the magazine of Blood Pressure UK ISSUE 46 > WINTER 2019 POSITIVE

WHO WERE THE LAST HEROES OF HYPERTENSION? Professor Gareth Beevers takes a look back at the great minds who shaped blood pressure history

OUR FAVOURITE KNOW YOUR NUMBERS! WEEK YET Sponsored rows, radio shows and headlines swept the nation ANYONE FOR TEA? The drinks for all seasons that will help you look after your numbers WE FEEL A NEW CAMPAIGN COMING ON Could combination pills be the answer for better blood pressure control?

Helping you to lower your blood pressure FOLLOW US ON LIKE US ON Blood Pressure UK Wolfson Institute, Charterhouse Square, London, EC1M 6BQ. Telephone: (020) 7882 6255 www.bloodpressureuk.org email: [email protected] § Welcome

is the magazine From Katharine Jenner, Chief Executive Officer of UK charity, Blood Pressure UK. We aim to significantly improve the This year two huge problems with the food we eat have made themselves prevention, diagnosis and treatment of known in such a way that they can no longer be ignored. The first is the

Healthy Eating high blood pressure in order to prevent damage to the environment, and the second is the damage to our health. death and disability from stroke and The last six months have seen an avalanche of news stories showing how heart disease. We are an independent registered charity and rely on donations pressing matters have become. More young adults have high blood and grants to carry out our work. All pressure than ever, people are having strokes and heart attacks younger, views expressed within the magazine and even the numbers of children with high blood pressure are growing are those of the authors and do not necessarily reflect those of Blood with the rise in obesity. Pressure UK. The information in this Globally, we are the first generation more likely to die as a result of magazine is designed to support and lifestyle choices than infectious disease. When food is both what keeps us supplement your relationship with your doctor, not to replace it. alive, and what kills us, the food system is broken. But all is not lost. We’ve been busy talking to the Department for Environment, Food & Rural Affairs (Defra) about tackling inequalities in Patron access to healthy food. We’re standing up for salt reduction as the Sir David Attenborough Department of Health and Social Care develops their plans for disease BOARD OF TRUSTEES prevention, and we’re getting involved with promoting sustainable and Chair healthy restaurants. Professor Graham MacGregor There are many more reasons to be hopeful too. Defra have launched Treasurer the first ever investigation into, and possible overhaul of, the UK food Guy Biggin system in 75 years, pharmacies are taking on a greater role in finding Professor Gareth Beevers people who don’t know they have the pre-cursors to serious illness, and Nirmala Markandu this year’s Know Your Numbers! Week was greeted with so much Professor Bryan Williams Professor Mark Caulfield enthusiasm there are clearly huge numbers of individuals and healthcare Dr Rebecca Suckling teams dedicated to the care of their communities. We hope you enjoy this issue and reading about all that’s going on in STAFF the blood pressure world. Before you settle down for a read, why don’t you Chief Executive Officer Katharine Jenner make yourself a cup of tea or coffee, which as you will see on page 12, Marketing Manager could even help lower your blood pressure. Hemini Bharadia Editor Kay Dilley SIGN UP Design FOR YOUR COPY OF www.chapmandesign.net POSITIVE PRESSURE Print If you’ve enjoyed this magazine but this Captiv8UK 01892 611500 isn’t your own copy, then why not sign up to become a Blood Pressure UK member and have your own Positive Pressure Company number: 3251531 delivered direct to your door, together Company Limited by Guarantee with a host of other members’ benefits? Registered charity in England and Call us on 0207 882 6255 Wales (1058944) and in Scotland or visit (SC040230) www.bloodpressureuk.org/ Supportingyou

2 Out and about A few things we’ve been up to lately

A glamorous day out We went to London’s stunning V&A museum for the launch of Queen Mary University of London’s 2030 strategy. They presented their plans for progress in medicine and we talked to potential collaborators about our work. We paid a little Lessons from the visit to the Dior exhibition while we were cutting edge there. Fabulous darling! We heard from the experts at the Primary Care Today

Issues & Answers OUT AND ABOUT conference – the education event of the year for front line health Legal highs professionals. Our We had queues of lawyers and legal professionals resources were so popular waiting for a blood pressure check at The Crown they were all gone by the Prosecution Service’s health and wellbeing event end of the day. And we may have given out one or in Westminster this summer. Of the 105 we tested, two free bp checks. three quarters had no idea of their blood pressure when they arrived, but a quarter had a reading A healthy team over 140mmHg. In around half of those it was is a happy team very high – over 160mmHg. We gave free pressure checks and health advice We were able to encourage them to see their GPs for medical care which they to the enthusiastic and wouldn’t have had otherwise, showing how much events like these really work. youthful team at talent consultancy GatenbySanderson in London. They find leaders for public services and not ONE OF OUR FAVOURITE KNOW for profits and we were YOUR NUMBERS! WEEKS YET very happy to support their Mental Health Week. Our flagship campaign is always a high point, but the support and enthusiasm this year really took us aback. In conversation There were news headlines, twitter storms, half a million with Defra visitors to our website and of course, a whole lot of Our CEO Katharine spoke blood pressure checks (page 10). on a panel at the Department for Environment, Food & Rural Affairs in September about their EXERCISING OUR BRAINS AT THE BIHS National Food Strategy ANNUAL SCIENTIFIC MEETING (page 8). She gave an There were lots of interesting updates at this impassioned speech on how the unhealthy foods year’s British and Irish Hypertension Society we’re surrounded by are (BIHS) meeting, and the evening reception ruining our health, and was a fun affair. We hosted a stand, and the how lowering fat, salt and Nurses Allied Health Professionals Working sugar in food Party celebrated 10 years of joining the is the most effective BIHS. The celebratory mug they gave us way to improve it. has pride of place in our office.

