Know Your Numbers

·       When blood pressure medication is prescribed, it is intended for long term use. Although, some people are able to reduce or stop taking medication entirely if they make and sustain lifestyle changes that reduce their blood pressure.

There has been a variety of research into herbal remedies, many of which have demonstrated a blood pressure lowering effect. These have a similar mechanism of action to blood pressure medication, working by widening arteries, increasing urine production (having a mild diuretic effect) or increasing blood flow (Vinmec, 2025).

However, herbal remedies are not recommended within the national guidance because there is insufficient research in the area (NICE, 2026). Unlike prescription medication, herbal remedies do not always have a standardised dose, nor do they have strict quality control. Some can even interact with other prescribed medication. Most importantly, there is insufficient data surrounding whether herbal remedies can prevent cardiovascular disease.

One of the roles of oestrogen in the body is to support the elasticity of blood vessels. During the perimenopause, oestrogen levels start to fluctuate and are at their lowest during the menopause. As oestrogen levels decline, arteries can become stiffer, which increases blood flow resistance and therefore blood pressure. 

As oestrogen is also responsible for maintaining blood cholesterol levels and sugar levels, low levels in the perimenopause/menopause can cause high cholesterol (hypercholesterolaemia) and diabetes. As both are risk factors for cardiovascular disease, in addition to hypertension, menopausal women are also at increased risk of cardiovascular disease.

The long-term effect of staying on blood pressure medication is to benefit your health by decreasing your risk of cardiovascular disease. As with all medication, blood pressure medication has side effects and should only be prescribed when the benefits outweigh the risks. If you are concerned about side effects with your medication, please consult a healthcare professional. 

Currently, the UK national guidance recommends starting and increasing a single blood pressure medication to the highest maximum dose before introducing another (single therapy) (NICE, 2026). However, the most recent research demonstrates that blood pressure targets can be better achieved, patient adherence is improved and there is a decreased risk of cardiovascular disease if two medications are used at the same time (combination therapy) (King et al., 2025). This is because combination treatment targets two separate physiological mechanisms through which the body controls blood pressure.

Combination therapy is currently the recommended first line guidance by the European Society of Cardiology and the American Heart Association and has been adopted in a variety of countries (Nguyen, 2019; King et al., 2025). It is down to the discretion of your healthcare professional as to which guidance they decide to follow because single and combination therapy is correct to use.

There may be a variety of different reasons why blood pressure naturally decreases as we age e.g. pre-existing medical conditions, medications or nutritional/hydration status etc.

The Autonomic Nervous System (ANS) is a branch of the nervous system that is responsible for regulating involuntary functions within the body e.g. heart rate, blood pressure, temperature etc. As we age, the ANS function naturally declines. The body may not be able to adapt to changes as effectively and blood pressure could fluctuate or decrease when sat down or decrease when you stand up.

Low blood pressure when sitting down (less than 90/60) or after standing (drop in systolic of 20 mmHg or diastolic 10 mmHg within 3 minutes of standing) is equally as dangerous because it can lead to dizziness, falls and injuries. It is therefore important to self-monitor the blood pressure and attend your annual blood pressure review. 

Home blood pressure monitors are very reliable providing the following criteria is met:

• Ensure that it is validated by the British and Irish Hypertension Society (BIHS)- this ensures that the device has passed accuracy tests. Validated blood pressure machines can be found on the BIHS website:
• An upper arm cuff is used - it is more accurate than a wrist monitor.
• The cuff is the correct size - it should fit comfortably around your arm, with sufficient space to fit 2 fingers underneath. 
• The blood pressure machine is serviced every 2 years.

If you are concerned about your home blood pressure machine, you can book an appointment at your GP surgery or pharmacy (over 40 years old) and bring your home blood pressure machine to verify it against the machine on-site.

Yes. The body does not build up tolerance or resistance to blood pressure medication like it can with painkillers or antibiotics. Blood pressure can however increase despite blood pressure medication due to changes in risk factors.

High blood pressure is defined as one or both systolic (top number) or diastolic (bottom number) measurements being raised more than 135/85 at home (145/85 if over 80). Isolated systolic or diastolic hypertension is treated the exact same as both values being raised.

Everyone that has been diagnosed with hypertension should have annual review but if you are concerned about your blood pressure, you should seek medical advice sooner.

The annual review involves a discussion about your adherence to treatment, lifestyle and a  blood pressure check. You will be asked to have a blood test to check your kidney function, cholesterol and HbA1c (to assess for diabetes). You will be asked to provide a urine test to check for protein, which checks for kidney damage as protein should not physiologically be in your urine.

Yes. This should be performed annually to assess your risk of cardiovascular disease. If you have no previous history of cardiovascular disease or are not on statins, this is usually performed using an online calculator that determines your risk of developing cardiovascular disease over the next 10 years. If you have established cardiovascular disease or are on statins, a healthcare professional will determine your risk.

No. It is unusual for hypertension to directly cause swollen ankles and feet. There are a variety of underlying medical conditions and medications that could be responsible for this. In the context of hypertension, swollen ankles may be a side effect to certain medications e.g. Amlodipine, or a sign of a complication of hypertension e.g. heart failure or chronic kidney disease. If you are concerned about any swelling, it is advisable to seek further medical advice.

There can be many reasons why blood pressure is erratic. It is vital to ensure that blood pressure medication is optimised because erratic blood pressure can not only cause irreversible organ damage, but it can also increase your risk of heart attack and stroke. If you do experience significant blood pressure fluctations, please seek further medical advice.

Yes. Amlodipine can cause gums to swell or overgrow. If this occurs, the medication should be stopped, an alternative medication should be prescribed, and you should visit a dentist.

Hot weather itself causes blood vessels to widen, which in turn decreases blood pressure. However, hot weather can also be associated with dehydration. Short term dehydration causes low blood pressure, but longstanding dehydration can cause hypertension.