Blood pressure facts, and the relationship between BP and headaches
NOTE: I am not a doctor, nor do I have any medical training. This is based on my own research using largely authorative articles and papers (e.g. the NHS), and personal experience in the form of altogether too many health issues and way too much time in hospital.
Apparently if you have high blood pressure you actually get LESS headaches, not more!
In fact you could suffer from up to 50% less according to Heart.org (The myth of symptomatic headaches), though they fail to link the specific article in Neurology.
It’s not all good news though as some researchers have suggested this is due to the high pressure physically damaging the nerve endings in the brain! (As in, “I can’t feel my toes. Is that normal, doctor?”). (See also : High Blood Pressure May Be Buffer Against Headaches.)
So, as many sites agree, headaches are not a sign of high blood pressure. Even the NHS state High blood pressure has no symptoms, cheerily adding that if not treated it can damage your kidneys, heart and brain.
Elsewhere they say up to 30% of people in England may have high blood pressure but be unaware of it, putting them at risk of a heart attack or stroke. (Around 25% in younger people, 50% in older people).
Referring to it as a “silent killer”, the NHS will tell you:
The only way of knowing there is a problem is to have your blood pressure measured. (NHS: High blood pressure (hypertension))
Strictly speaking, that is not always true, it’s down to generalisation and semantics. High blood pressure may (or may not) cause the odd headache, but consistently extremely high blood pressure (hypertensive crises) is another matter entirely.
Bear in mind these figures are rough generalisations, mediated by fitness, age, gender, race and any underlying conditions. Furthermore, blood pressure fluctuates over the course of a day, and a month, with weather and the season also having an impact. Also, the ranges can vary based on research and differing medical opinions. People with high blood pressure will find their BP can vary greatly from day to day. It should be noted that you only need one value in the range to apply, having both just makes it better/worse. These relate to consistency, not a one off-reading. These caveats aside, for an average adult:
60/40 or less (hypotension) and you very likely need emergency treatment. I suspect you’ve just been shot by a large calibre rifle and are bleeding to death! (Half) joking aside, there’s actually a lot less information about low blood pressure than high. It should be noted that while low blood pressure is generally good, when BP is very low it can be a sign or result of an underlying condition such as heart failure, dehydration, diabetes, anaemia, autonomic neuropathy or atherosclerosis (clogged arteries).
90/60 or less (hypotension) is too low and may need treatment to bring it back up.
One NHS page, referring to a specific causes of low blood pressure, says that “Depending on what your seated blood pressure is, if your systolic reading falls by between 15 to 30mmHg when you stand up, you may have orthostatic hypotension (postural hypotension)” (NHS hypotension diagnosis). According to Bupa around 10 to 20% of people over age 65 have postural hypotension.
(The affects being light-headedness and flopping to the floor like a sack of jelly when you try to stand up, from what I’ve seen!).
91-119/61-79 Either a little low or you are young and/or fit. (e.g. an athletic person may be be around 110/65). The NHS say there is no need to worry as naturally low blood pressure rarely causes problems or needs treatment.
120/80 (give or take a bit) is the ideal.
121-139/81-89 can be considered pre-hypertension or the high end of normal, if consistently at the high end. You might want to change your lifestyle, exercise more, drink less coffee, eat more healthily. Patient Info suggests that those with high normal values (130-139/85-89 mmHg) should be checked annually. (For older people and those with (known) conditions like diabetes or kidney problems this may be considered a normal range.)
140-179/90-109 OK, that’s stage 1 (140/90) or stage 2 (160/100) hypertension and needs bringing down.
It should also be noted that, according to the NHS’s hypertension page, even 140/90 is considered high blood pressure and needs bringing down, adding:
Risks of high blood pressure
If your blood pressure is too high, it puts extra strain on your blood vessels, heart and other organs, such as the brain, kidneys and eyes.
Persistent high blood pressure can increase your risk of a number of serious and potentially life-threatening conditions, such as:
peripheral arterial disease
If you have high blood pressure, reducing it even a small amount can help lower your risk of these conditions.