3 POSITIVE PRESSURE Blood Pressure News

GOVERNMENT PLANS TO PREVENT DISEASE NEED TO TAKE A HARDER LINE We’re fighting for stronger commitments in The new NICE preventing unnecessary deaths and disability guidelines are NEWS The Department of Health and finalised, and don’t Social Care (DHSC) have put together a new Green Paper detailing go far enough how it plans to prevent diseases of the heart and blood vessels, shifting New recommendations for health the focus of health care to professionals don’t make enough prevention rather than cure. But progress in tacking high blood pressure there is a widespread view among In the Summer issue of Positive health professionals and charities Pressure, we let you know that the that they’re missing an opportunity National Institute for Health and Care to go so much further. Excellence (NICE) had released a draft This paper, Advancing our Health, of their updated guidelines for health Prevention in the 2020s, includes are not enough to tackle widening professionals diagnosing and treating many positive steps, like more health inequalities, obesity, high high blood pressure. They included only support for quitting smoking and blood pressure, and the worsening a modest change to treatment alcohol, and launching a prevention health of children and young people. guidelines from the 2011 version, programme at work, among many We fed back our views on the draft suggesting doctors consider medicines more. The problem is, these changes paper, which is now being finalised: for people with a 10% risk of serious illness in the next ten years instead of WE NEED A RENEWED FOCUS a 20% risk. 1 The idea is sensible enough, making ON SALT REDUCTION treatments available sooner rather Salt reduction is a cost-effective and simple way to improve health and has than later for people with blood been very successful in the past. The Government have set targets for food pressure over 140/90mmHg. But in manufacturers to lower the amount of salt they add to food. But, there practice it’s unlikely to make any real seems to be a lack of interest from manufacturers in meeting them, and difference as GPs already consider from the Government in enforcing them. So, the strategy must evolve to: multiple factors in deciding when to • educate the public offer medicines. • be monitored independently rather than by the businesses themselves There was also little emphasis on • improve food labelling home monitoring, despite strong • bring the out of home sector on board. evidence that it helps to control blood pressure. 2 NHS HEALTH CHECKS NEED MORE We fed back our view that the FOCUS ON PREVENTION guidelines need to go further, but Health Checks for 40-74-year olds should be done with a stronger focus on unfortunately, NICE didn’t change prevention, so that even people who are healthy at the time receive their recommendation in the final healthy living advice. The age range should also be extended beyond 74 version, published this August. so that everyone has access to encouragement and support. With options like home monitoring, using combination pills (page 9) WE NEED MORE EDUCATION or a lower target blood pressure of 3 130/80mmHg, there were opportunities FOR HEALTH PROFESSIONALS for real progress that have been missed to Doctors receive an average of six hours of nutrition education in medical support the huge numbers who don’t have school, but we feel it should be longer so that they can give evidence- their blood pressure under control. based advice to patients, and easily judge when to refer on to a dietitian.

4 POSITIVE PRESSURE chemical too Salt is justa 2017 theexpertsatScientific worries abouthealthrisks.But,in seemed tobebasedonunfounded guidelines andthedecision exclude potassium saltsfrom the people don’tcurrently eatenough. is goodfor bloodpressure, and raises your potassium intake which your bloodpressure. What’smore, it contain sodium,itdoesn’traise regular salt, butbecause itdoesn’t reason why. pressure’. Butthere was noclear lower saltintakes andlower blood sodium chloridecouldbeusedto of potassium chlorideinstead of recommendation that‘saltmade draft guidelinesremoved the There issome goodnews.The BACK INTO THENICEGUIDELINES POTASSIUM SALTS WEREADDED OUR CAMPAIGNING MEANT There wasn’t aclearreason to Potassium salttastes similarto

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5 NEWS Blood pressure news

Addicted to salt New survey reveals Brits are so addicted to salt, we even add it to takeaways NEWS A new survey of 2,000 people by LoSalt has shown the extent of the UK’s taste for salt, and how little THE SALTY PRODUCTS LURKING people know about its link with blood pressure. The results were IN YOUR CUPBOARDS New surveys have revealed yet more blood pressure-raising foods pretty shocking: • Eight out of ten add salt to their MEAT ALTERNATIVES We’re in favour of eating less and better meat and food while cooking or at the more veggie food – for health and the environment – but unfortunately table, a clear sign that we’re still many meat-alternatives aren’t yet in the healthy category. addicted to salt. Meat-free burgers contain more salt than meat burgers • Almost a third (29%) don’t on average, while all meat-imitation products – ham, understand why salty food is kievs, mince, sausages, you name it – had more salt harmful, and that it’s the biggest than their maximum salt target, even Greggs cause of high blood pressure, famous vegan sausage roll. Disappointing. despite national campaigns to raise awareness. PICNIC FOOD Whether you’re having a winter • One in eight add salt to buffet or a summer picnic, a selection of savoury microwave meals and snacks can easily take you over the 6g a day takeaways, even though some maximum for salt. A portion of olives can contain takeaways already contain more nearly 2g, Cornish pasties can contain nearly 3g, and pork than a day’s worth. pies, sausage rolls and savoury eggs will all add up. • People believe they eat just 3.2g of salt a day, but the average is PANCAKES, WAFFLES, PRETZELS, CREPES When you buy these foods out more like 8g, well over the of home they can contain more salt than a McDonalds! One cheese crepe healthy target of less than 6g. contained more salt than three Big Macs, with an unbelievable 8.5g of salt. This shows how hard it is to know So, what do these European batter-based delights have in common? how much salt you’re eating. They’re all full of salt, sugar and fat. Eat like the French and only have a little. • Almost half (44%) said they wouldn’t stop using salt TABLE SAUCES, ASIAN SAUCES AND MARINADES Asian sauces always regardless of the consequences tend to be salty, but they might be worse than you think. Fish sauce can for health. More worrying than contain 4g in just one tablespoon and soy sauce can contain almost 3g. the lack of knowledge was that Marinades like Piri Piri and staples like tomato ketchup, mayonnaise and many just don’t seem to care. brown sauce can also be a problem, around half would get a red traffic light label for salt. Worst of all, some have even been If salt intake fell by WELL DONE getting saltier. a third it would prevent 8,000 HEINZ Congratulations to Heinz for premature deaths and their No Salt Added Tomato GET SALTSWITCH save the NHS over Ketchup. It contains 96% less £500 million each Get the SaltSwitch app on your phone sodium than regular ketchup year. This survey to scan in products and find healthier AND it tastes good. We’re shows just how much alternatives while you shop. Now with impressed. work there is still to do. lots more products in the database.

