High blood pressure, or hypertension, is diagnosed when the pressure in an individual’s blood vessels is found to be consistently high on a number of occasions1. Blood pressure is measured using two values:
 

• systolic pressure (when the heart contracts forcing blood through the vessels)
• diastolic pressure (when the heart relaxes and the pressure decreases)1

Systolic pressure is always recorded before diastolic pressure and the unit of measurement is millimeters of mercury. Hypertension is defined as a systolic pressure of 140 mmHg or above, a diastolic pressure of 90 mmHg or above or when both values are raised.1 The ideal blood pressure is defined as 120/80 mmHg1.
 

High blood pressure is the leading cause of cardiovascular disease, which is the world’s number one cause of death2. When a person’s blood pressure readings exceed normal levels, that person is at risk of damage to vital organs such as the heart, kidney, brain, and eyes3. This can increase the risk of life-threatening events such as heart attacks and strokes 3.
 

In the UK, about half of people over 65, and about 1 in 4 middle aged adults, have high blood pressure4. Most cases are mildly high (up to 160/100 mmHg), however at least 1 in 20 adults have blood pressure of 160/100 mmHg or above 4.

There are 5 million people with diagnosed high blood pressure in the UK who do not reach the target set by UK leading experts at the British Hypertension Society (BHS) and by the National Institute of Clinical Excellence (NICE)5,6. This represents an unmet need in the management of this leading cause of death.
 

While high blood pressure can be easily measured and successfully treated, the British Hypertension Society asserts that 70% of patients with high blood pressure require at least two blood pressure lowering drugs to achieve recommended blood pressure levels7
 

If blood pressure is properly controlled, the incidence of stroke can be reduced by almost 50%, heart attacks by 25% and heart failure by 50%8. Every increase of 20/10 systolic mmHg in blood pressure doubles the risk of cardiovascular events such as stroke and heart failure8.
 

Treatment goals, established by the BHS and NICE, are designed to reduce cardiovascular risk by treating modifiable factors (such as smoking, being overweight and lack of exercise) and to reduce systolic and diastolic measurements4.

Poor blood pressure control is estimated to cause 62,000 deaths from stroke and ischaemic heart disease in the UK every year09. Improved management of hypertension can reduce that figure.
A range of blood pressure-lowering agents are currently available. In order to facilitate control of blood pressure levels and address the ‘need to increase recognition that monotherapy is usually insufficient therapy for hypertension’, the BHS developed a treatment algorithm for hypertension6,10. This algorithm was designed to identify the most likely effective combination of drugs for an individual10 (see Figure)6. The algorithm, based on clinical trial outcomes, has two arms of treatment: one for patients under the age of 55 years and who are not black and the other for those aged 55 and above or who are black.
 

British Hypertension Society/Royal College of Physicians recommendations for treatment of newly diagnosed hypertension. NICE Clinical Guideline partial update6.
 

A = ACE inhibitor (*or angiotensin receptor blocker if ACE-I intolerant),
C = calcium channel blocker, D = diuretic (thiazide-type).
 

• Angiotensin converting enzyme (ACE) inhibitors – reduce blood pressure by inhibiting the conversion of angiotensin I to angiotensin II, thus reducing the levels of angiotensin II (ARBs can be used if the patient is ACE intolerant)¹¹
• Angiotensin receptor blockers (ARBs) – reduce blood pressure by blocking the effect of angiotensin II at receptor level¹¹
• Calcium channel blockers – reduce blood pressure and cardiac output by reducing the contractility of arteriolar smooth muscle and cardiac muscle¹²
• Diuretics (thiazide) – reduce blood volume by reducing the reducing the re-absorption of water from the renal tubules and act as vasodilators¹³