180+/110+ Severe hypertension / hypertensive urgency and into (very) life-threatening hypertensive crisis. I saw one medical slide that (for pediatrics) advised “panic”. For adults the recommendation is to seek immediate emergency medical treatment. (As a reminder, it’s for several reading over days, not for a one-off spike).
For comparison, Bloodpressure OK’s main chart caps at 180+/110+ (stage 3 hypertension / hypertensive crisis), and their reading page (enter your values) caps at 220/150.
My BP for today (30th Dec 2017) was 192/114 – which it labels as
Way too high – and they suggest that I
consider finding a doctor as soon as possible. (The “emergency” doctor suggested I just take extra amlodipine and blanked me when I pointed out my last blood test put my eGFR at 16 (i.e. SERIOUS kidney failure). Fortunately my (new) GP was not a complete pillock and had me rushed into hospital when I saw her the day after.
Actually it was higher earlier the previous month (Oct 2017)- and basically my body went into shock and starting to shut down, necessitating an emergency ambulance and a few weeks in hospital to stabilise me. My kidneys are shot (even more than usual), my eyesight is still blurry and the tingling in my fingers etc is getting annoying. I joked about Googling my symptoms and one the the doctor’s rolled their eyes and agreed it was ‘never a good idea’, especially given Google results all suggested I was pregnant! Still, is serves to correlate that really high blood pressure is VERY BAD.
Similarly, BUPA’s hypertension chart turns red at 140/90 and caps at 190/100 – by which time you are at a high risk of a heart attack, heart failure, stroke and other conditions including kidney disease and dementia. You can add blindness and aneurysms to that list.
200+/130+ Malignant (accelerated) hypertension / hypertensive emergency. You are now firmly in the realms of failing organs as a cause or result and need urgent assessment and immediate treatment to reduce the blood pressure – within minutes to hours. Your body can’t take this for long, it will kill or cripple you.
I was recently in hospital for high blood pressure (and associated issues), and was told that the diastolic (around 110 at the time) was of lesser concern, but if my systolic goes over 200 again that I should “get back to A&E”
I’ve not (yet) read any authorative papers on malignant hypertension but I can tell you from personal experience (and base logic), that that narrower the gap the more likely it is to kill you. Thus 200/130 you have some room for the blood to pulse; at 185/145 you are dying, the pressure is intolerance; (if it’s even possible), at 165/150 or narrowerâ€¦
The first, higher number is the systolic measure (when the heart beats), the second, lower number the diastolic (when the heart relaxes). The pressure is measured in mmHg. Suffice to say the higher your diastolic, the more important it is to seek medical attention, though different doctors have different opinions on this. Either way, systolic blood pressure being consistently over 200 is a very bad thing.
I never really pay attention to my pulse, though I record it daily all the same. It was only during my last trip and A&E and subsequent admission that I gave it more thought. When I was younger, and a lot fitter, my pulse was around 60, now it’s almost double that, but how much is too much? Well, a quick Google suggests: “Most adults have a resting heart rate of 60-100 beats per minute (bpm). The fitter you are, the lower your resting heart rate is likely to be. For example, athletes may have a resting heart rate of 40-60 bpm or lower.”
Well, personally I was concerned about my blood pressure, but they took one look at my at rest pulse (119) and wheeled out an electrocardiogram (ECG). And every time it went over 120, out came the ECG, within minutes. The NHS advise:
You should contact your GP if you think your heart rate is continuously above 120 bpm or below 40 bpm, although this could just be normal for you.
Similarly, heart.org say that “a heart rate of more than 100 beats per minute (BPM) in adults is called tachycardia.” and goes into possible causes (anxiety attacks, too much caffeine, heavy drinking/smoking etc), and why this is a bad thing (e.g. angina, cardiac arrest).
Returning to the NHS, they describe supraventricular tachycardia (SVT) as an ‘abnormally’ fast heart rate (of over 100 bpm). Symptoms include chest pain, dizziness, light-headedness and breathlessness. Apparently it is “rarely life-threatening, but you should contact your GP as soon as possible, if you experience symptoms.” Noting as an addenda that SVT can sometimes be difficult to diagnose and may need a cardiologist.
It does add – in bold –
Dial 999 to request an ambulance if you experience severe chest pain or breathing difficulties and you feel faint, but that’s pointing more a heart attack, I’d say.
