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Anon asked...

I have suffered with high BP for around 4 months now...

I have suffered with high BP for around 4 months now, the last reading on the 31st January was high yet again, I am prescribed Ramipril - firstly at 2.5mg and then increased to 5mg, 7.5mg and now 10mg - is this something that should go on for this long without being rectified? Is it something that I can pursue privately with you and be covered for?

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The answer

Thank you for writing in to Ask the Expert.

Blood pressure is how we measure the force that is required to push the blood out of our hearts to the rest of our body.

The exact cause of a high blood pressure (hypertension) is often not known in individuals, but is associated with the following risk factors. We can learn how to reduce and manage some of these risk factors and this should be done as early as possible in our lives to reduce ill-health and disease.

Risk factors for hypertension include:

  • Being overweight or obese
  • Consuming too much salt in our food
  • Drinking too much alcohol
  • Smoking
  • Not exercising enough
  • A family history of high blood pressure
  • Increasing age
  • Our ethnicity, being African or Caribbean

There are also known medical causes of a high blood pressure and some of these include: thyroid problems, kidney diseases and obstructive sleep apnoea. Some medications can also cause a high blood pressure and some examples of these would be steroids and the combined oral contraceptive pill.

A high blood pressure is defined as a blood pressure that exceeds 140/90mmHG or higher and this will often require lifestyle changes and treatment, this is especially so if you have cardiovascular risk factors. A low blood pressure is defined as a blood pressure that is lower than 90/60mmHG or lower.

If your blood pressure is between 130/80mmHG and 140/90mmHG and you have any of the following conditions, then it may be advised to start medications to lower your blood pressure still further.

  • Kidney problems
  • Transient Ischæmic Attack
  • Complications of diabetes
  • Have had a stroke
  • Have had a heart attack

In your particular circumstance, you say that you have been commenced on Ramipril.

With any blood pressure medication you are usually commenced on a low dose and then this is gradually increased as your body adjusts until the dose that keeps your blood pressure at a safer level is found.

The process of increasing the blood pressure medication, is usually done in stages of 1-2 weeks duration over a period of a few months until a maximum dose is achieved or until the effective dose is found.

Your GP should me monitoring you closely through means such as BP checks and blood tests in order to determine whether the medication is having the desired effects of lowering your BP, to assess the need for further medications as well and to observe for side effects caused by medications being taken.

We would say, at this stage, that you may need to be reviewed again by your GP, to see whether there have been any positive changes to your BP as a result of the medication or whether you need to be tried on other types of medication.

As a rule, BP medications are a long term requirement and therefore monitoring of the condition and prescribing are to be done by your local GP rather than Specialists.

Private medical insurance does not usually cover long term management of issues such as raised BP but may be used if investigations are required where raised BP is part of the symptoms being caused by other medical concerns. This would need to be discussed with your policy team in order to establish what medical care cover you have.

We would suggest that you liaise with your GP regarding treatment and management and, whether your high BP is linked to any other medical conditions. If there are other concerns then it may be appropriate for a specialist referral and this can then be discussed by your policy team regarding cover.

We hope this helps.

Answered by the Health at Hand nurses