6 POSITIVE PRESSURE Blood pressure news

High blood pressure now affects children and young people High blood pressure is no longer some-

thing that only affects older adults NEWS High blood pressure Now even kids have high blood pressure on the rise in young As many as one in twenty (5%) children around the world aged 19 and adults under have high blood pressure, and another tenth (9.7%) have pre-high blood pressure, according to a major new review by Oxford University. The A study of 140,000 people by numbers doubled between 2000 and 2015, rising with the obesity LloydsPharmacy found that a epidemic. staggering two thirds (66%) of under 35s have high or pre-high blood pressure, and a third (35%) Heart attacks and strokes becoming more have above average or high common at a younger age cholesterol. There has been a 4% rise in deaths from diseases such as stroke and heart disease in High blood pressure the under 65s in the last five years, early on linked to poorer according to new research from the BHF. brain health A study in Lancet Neurology found that raised blood pressure during your 30s and Blood pressure in young 40s was linked to smaller brain size. This does adulthood determines health not prove a link with dementia, but the link is in later life plausible and is being explored. It was already known that blood pressure in midlife in part dictates your health later on. Now, US researchers have shown that raised numbers from age 18 to 39 are also linked to a higher risk of heart disease, heart failure and Is bedtime the best time to take stroke in older age. your blood pressure medicines? Your blood pressure and cholesterol A major new study shows that taking blood pressure medicines at numbers matter throughout your night could halve the risk of heart disease and strokes whole life, and families need education so Growing evidence shows that many different drugs might work better if taken at that young people can develop healthy specific times of day. Experts believe this is because our biological clock, or habits. The Government’s current Childhood natural 24-hour rhythm, affects the ways our bodies respond to them. It was Obesity Plan does nothing to address this often assumed that blood pressure tablets were best taken in the morning, as and needs to be reviewed straight away. blood pressure is higher during the day than at night. At the same time, there’s lots of evidence Now, a new trial of 19,000 people in Spain has found that those who took their showing that healthy lifestyle changes have pills at night had lower average blood pressure during the day than at night (and a positive effect no matter what your age. you might be more likely to remember to take them in the morning!), and half So, don’t be put off, it’s never too late to the risk of a heart attack, stroke or heart failure over the next five or more years, start. compared to people who took their pills in the morning. The most important thing is to take your blood pressure medicines as prescribed, so speak to your doctor if you’re having trouble. Then, if it fits your daily routine, why not try taking them at night and use a home blood pressure monitor to see if it makes a difference for you? 7 POSITIVE PRESSURE Blood pressure news

were to have serious heart problems. But the authors think this is probably because other health problems were making them feel tired, rather than Get your that napping caused ill health. The authors said: “While there SLEEP remain more questions than answers, it is time to start unveiling the power NEWS ON of naps for a supercharged heart.” for between five minutes and an hour This study isn’t strong enough could improve heart health. In a study to show if siestas can affect of 3,262 people, those who napped your heart health, but we’re happy to Could a quick nap once or twice a week had around half make the excuse for a quick snooze. lower your blood (48%) the risk of heart attack, stroke or We also know that good sleep at pressure? heart failure over five years than those night will do wonders for your well- who didn’t nap at all. being. Visit www. nhs.uk/live-well for A new study in Switzerland has Interestingly, the more people advice on getting a good night’s suggested that napping twice a week napped above this, the more likely they sleep.

HEART HEALTH ON THE HIGH STREET Pharmacies take on a bigger role in preventing illness High street pharmacies have started offering free health checks to customers as part of a new £13 billion plan from NHS FOOD PRODUCTION IN THE UK England to prevent diseases like GETS A HEALTH CHECK heart attacks and strokes. 320 pharmacies are taking part The National Food Strategy is Leon and the Sustainable in the plan, launched on October launched to make food Restaurant Association. 1, offering checks for blood production sustainable, fair and His recommendations will be pressure, cholesterol and irregular healthy, from field to fork. published next year, aiming to heartbeat. The aim is to reach make food healthy and affordable people at risk of illness before For the first time in 75 years, the for everyone, and make sure food any problems develop, giving entire food system is being production contributes to well paid them the chance to get lifestyle investigated to see how cost- jobs, fair economies, and enhances advice and medicines earlier on. effective, robust and healthy it is. the natural environment. If successful, the checks will be The aim is to find out what’s The strategy should benefit rolled out to all UK pharmacies working, and what’s not, so that everyone no matter their over the next three years. changes can be made for a income or postcode, while protecting Pharmacies are perfectly sustainable future. the environment and placed to give health The project, launched this improving health. We checks because they can reach summer, is being led by Defra look forward to an people who wouldn’t normally (Department for Environment, Food innovative and bold go to the doctor unless they & Rural Affairs) and headed up by new strategy that have to. Henry Dimbleby (pictured), incorporates our co-founder of restaurant chain suggestions.

8 POSITIVE PRESSURE Blood pressure news

“I can’t thank you enough” WINTER The difference a phone call makes APPEAL “I can’t thank you enough for taking the time and the trouble to answer all my This Winter, can you help us to keep questions and for sending me all the giving much-needed support to people information which has helped so much.” with high blood pressure? “It was a pleasure talking to you. You gave me good advice and, most of all, Our hypertension nurse Nirmala has become a well-known confidence.” voice to many of our members, providing an invaluable service “I understand much more about the for people concerned about their blood pressure. Whether condition now and how the various blood they don’t have enough support locally, or just need to hear a pressure conditions work.” reassuring voice, it’s important that they have someone to speak to for independent trusted advice and guidance. “You were very helpful and I appreciate

To keep our helpline service running is always a challenge, so, your kindness.” APPEALS AND CAMPAIGNS this Winter we are asking if you would consider making a “Thanks for talking to me yesterday. You donation. Your support can make a real difference and is very were a big help and I'm feeling less much appreciated. anxious. Anxiety is a bad thing to have with regards to your body. Once you get THERE ARE MANY WAYS TO GIVE that under control everything else settles.” • Online: visit www.bloodpressureuk.org “Thank you so much for that great • By phone: Call 020 7882 6255 information. It has guided me • By post: Send a cheque to 'Blood Pressure UK', postal through – I have registered in a order or charity voucher to the Freepost address on the zumba class and I’m walking a lot

inside front cover. so I hope this will help me.”