Charts and tables
There’s a chart at Blood Pressure UK, or my own, below:
Another chart, from a joint draft paper by the British Hypertension Society offers this table (in mmHg) for the classification of the stages of hypertension.
Stage 1 140 â€“ 159 systolic, diastolic 90 â€“ 99
Stage 2 160 â€“ 179 systolic, diastolic 100 â€“ 109
Stage 3 180 â€“ 209 systolic, diastolic 110 – 119
Stage 4 â‰¥ 210 systolic, diastolic â‰¥ 120
There is also a good guide and chart here: Blood Pressure OK
This site is useful as it also has a handy little ‘Blood Pressure Quick Check’. Enter your readings and it offers a chart and advice, along with a sensible caveat that it’s a guide, go see a read doctor. So for my current BP (pushed up with kidney problems, elevated further at the minute (May 2016) perhaps due the that evil flu doing the rounds in the UK) is around 163/100.*
(*And yes, I do have a lousy headache with it, thank you. Yes, I am on amlodipine. Yes, I probably do need to see my GP immediately if it doesn’t quickly drop again!)
Risks of Hypertension Stage 2 Blood Pressure
There are a myriad of risks associated with the onset of hypertension stage 2. For one, hypertension is a huge risk factor for peripheral arterial disease, chronic kidney disease, aneurysms within the arteries, strokes and basic heart disease.
They do go on to advise that I exercise more (not easy in my condition, but I do a bit), that I eat lots of fruit and veg (check) and reduce my salt intake (check). Elsewhere on the site they say ginger helps, as does rosemary and lavender, and suggest I cut back on my caffeine too.
HOWEVER, please note that herbal remedies like these (and others like garlic, ginkgo, hawthorn and licorice root – and especially St. John’s wort) can be adverse and/or conflict with medications. Always tell your doctor if you are experimenting with herbs!
For extreme hypertension, by the time your blood pressure is this high for any length of time, according to the NHS, you may – in some rare cases – be experiencing any or all of the following :
shortness of breath
blurred or double visionOther sites, like Everyday Health add :
confusion or other neurological symptoms
chest pain and abnormal heartbeat
back pain (across lungs)
Pretty much, by this time you’ve had severe hypertension so long that it’s causing organ damage. In a related way, for kidney failure, you may be told by doctors you can’t feel it as they poke your back, saying, “see!” Of course if you reply, “”Ow!” the consultant will amend it to, ” OK, that’s not good. You’re not going home!”
If you happen to have a decent home blood pressure monitor and notice it rising alarmingly, a telephone call to your GP might well go like this:
Patient: “Sooner would be better please, my BP is 204/111”
Receptionist: “I spoke to the doctor, can you get here in an hour?”
If the readings are accurate you’ll either be put on blood pressure tablets immediately* or sent straight to A&E.
*As in, take this prescription to the chemist now, then go for blood tests. See me about in 2/3 weeks.
If you have blood pressure in the range of 185/145 or higher, this is what it can feel like – ((In)famous and gory exploding head scene from Scanners, 1981):
Actually it hurts a LOT more than that and while your head won’t explode your brain might, in the form of an aneurysm.
This is what an aneurysm feels like, apparently:
” a sudden agonising headache, similar to a sudden hit on the head, resulting in a blinding pain unlike anything experienced before. A stiff neck. Sickness and vomiting. Pain on looking at light.”
Extremely high blood pressure (and possibly an associated aneurysm) can be all of that and worse – if you can imagine that! And it goes on and on and on until they lower it or until it kills youâ€¦
(Starting to wonder if I didn’t have an aneurysm when my own bp passed the 185/145 mark once, something my doctor thought quite possible. That headache felt like I’d been hit in the head with a metal baseball bat, and had needles poked into my eyes. The grip on the headache was beyond intense; I threw up all the amlodipine and – between stifled screams at the vice-like waves of agony keeping me in the foetal position – kept the ward awake half the night with my dry retching, coughing up blood from torn throat muscles when everything else had long since gone into the bowl.
