With 16 million people in the UK suffering from hypertension, it is a condition commonly disclosed by applicants. Kevin Smith gives an underwriter's view
A person's blood pressure is constantly rising and falling in a cycle as the heart pumps blood around the body through a network of tubes called arteries. The force that your heart produces in your arteries when it pumps is your blood pressure. We measure blood pressure at two stages in this cycle: the systolic blood pressure and the diastolic blood pressure.
Blood vessels
The systolic blood pressure is the maximum pressure exerted by the heart and occurs as the ventricles (a part of the heart that contains the blood at the start of the cycle) contract and force blood into the arteries. The diastolic is the minimum pressure which occurs when the ventricles are relaxed. Your blood pressure reading is given as your systolic pressure and then your diastolic pressure.
Blood pressure is measured using a sphygmomanometer or by using an automatic machine. The sphygmomanometer uses a column of mercury and a cuff which goes around the arm. The cuff is pumped up and a stethoscope is used to listen to your pulse. The sound of the pulse heard through the stethoscope will start and then finish at certain points on the mercury column and this will give you your blood pressure reading. An automatic machine uses a cuff but the mercury column is replaced by a digital reader which measures your blood pressure. The blood pressure reading we see is given in mmHg (the change in height of the mercury in the mercury column) for example 140/90mmHg.
Symptoms
High blood pressure, or hypertension, is where your blood pressure is higher than the normal range. This normal range varies depending on your age and sex. Blood pressure is considered high if it is raised consistently above 140/90mmHg.
There are three different types of hypertension:
• Primary/essential hypertension
This is where no specific cause is found for the raised readings and accounts for the majority of cases of high blood pressure. The small blood vessels in the body narrow which causes the pressure to build up. Although no cause is known for the increase in blood pressure for primary/essential hypertension, it is associated with other risk factors such as salt intake, family history, high alcohol consumption, stress, obesity and smoking.
• Secondary hypertension
This is where the raised blood pressure is due to an underlying cause such as kidney disease, glandular (hormone/endocrine) problems, pregnancy and as a side effect of some medications.
• Malignant/accelerated hypertension
Malignant (or accelerated) hypertension is a life-threatening acute elevation of blood pressure which can damage the kidneys, brain and heart. This damage is sometimes irreversible.
High blood pressure usually has no symptoms, which means people don't know they have it. In these cases, the only real way to check if you have high blood pressure is to get it measured. If high blood pressure is left untreated, symptoms will become apparent as it will eventually cause damage to organs such as the kidneys and the heart.
Although high blood pressure is not something that can usually be cured, it can usually be quite easily treated and controlled. There is very good evidence from many studies which shows that lowering blood pressure does cause a large reduction in strokes, heart attacks, heart failure and kidney disease, that would otherwise have occurred.
Lifestyle
If your blood pressure is only slightly above the normal range, you will probably only have to make adjustments to your lifestyle - such as cutting down on salt and alcohol, losing weight, eating more healthily and exercising more - and will not need to take any medication. However, some people in this bracket may need to take medication if they are elderly or have other risk factors, such as high cholesterol or smoking.
If your blood pressure is consistently raised above a certain level, tablets may be prescribed to reduce it. There are various medications available which all do essentially the same thing - reduce your blood pressure. Treatment with one drug achieves adequate control in about one-third of cases with a further third requiring at least three different drugs for adequate control.
Kevin Smith is a life & disability underwriter at Scottish Equitable Protect
Hypertension - the statistics
• There are around 16 million people in the UK with high blood pressure.
• Essential hypertension is very common and affects around 20% of the population.
• Essential hypertension accounts for around 90% of hypertensive cases.
• One in every three women and two in every five men now have high blood pressure with larger numbers affected in older age groups.
• At least half of all people over the age of 75 have high blood pressure.
• Less than 10% of people with high blood pressure are in a position of being diagnosed and receiving treatment that is controlling their blood pressure.
• Out of those who are being treated, six out of 10 still have high blood pressure.
• Hypertension occurring during the second half of pregnancy is usually part of the spectrum of pre-eclampsia, which occurs in about 5% of pregnancies.
• Average intake of salt is 9g, compared to the recommended maximum of 6g and three-quarters of the salt we eat is hidden in processed foods.
• About one in seven deaths from heart disease are caused by high blood pressure.
Source: The British Heart Foundation, the Blood Pressure Association, NHS Direct and Patient UK
Underwriting implications