WHY AREN’T COMBINATION PILLS USED MORE? Combining blood pressure medicines But there is a solution. There are combination pills. We feel they have into a single tablet has been shown to tablets available which combine missed a trick – it’s time to bring them help people stick to their medicines, multiple medicines into one tablet. into use. control their blood pressure, and lower There are various combinations and their risk of heart attacks and strokes. doses available, they’re inexpensive, Time to investigate They’re used around the world but are and they’ve been shown to improve We’re going to find out why these hardly used in the UK. We want to find compliance and blood pressure control. tablets aren’t used in the UK. Once out why. we’ve got an answer we’ll be a step One of the biggest challenges to Why we need a Blood Pressure closer to bringing them into use. Watch keeping blood pressure under control is UK campaign this space. taking medicines as prescribed. It’s Combination tablets aren’t often used very common to need more than one in the UK, even though they are medicine, and research shows the more common throughout the rest of the medicines people have to take, the less world. The European Hypertension likely they are to take them. Society Guidelines and the US But skipping medicines comes at a equivalent both recommend them as high price. Without taking them every the first line drug treatment for high day, high blood pressure stays high. In blood pressure. The National Institute the long run, the results can be for Health and Care Excellence (NICE) catastrophic, including heart failure, recently updated their UK blood heart attacks and strokes. pressure guidelines and don’t mention

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POSITIVE

KNOW YOUR NUMBERS! WEEK We had so much support for this year’s campaign we almost couldn’t believe it 2019 KNOW YOUR NUMBERS! KNOW YOUR

Making headlines This year our theme was Live well for longer – as many people are now able to live such long lives, but not he only way to Know Your Numbers! is to get a blood pressure necessarily in good health. test. That’s why, every year, we do everything we can to reach If the 6 million people in the UK those who don’t know theirs. T who don’t know their numbers got This year we made radio appearances, news headlines, and even tested, this could save 230, 000 featured on Arsenal football club’s website. But the most important people from disease and £120m for events were the pop-up venues we call Pressure Stations, offering free the NHS and social care system over blood pressure checks to passers-by. the next 20 years. A week of free blood pressure checks To all the pharmacies, PHE teams, CCG’s, NHS Trusts, libraries, shopping centres and places of worship who Lowering the salt at wholesale food took part, we can’t say ‘thank you’ enough. giant, Bidfood LoSalt got the week got off to a flying start at Bidfood’s well-being event. As one of the largest wholesalers in the UK, supplying hospitals, hotels, schools, pubs and restaurants, they are ideally placed to lower salt in food. LoSalt explained the benefits of less salt for blood pressure, and we gave free blood pressure checks to staff.

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We trended on twitter for the third year in a row Making a difference, saving lives There were so many enthusiastic and Chippenham Pit Stop service station on informative tweets about the M4 summed up perfectly just how #KnowYourNumbers, they reached an these events make a difference. unbelievable 52.8K people! “We had the pleasure of seeing a NHS England, NHS UK, Stroke young man in his 20’s who had Association, ME Association and unbelievably high blood pressure this Public Health England’s prevention time last year. The check shocked him lead Professor Jamie Waterall all got into action – he signed up for a healthy behind us, to name just a few. We living course, gave up smoking, hugely especially loved Barts Health Archives reduced a drinking habit and sought and Museums tweet about their help with mental health issues. He has antique sphygmomanometer. done a cookery course and is now seeking employment. “He said that the fact we had taken his blood pressure We featured on Arsenal FC’s website and made him realise the KNOW YOUR NUMBERS! KNOW YOUR We featured on the Arsenal Football harm he was causing had Club page of gladiatorfootball.co.uk given him a future. His Dad with information about our was with him and the whole campaign. The promotion is helping family has got behind him, us to reach more young people and and other members have given more men, who can be less engaged up smoking – so the snowball when it comes to health. grows!!”

Half a million people viewed our website Our blood pressure chart was a favourite as ever. A sunrise row on the River Thames Cheval Collection teamed up with Milo And The Bull boutique rowing studio, and nutrition and lifestyle expert Emma Broome of LIFE Acrobat, to host a sponsored rowing challenge to raise money and awareness for us. With two WaterRower machines on the terrace of one of their luxury residences on Making (radio) waves the Thames, the staff and residents rowed a massive 56km at sunrise. Our CEO Katharine Jenner joined Hemini Bharadia, our Idyllic. veteran presenter Eamonn Holmes – Marketing Manager, says: who lives with high blood pressure – for “With many of us living a delightful interview at talkRADIO. well into our 70s, 80s and They discussed why the week is so 90s, we want these years important and how to look after your to be healthy and happy blood pressure – including Eamonn’s for everyone. Thank you for daily dose of beetroot! helping us in our efforts to make it a reality”.

11

A CUPPA? FANCY

Fancy a cuppa? When it comes to looking after your blood pressure, you’ve probably had quite a few conversations about what to eat. But did you know that what you drink can have an effect as well?

one of these healthy drinks are to replace your medicines of course, and the evidence isn’t strong Nenough to make any really confident claims. But they won’t do any harm and might even help. So, put the kettle on, put your feet up, and take a look at these natural wonders to sip at tea time – plus a few that are best avoided.

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Tea (good old regular black and green tea) The great British cuppa is more than a comforting brew A CUPPA? FANCY

Camellia sinensis, more commonly known as ‘tea’, is the most consumed drink in the world after water. And some research suggests that people who drink around three cups a day Above: Our Editor have a lower risk of developing high Kay Dilley posing blood pressure. with her hibiscus tea: One large review found that in the Hibiscus tea The colourful "not only is it pretty and short term, tea had no effect on blood delicious, it could be pressure, but after drinking it daily for tea that is pretty good for you helping with my blood three months, it did, lowering systolic pressure too". blood pressure by 2mmHg. Green tea The leaves and flowers of area for had an even bigger effect. Hibiscus sabdariffa are rich in research, but too The effect is thought to be due to plant chemicals, called early to make any firm polyphenols making nitric oxide (a polyphenols, so they have recommendations. However, the chemical found naturally in your blood many potential uses in tea doesn’t seem to have any vessels) more active, allowing your medicine. From the Bedouins in side effects, except at very high blood vessel walls to relax – it’s the Jordan to the herbalists of Iraq, doses, so it’s safe to drink same chemical that’s involved with healers in at least 10 countries regularly. beetroot juice. use hibiscus tea to prevent Tea has other benefits as well. One heart disease. WHY NOT TRY: A cup a day, if small study found that a week of tea- Several small studies appear to you enjoy hibiscus tea. Why not drinking boosted blood vessel health, back up the effects, showing that use a home blood pressure making them less stiff. Even one cup of hibiscus tea can lower blood monitor to see if it has any effect a day was enough to relax blood pressure by up to 7.5mmHg on your blood pressure? vessels. systolic and 3.5mmHg diastolic. Another small study of people with Others suggest an effect on blood high blood pressure showed that six fats too. This dual effect is months of regular tea drinking reduced potentially very important, as potentially-harmful night-time high blood pressure and high variations in blood pressure. blood fats together cause fat to be laid down in the artery walls, WHY NOT TRY: Drinking up to four leading to disease of the heart cups of regular black tea daily with a and blood vessels. splash of milk and no sugar. Green tea These studies were small and is also a good choice. short term, so it’s a promising