With that in mind, if you are in a high-stress job (parenting can come under this!) and/or are getting older, it might well be worth investing in a decent blood pressure monitor. Ignoring cheap tat, prices can range from around Â£20 upwards, with a good quality one still only being around Â£55. I use an old but reliable Philips HF305 blood pressure monitor, but if I was going to replace it I’d look at something like the Omron Healthcare M6, or similar. All that’s really needed though is for it to be clinically validated. If you have large upper arms though you may want a bigger cuff size*.
Small cuff : 18-22 cm
Medium cuff : 22-32cm
Large cuff : 32-45cm
High blood pressure and surgery
Bearing in mind all the above, it’s general taken as read that you aren’t aware of your blood pressure. Your GP might well tell you you have ‘high blood pressure’ but you can’t feel it, not like a toothache or anything. Then there’s really high blood pressure, the type that makes your GP blanch and look all thoughtful. (Dithering came to mind!)
Here’s the catch-22. If, like mine has been this week, your BP is hitting of 220/112 and rising daily, then you have a problem, or two. Firstly, it’s killing you and you may well need a surgical solution; secondly, the anaesthetist will be having kittens and will almost certainly be inclined to cancel.
It’s was lower than that last time I was in hospital and even then I was told by a doctor, “It’s a brave anaesthetic that would take on that!” So, I have more surgery planned for Monday – with a default risk of side-effects like heart attack, stroke and death. Wonderful. If they don’t operate, you may die, if they doâ€¦
In a draft paper I read today, on Pre-operative measurement of adult blood pressure and management of hypertension, by the Association of Anaesthetists of Great Britain and Ireland, and the British Hypertension Society they recommend that
a patient with a blood pressure greater than or equal to 180/110 should not proceed to non-urgent surgery., and that
A reduction in blood pressure to less than 160/100 mmHg should precede non-urgent surgical referral.
Similarly, Stateside, in a NCBI 2008 paper on Perioperative hypertension management considered ‘elevated’ BPs of 170/100 a problem and states that:
“Hypertensive emergencies (ie, severe elevations in BP [>180/110 mm Hg] complicated by evidence of impending or progressive target organ dysfunction) require immediate BP reduction to prevent or limit end organ damage. Examples of hypertensive emergencies include hypertensive encephalopathy, intracerebral hemorrhage, subarachnoid hemorrhage, and acute stroke; hypertension-induced acute renal dysfunction; and hypertension associated with unstable angina, acute myocardial infarction, acute coronary heart failure, and acute aortic dissection. Blood pressure should be reduced by 10%â€“15% (maximum of 20%) in a controlled fashion within the first hour with a continued decrease towards 160/100 mm Hg over the next 2â€“6 hours as tolerated by the patient. A more rapid reduction is indicated in patients with aortic dissection.” **
**(As opposed to two GPs (on separate occasions) who said to go home, have an extra amlodipine and talk to the hospital tomorrow).
Meanwhile, in an article by the ‘The anesthesia consultant’, they ask Should you cancel (elective) surgery for a blood pressure of 178/108? and the Standford-based doctor suggested that “Based on the Howell study, Miller’s Anesthesia recommends that elective surgery be delayed for hypertension until the blood pressure is less than 180/110 mm Hg.”
Again, when the question was asked on Researchgate – What blood pressure limits would you accept before anaesthesia? – the answers suggest there are no hard rules, only guidelines. Some draw the line at a diastolic of 100, others center on 180/110, with typical comments of “185 / 110 is critical and must be treated and diagnosed prior surgical procedure” and, from a Melbourne doctor:
There is no evidence to support a single cut-off point for preoperative hypertension.
While BP < 180/110 is reassuring, particularly in terms of the patient’s risk of perioperative cardiac events, I would not routinely cancel/defer patients above that level, though I would consider it. I tend to think seriously about this at BP > 200/110.
This is my at rest BP as at 1.25pm, 16th Feb, 2018, (pre-op) was 228/113, with racing race, which went off the charts at BloodpressureOK :
Recommended viewing: TED-Ed: How blood pressure works, by Wilfred Manzano
If you have a spare half an hour, I suggest watching this enlightening medical talk on ‘How to Have Healthy Blood Pressure’. Premise is high blood pressure bad, patent drugs to fix it, worse. As he rightly says, rather than treating the blood pressure you need to find and treat its underlying cause.