus. Pressure that is high most of the time, including when you're resting.

The reason you can't feel it is simple: nothing about steadily raised pressure turns into a sensation you'd notice. Your heart works harder, the walls of your arteries thicken and stiffen, the tiny vessels in your brain, kidneys and eyes take a beating, and none of it sends a signal you would notice. You go to work. You sleep. You feel normal.

The NHS puts it plainly: high blood pressure "does not usually cause any symptoms". The World Health Organization says the same: most people with hypertension don't feel any symptoms, and the only way to know is to have your blood pressure checked.