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100%orange juice More than vitamin C Beetroot juice Oranges are known for their high The other nutrient, hesperidin, is The natural world’s vitamin C content which is essential a plant compound found mainly in for good health. They also contain the white pith of oranges. When blood pressure other nutrients which evidence oranges are squeezed, some of the medicine? shows help to look after your blood hesperidin makes its way into the pressure – hesperidin and juice. Beetroots are rich in chemicals called potassium. A large review of fruit juice nitrates which have been known for a The European Food Safety studies found that drinking pure long time to lower blood pressure. Authority say that potassium is orange juice regularly lowered They’re converted into a gas called proven to support normal blood diastolic blood pressure by 2mmHg. nitric oxide in the blood which allows pressure, and one glass of orange It appears to improve the health of your blood vessel walls to relax. juice contains more than a tenth of small blood vessels and how well Other foods contain nitrates too – your daily potassium. they work too, along with other green leafy veg like kale, celery, drinks made with hesperidin. cabbage, lettuce, rocket, spinach, In one trial, overweight men

A CUPPA? FANCY watercress and parsley. Dr Carrie Ruxton, were given 500ml of 100% Nitrates don’t last very long registered dietitian, orange juice a day for four in the body, so it’s good to enjoying a glass of weeks. At the end of the trial, have a daily dose. pure orange juice. they had lower diastolic blood Lots of small studies have pressure and improvements in shown that adding nitrates how well their blood vessels to the diet can lower blood contracted and relaxed. The pressure by around researchers believe that this was 4.5mmHg systolic (the top due to the combination of number) and 1.1mmHg or hesperidin and potassium in the more diastolic (the bottom orange juice – since a dummy drink number). fortified with only hesperidin also Nitrates appear to have reduced blood pressure, but to a other effects too. They’ve lesser degree. been shown to improve WHY NOT TRY: A daily small performance in athletes, and 150ml glass of 100% orange juice the same effects could make with a meal (to protect your teeth), a major difference to people which will count as one of your 5-a- with diseases of the heart day of fruit and veg. Make sure and blood vessels. They get that you also eat plenty of whole oxygen to where it’s needed, fruits and vegetables to reach your making exercise and 5-a-day. moving about easier, you can exercise for longer, and they reduce pain. WHY NOT TRY: Being Coffee Your morning- Even though like Eamonn Holmes the studies are (page 11) and pick-me up won’t all quite short drinking a glass of do you any harm, and in small beetroot juice a numbers of people, day, and eat lots and might even beetroot and other nitrate-rich foods of green leafy do some good seem to have a genuine effect. veg. You’d have to eat a lot to Given that coffee is the most lower your blood pressure, consumed drink in the world after NITRATES but they won’t do any water and tea, and contains hundreds VS NITRITES harm – although The nitrates in vegetables of active compounds, it’s been a big beetroot might turn don’t have the same effect area of interest for researchers. your wee red. as the cancer-causing They’ve consistently found that coffee nitrites in bacon and doesn’t raise your blood pressure in meat cooked at high temperatures. 14 POSITIVE PRESSURE

Liquorice tea body. Too much of it will make you hold onto water – raising your blood Sweet to taste, but pressure and causing swelling. BAD for blood Some people seem to be more sensitive to glycyrrhizin than others pressure so it raises their blood pressure higher. There are examples of people Liquorice comes from the root of a drinking lots of liquorice tea, thinking plant called Glycyrrhiza glabra L. and it was a healthy choice, whose blood you may know it for its flavour in pressure rose dangerously high. sweets and tea. It’s also been used in Products high in glycyrrhizin are even the long term, in fact, it might even Chinese and Japanese medicine for required to carry a warning for lower it and protect your heart thousands of years because of its people with high blood pressure. health. supposed anti-inflammatory and The European Scientific Committee One recent review including anti-oxidant effects, treating all sorts on Food recommend an upper safe 240,000 people found that each cup of ailments from coughs to liver limit of 100mg of glycyrrhizin per of coffee per day lowered the risk of disease. day. That’s exactly the amount high blood pressure by 2%. Other The sweet flavour of liquorice that’s in many liquorice flavour teas A CUPPA? FANCY reviews aren’t quite so enthusiastic comes from a chemical called – typically 50-100mg. but still showed that coffee is safe to glycyrrhizin, but this chemical has drink, appears to help with blood another surprising effect – it can AVOID LIQUORICE TEA: It raises pressure, and has benefits for heart push up your blood pressure. It your blood pressure no matter problems such as coronary artery affects a group of hormones which what it is to start with so it’s safest disease and heart failure. control the amount of fluid in your to steer clear. There is one proviso. Coffee contains caffeine, so it’s a stimulant. Sometimes people even refer to it as a drug. Caffeine raises your blood Alcohol It’s the amount that counts pressure in the short term (although There’s good news ultimately can be 1.2% for women. This the effect wears off within about and bad news when it fatal. might not sound like a three hours) and can cause other comes to alcohol. The Encouragingly, a lot, but would save problems like poor sleep and good news is that recent review found about 700 lives per headaches. around a glass a day that when people who year and over 7,000 WHY NOT TRY: Enjoying your doesn’t seem to do drink two or more hospitalisations. morning coffee, just don’t go over any harm. There are drinks per day cut about four cups of medium-strength some reports that it back, their blood AVOID TOO MUCH coffee a day. Avoid very strong coffee could even do some pressure fell. The ALCOHOL: Don’t feel in large amounts, especially if your good for your heart effect was strongest you need to cut high blood pressure isn’t well health (although this for people who drank alcohol out altogether, controlled. And especially near is quite controversial six or more drinks per just stick within the bedtime if it keeps you awake! and certainly not day. When they cut recommended limits of grounds to start back by about half, 14 units per week (for drinking if you don’t their blood pressure both men and Don’t feel like you need to already). fell by 5.5mmHg women), have some drink everything we cover here On the other hand, systolic and 4mmHg alcohol free days, and every day, that would be a lot drinking larger diastolic. don’t drink more than of tea and coffee! Why not use amounts over a long The researchers six units in six hours. your home monitor to see if time will raise your estimated that if half There’s some evidence any of these drinks make a blood pressure. Heavy of the people in the that red wine is a difference for you, and let us drinking in particular is UK who drink more better choice than know!? a problem and causes than two drinks per other drinks, although Drink water too so you’re not other illnesses day cut down to one it’s not conclusive. relying on tea and coffee for all including irregular drink, the number of Get lots of tips for your liquids. And don’t use heart beat, stroke, liver people with high blood cutting down on these drinks to replace the and stomach pressure would fall by alcohol from medicines you’re prescribed. problems, and 4.4% for men and www.nhs.uk/live-well

15 POSITIVE PRESSURE The HEROES of hypertension PART 2

Dr Scipione Riva-Rocci, he premature death of Frederick Akhbar Mahomed in 1884 1863-1937 perhaps marks the end of an era in our understanding of high Tblood pressure. He developed the precursor to blood pressure Many attempts were made during the late monitors, and was the first person to identify essential hypertension, the 19th century to find an accurate way to most common type of high blood pressure. measure blood pressure but most were wildly There could be no more advances until the development of a simple impractical. The solution was eventually and reliable method of blood pressure measurement. found in Turin by Dr Scipione Riva-Rocci. In this second article, Professor Gareth Beevers takes us into the Riva-Rocci devised an air-filled cuff that modern era with the invention of the mercury manometer. And for this could be placed around the upper arm. This we have to travel to Turin. was attached by a rubber tube to a small See our summer issue for part 1 bottle (originally an old ink bottle) half filled

HEROES OF HYPERTENSION OF HYPERTENSION HEROES with mercury, attached to a glass column. A second rubber tube from the cuff was attached to a rubber inflation pump. By squeezing the pump, the pressure in the cuff could be raised until it stopped the blood flow through the arm, and the pulse at the wrist could no longer be felt. The pressure in the cuff was then slowly reduced until the pulse could be felt again. This moment, when the pulse returned, was the highest point of the pulse wave, namely the systolic pressure (the top Professor Riva-Rocci, who number in your blood pressure reading). This developed the first simple is the moment your heart beats. way to measure blood The pressure could be read by the height pressure. of the mercury in the glass tube. That’s why Image from Gazzetta Medica di Torino n° 47 (1896). With thanks to the blood pressure is measured in millimetres of University of Turin. mercury. The whole procedure took no longer than 20 seconds and was easy to repeat. This was the first practicable sphygmomanometer. Riva-Rocci published a description of his apparatus in 1896. For the first time, there was a simple way to measure blood pressure. It is possible that this invention would not have received much attention but for the support of the famous neurosurgeon, from Johns Hopkins Hospital, Baltimore (see Positive Pressure, Winter 2018). Cushing visited Riva- Rocci in 1901, sketched the apparatus and arranged for it to be made at Hopkins. Over the following years, improved Riva- Rocci manometers became standard around Riva-Rocci's spygmomanometer the world until the development of electronic in use. machines almost a hundred years later. With thanks to the Wellcome Collection.

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Dr Nikolai Sergeyevich Korotkov, 1874-1920 Our next hero was almost forgotten until medical historians discovered the only surviving photograph of him in the archives of the medical faculty of University and published his biography. A Russian army surgeon, who served during the Russo-Japanese war of 1904, Korotkov will have seen many injuries with severely damaged arteries. When he returned to St Petersburg, he used the Riva-Rocci apparatus to measure systolic pressure. He had the idea of listening to the He had the artery at the front of the elbow with a idea of listening to stethoscope as the cuff deflated. He the artery at the found that when the pulse became detectable at the wrist, he could hear front of the elbow turbulence sounds below the cuff, so with a stethoscope OF HYPERTENSION HEROES he could measure systolic blood as the cuff pressure by listening for the turbulence deflated. Dr Nikolai Korotkov as a medical student. With thanks to the Faculty of Basic Medicine, and noting the height of the mercury . in the tube. He found that the turbulence sounds persisted as the cuff deflated further, Robert Tigerstedt, Sir Willian Osler FRS, then disappeared. He concluded that 1853-1923 1849-1919 this disappearance must coincide with the diastolic pressure (the bottom While early blood pressure monitors For the next of our heroes, we must number) where pressure is lowest were evolving, so too was the turn to Canadian physician William between heart beats. understanding of how kidney diseases Osler, one of the most admired From now on, both systolic and raise blood pressure. physicians in his day. diastolic blood pressure could be The turning point was the discovery Osler co-founded Johns Hopkins measured easily. He published his of renin by Robert Tigerstedt in 1897. Hospital with his friend Cushing, findings in 1905 in the Proceedings of Renin is an enzyme produced by the among others, and was the first to the Emperor’s Military Medical kidneys which leads to the generation bring medical students out of the Academy, St Petersburg. of the hormone angiotensin. This classroom to the bedside for clinical hormone is a powerful constrictor of training. In 1892 he published his blood vessels. Thus, renin and magnum opus, The Principals and angiotensin raise blood pressure. Practice of Internal Medicine, which The significance of was widely regarded as the most Tigerstedt’s discovery authoritative medical textbook in the was under-recognised world. until the 1960s when In his first edition there is no drugs were created to mention of high blood pressure, or block the production or even of blood pressure. This is effects of angiotensin. unsurprising as there was, at the time, These drugs are now the no method for measuring it in clinical mainstay of the treatment practice. But in 1913, now professor of high blood pressure and of medicine at Oxford, he published heart failure. his findings on hypertension, its causes and consequences, based on A painting of Tigerstedt who discovered his extensive clinical experience. the enzyme renin, by A Edelfeldt. Osler classified patients with raised With thanks to Ulf Sirborn, Karolinska Institutet. systolic blood pressure in three

17 POSITIVE PRESSURE

groups: those who had clear evidence of kidney disease; those who already had evidence of heart involvement, having suffered from what we would now call “end-organ damage” due to a heart attack or stroke; finally, those with raised pressure but no other abnormalities. There is no mention of diastolic pressure so he had probably not seen Korotkov’s paper of 1905. Osler had come up with a way to classify hypertension, but in those days there was little the clinician could do about it. There were no Sir George Pickering, who showed the

antihypertensive drugs. immense variability of blood pressure, with his wife Lady Carola Pickering. Photo by Savile Bradbury, reproduced by kind permission of Osler had come the Master, Fellows and Scholars of Pembroke College, Oxford up with a way to classify hypertension, Sir George Pickering FRS, 1904-1980 but in those days there HEROES OF HYPERTENSION OF HYPERTENSION HEROES In the 1950s information was immense variability of blood pressure was little the clinician becoming available on blood pressure in individuals. A single measurement could do about it. in large numbers of people, largely could not represent a person’s usual There were no from American life insurance pressure. antihypertensive companies. At this time, George Any stressful or intense stimulus can drugs. Pickering was the professor of medicine raise pressure to levels which might be at St Mary’s Hospital, London, and worrying if sustained. He demonstrated Sir William Osler, a revered later at Oxford in the professorship this with his classic 24-hour blood physician who was the first to previously held by Osler. pressure study on one of the junior classify hypertension When looking at large numbers of doctors in his department. Painting by Kanak, 1914. individuals, it was clear that the risk of He inserted a canula into the young With thanks to the Wellcome Collection. developing a heart attack or stroke was doctor’s brachial (elbow) artery and closely related to rising blood pressure, attached it to a pressure transducer (or even if it not particularly high. sensor), providing a continuous Pickering realised that it was difficult recording. There was no need to tie the to define a point where doctor down to a gate as was “normotension” becomes hypertension. necessary with Stephen Hales’ horse There was no defining line between back in 1733 (see part 1). healthy and high blood pressure. During the working day the young He poured derision on “experts” who doctor’s blood pressure was declared that hypertension began at unremarkable but during Sir George’s some particular arbitrary pressure level; ward round, at a prearranged moment, say 140 or 160 mm mercury. At the the ward sister stuck a pin into the time this was revolutionary thinking. doctor’s bottom. His numbers shot up to Most clinicians tended to ask levels that looked alarming. There was themselves or their trembling students also a sharp rise in blood pressure at the question “Has he or has he not got home at around 11.30 that evening but hypertension!?” I will leave it to the reader to speculate Professor Geoffrey Rose wrote: “I well why this happened. remember the widespread bafflement Later during sleep the doctor’s which greeted this famous professor of pressure fell to low levels which might be medicine when he asserted that considered worrying in an acutely sick hypertension, in which he was the patient. Not commented on at the time, world expert, did not exist as a were the raised readings when the distinguishable entity”. doctor and his wife were packing their Pickering also drew attention to the children off to school in the morning.

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HEROES OF HYPERTENSION OF HYPERTENSION HEROES Professor Geoffrey Rose, whose studies showed us we need a public health approach to blood pressure reduction.

Images Courtesy of Library & Archives Service, London School of Hygiene & Tropical Medicine. Copyright: London School of Hygiene & Tropical Medicine. Geoffrey Rose, 1926-1993

The concept of hypertension as a finding in 1992 in a review entitled, intake could be cut to no more risk factor for diseases of the heart Sick populations and sick people. than 5 grams per day, the average and blood vessels was further The implications of Geoffrey blood pressure would fall, fewer advanced by Geoffrey Rose. He Rose’s studies affect us all. If we people would have clinical worked for Pickering in the 1960s could lower the average blood hypertension and the whole then specialised in population pressure of the whole population community would become health, becoming professor of then the number of people with healthier. epidemiology at the London School high blood pressure would fall, of Hygiene. preventing countless heart attacks Nowadays, almost all research Rose came up with a pragmatic and strokes. So, we need a public involves collaboration between definition of hypertension as: “that health approach as well as a investigators on a national or level of blood pressure where clinical approach to the problem. international basis. These projects investigation and treatment do If the population average salt are carried out by teams of more good than harm.” experts, so it is likely that there The threshold for diagnosing will be few more individual heroes hypertension, therefore, depends making major breakthroughs. As on the evidence around drug we work more as a team to treatment for preventing heart Rose came up with improve lives around the world, attacks and strokes. A figure which a pragmatic definition of we tip our hats to the heroes who will change as new information led the way. from long-term treatment trials hypertension as: “that level becomes available. of blood pressure where Professor Gareth Beevers is a Rose also noted that the investigation and Trustee and Medical Advisor for number of people with high blood treatment do more good Blood Pressure UK. He is Emeritus pressure is closely linked to the than harm.” Professor of Medicine, University of average blood pressure of that Birmingham and retired consultant population. He published this physician, City Hospital, Birmingham.

19 POSITIVE PRESSURE 20 INSIDE HEALTH POSITIVE PRESSURE define hypertension onthebasisof heart diseaseandstroke. “Andso,we to beeffective atlowering theriskof the point atwhichtreatment isknown 140/90mmHg intheUKbecause that’s define highbloodpressure as defined as120/80mmHg.Butwe higher therisk,andviceversa. meaning thehighernumbers numbers andhealthproblems, relationship between bloodpressure world stating different targets. are different guidelinesaround the discussed theidealnumbers,asthere authority onhighbloodpressure. He and isrecognized asaworld-leading Medicine atUniversity College London a Consultant Physician andChairof Our Trustee Professor Bryan Williamsis blood pressure numbers Clearing up theconfusion on glimpse ofwhatcame up: entire show tothetopic.Here’s a Mark Porter (pictured) dedicated the With somuchtotalk about,hostDr topics inhighbloodpressure rightnow. Inside Healthdiscussingallthemajor health professionals onBBCRadio4’s T Optimal bloodpressure isusually He explainedthatit’salinear Health Health Inside Health talk show, Inside Radio 4’spopular blood pressure on We talk allthings Bryan Williamsjoinedapanelof Jenner andTrustee Professor his January,ourCEOKatharine And stopping smoking, notbecause is often sufficient five timesaweek. recommended regular exercise “walking elevations inbloodpressure”. Healso be associated withquite significant Williams noted that“bingedrinkingcan being theidealbodyweight, Professor As well asahealthy low saltdietand So, whatcan you dotohelpyourself? Which lifestyle interventions work? a very commoncondition.” have highbloodpressure, soitreally is to usealotofforce. to blowing upanewballoon–you have flow, raising thepressure. Hecompared it has topumpharder togettheblood stiffer andlessdistensible”. So,theheart your large arteries andthosearteries get 50 you’ve lost abouthalftheelasticityof explained. “By thetimeyou gettoabout super healthhave highbloodpressure. some peopleintheir60sotherwise Show hostDrMarkPorter asked why rise with age? Why does blood pressure to seethebenefit.” would have totreat many more people beneficial even atlower levels, butyou treatment. Treatment islikely tobe whether you’re likely toneeddrug “One intwo adults over theageof65 “ .” Williams It’s partofageing.”Williams m0001xtr type inwww.bbc.co.uk/programmes/ 4, InsideHealth,Highblood pressure or well worth alisten. Justsearch for Radio the show isstill available online and There was muchfood for thoughtand Food for thought Margaret McCartney. “Start low andgoslow” addedGPDr “The sweet spot”DrPorter called it. dose rather thanone atahighone. doses. It’sgoodtotake two atalower more likely tocause sideeffects athigh Professor Williamsexplained. hasn’t responded toonedrug” they discover thattheirbloodpressure patients feel very disappointed when important messagebecause often need two different drugs.“That’san best drugstouse,andthatmostpeople across theworld have agreed onthe Over thelastfive years guidelines medicines to use? And what are thebest enough toavoid treatment. millimetres ofmercury –sometimes your bloodpressure by about10 risk management.” pressure butbecause it’simportant in that hasamajoreffect onblood In terms ofdose,somedrugsare Together thesewould probably drop Meet the Trustees Professor Bryan Williams is a world leader in high blood pressure research and a founding member of the Blood Pressure UK Board of Trustees.

You have multiple roles How did you get to where diagnostic test to pick up testosterone- Qincluding Chair of Medicine and Qyou are now? producing adenoma – a benign tumour Director of Research at University I studied medicine and renal medicine which raised blood pressure. It might be College London (UCL) Hospitals. at St Mary’s and went on to work with more common than people thought. MEET THE TRUSTEES What do these involve? three stars of blood pressure medicine I’d also like to work on blood I’m the Director of the Biomedical – Professor Stanley Peart in pressure and dementia. Treating Research Centre at UCL Hospitals. We London, Professor John blood pressure early could fund research exploring new and Swales in Leicester, and I still have slow the process and inventive ways to diagnose and treat a Professor Robert Schrier reduce the risk of whole spectrum of diseases. in Colorado – so it was my hypertension dementia. My role as Director of Research at inevitable that I would clinic. It’s UCL Hospital is more about applying be interested, and I important to How do you look high tech new research to treating really was. be on the Qafter your own patients. We test treatments further I stayed in Leicester a front line. blood pressure? down the development path to see if long time because I I like to go to the gym they’re working well. We have 1,000 enjoyed it, we were doing regularly and keep myself trials going at a time. great research. When UCL pretty fit and active. I measure my I’m also still a practicing physican. I approached me in 2011 it was good blood pressure and, like most adults, I work with patients with a range of timing. My kids had left home and I take tablets. It’s really no big deal. My problems and I still have my was ready for a leadership role. patients always look surprised when I hypertension clinic. It’s important to tell them that but raised blood pressure be on the front line. What are the main areas is really not a very exclusive club. Qof your research? What inspired you to choose a My main focus has been on finding What are your goals for Qcareer in medicine? the best ways to measure blood QBlood Pressure UK? I grew up in Liverpool in a working- pressure. I helped set the NICE I would like us to be involved in class family and wasn’t expected to go guidelines for diagnosing and treating moving the UK towards combination to University, so I broke the mould. high blood pressure in 2004 and 2011. pills for high blood pressure. People My brothers and I spent a lot of time We made some very bold changes and don’t like having to take lots of tablets in hospitals growing up because we it’s been fantastic to see how different and I’m convinced that having were always injured from playing parts of the world have picked them medicines combined into one pill football. I was good at science and I up and developed their own. It’s very would lead to better blood pressure thought medicine would be an humbling. control. interesting way to pursue that with the privilege of being able to interact with What projects are you working What do you like to people and try to help them. Qon at the moment? Qdo for fun? It’s a fantastic career. Working with My big interest is high blood pressure I love spending time with my son and the university means I can work on in young people. I’m trying to find out daughter and we do a lot of travelling. research and expect to see it being if there might be a benefit of treating Between that and travelling for rolled out into patient care. I’m at the blood pressure earlier on. conferences, I’ve been everywhere in forefront of medicine, it’s exciting. I’m also trying to develop a the world. And sport, I love rugby.

21 POSITIVE PRESSURE 22 Helping others with We have put High Blood Pressure together a simple leaflet to guide you through the process Have you thought of Blood information packs, range of and you can get a copy by telephoning: Pressure UK in your Will? leaflets and our helpline, we (020) 7882 6255, visiting the website: Finding out that you have high provide reassurance and support www.bloodpressureuk.org, blood pressure is traumatic, to sufferers and their families. But or by writing to: Blood Pressure UK, particularly if you are young. all of this work is expensive and Wolfson Institute, Charterhouse Square, Most people don’t know while membership subscriptions London, EC1M 6BQ. anything about the condition and general donations help and worry about how it will enormously, leaving a gift in your affect themselves and those Will can help us make a bigger around them. But Blood Pressure difference. UK is here to help, and with our It isn’t as complicated as you might think, doesn’t have to be a large amount, and will give you the reassurance that our work helping fellow sufferers will continue once you have gone. Obviously, providing for your family and friends comes first, but once that is done please consider a gift to Blood Pressure UK in your Will. the blood pressure charity Information & publications

We have a range of booklets and fact sheets giving valuable information about living with high blood pressure to help you understand it, lower it and manage it.

Introducing high Getting the most from blood pressure blood pressure This booklet explains what medicines high blood pressure is, who Most people with high gets it and why. It gives blood pressure will need to basic information on take medicines to control it. lifestyle changes to lower This booklet talks about the blood pressure, and about different medicines for high measuring your own blood blood pressure and about pressure at home. how you can get the best results from them. It also Healthy lifestyle and looks at side effects of blood pressure blood pressure medicines This booklet shows how and what you can do to getting more active and avoid these. keeping to a healthy weight can help lower your blood Healthy eating and pressure. It looks at how you blood pressure can start to build more This booklet looks at how activity into your day, and what you eat can affect your what types of activity may be blood pressure. It shows you best for you. It also talks how you can start to eat less about sensible approaches to salt, and how to get your five losing weight if you need to. daily portions of fruit and vegetables. It also explains Measuring your blood how alcohol, fats and sugar

ﮨﺎﺋﯽ ﺑﻠڈ ﭘرﯾﺷر ﮐﺎ pressure at home về bệnh can all affect your heart and ﺗﻌﺎرف Giới thiệu áp This booklet can help you cao huyết body. decide whether measuring your blood pressure at home With great thanks to the is right for you, and how to Big Lottery Fund, we have choose the right type of pko/ been able to translate monitor. It also gives you tips s visokim jkJh pb`v gq?Fo Upoznavanje tlakom ikD-gSkD our award-winning about how and when to krvnim ‘Introducing high blood measure your blood pressure pressure’ leaflet into 32 to be sure you are getting languages. They are all reliable readings. available to download from our website only.

Our full range of resources includes ‘Love your heart: a South Asian guide to controlling your blood pressure’ and factsheets on all the common blood pressure medicines.

Helping you to lower your All these publications are free to Blood Pressure blood pressure UK members. Call 020 7882 6255 for your copy or visit www.bloodpressureuk.org