Written by Dr Andrew Stein, Consultant Physician (Hospital Specialist), UHCW Coventry. Last updated: June 2026
Many of my patients have high blood pressure (BP), and are overweight or obese. They also often have diabetes, CKD and a high cholesterol, as well.
This article is the advice I give my patients on their journey to normal blood pressure and better health
When I talk to my patients in clinic, I like to explain blood pressure using a simple analogy: think of your cardiovascular system as the plumbing in your house. Blood pressure is simply the physical force that your blood exerts against the walls of your blood vessels as your heart pumps it around your body.
If the pressure in those pipes stays too high for too long, it puts a constant, dangerous strain on both the pump (your heart) and the pipes (your arteries). Over time, this extra strain can cause the blood vessels to become stiff, narrow, or weak, making it significantly harder for oxygen-rich blood to reach your vital organs.
Whenever you have your blood pressure checked by a doctor, nurse, or pharmacist, you will always be given two numbers, measured in millimeters of mercury (mmHg). Patients frequently ask me what these numbers actually mean:
Systolic Pressure (The Top Number): This measures the maximum pressure exerted against your artery walls at the exact moment your heart contracts and beats.
Diastolic Pressure (The Bottom Number): This measures the pressure in your arteries when your heart rests between beats.
For most adults under the age of 70, a consistent home reading of 135/85 mmHg or higher is the standard clinical threshold where we need to start a formal medical assessment.
High blood pressure, or hypertension, has earned the ominous nickname of the “silent killer” for a very specific reason: it rarely causes any noticeable symptoms. Many of my patients are shocked to find out their numbers are high because they feel completely fine.
Because you cannot feel high blood pressure happening, significant damage can be done to your internal organs quietly over several years. Leaving hypertension untreated dramatically increases your baseline risk of experiencing a life-altering medical emergency, such as a stroke, a heart attack, or progressive kidney damage. Knowing your numbers through regular screening is the only definitive way to protect yourself.
If you want to lower your numbers, the kitchen is the absolute best place to start. Making deliberate adjustments to what you eat is a highly effective, first-line medical treatment that empowers you to take direct control of your cardiovascular health.
Slash Your Salt Intake: Aim for less than 5g of salt per day. Excess sodium acts like a sponge, causing your body to retain fluid and directly driving up the pressure in your vessels. I advise my patients to stop adding salt during cooking or at the dinner table. If a recipe absolutely demands it, swap standard ingredients for low-sodium or no-salt alternatives.
Adopt the DASH Approach: DASH stands for Dietary Approaches to Stop Hypertension. This eating plan focuses heavily on whole grains, lean proteins, fruits, and vegetables that are rich in potassium, calcium, and magnesium—minerals that naturally relax your blood vessels.
Beyond your diet, your daily routines play a massive role in determining how hard your heart has to work. Small, consistent shifts in your lifestyle can lead to a substantial, measurable drop in your mmHg readings.
Move More Every Week: Aim for at least 180 minutes of moderate aerobic activity every single week. Activities like brisk walking, swimming, or cycling strengthen your heart muscle, allowing it to pump more blood with less effort.
Manage Your Weight: If your body mass index (BMI) is over 30 kg/m², losing weight is one of the most powerful tools available to relieve the mechanical workload on your heart.
Limit Alcohol and Quit Smoking: Keep your alcohol intake safely under 14 units per week. Additionally, stopping smoking is vital; nicotine causes an immediate spike in blood pressure and actively damages the structural lining of your arterial walls.
In about 90% of cases, high blood pressure develops gradually over time with no single, clear cause (known as essential hypertension). However, for roughly 1 in 10 people, the high reading is actually a secondary symptom triggered by a completely separate, underlying medical condition.
When we identify and treat that root cause, the secondary high blood pressure will often completely resolve or become much easier to manage. Common secondary causes that I look out for in patients include:
Chronic Kidney Disease (CKD): Especially when a patient reaches Stage 3B or worse, as the kidneys play a major role in regulating fluid and blood pressure.
Hormonal Imbalances: Rare endocrine disorders such as Cushing’s syndrome or Conn’s syndrome.
Structural Conditions: Cardiovascular issues like coarctation (narrowing) of the aorta.
Pregnancy: Conditions like preeclampsia require highly specialized obstetric monitoring to keep both parent and baby safe.
If you have spent two to three months dedicated to lifestyle changes and your readings are still remaining stubbornly high, it may be time to introduce medication. I always tell my patients: do not be frightened of prescription treatments. Modern blood pressure medications are highly effective, have low risk profiles, and generally cause very few side effects.
| Medication Type | Common Example | Who It Is Typically Best For |
| ACE Inhibitors | Ramipril | Patients under 55, or those managing diabetes. |
| Calcium Channel Blockers | Amlodipine | Patients over 55, or individuals of Afro-Caribbean descent. |
| Angiotensin Receptor Blockers (ARBs) | Losartan | An excellent alternative if an ACE inhibitor causes a dry cough. |
| Thiazide-like Diuretics | Indapamide | Helps your kidneys flush away excess water and salt. |
Please keep in mind that hypertension management is often a long-term commitment. While a few patients are eventually able to wean themselves off medication through major, sustained lifestyle transformations, most people will take them long-term to keep their organs fully protected.
For patients who are managing more complex, concurrent health problems like advanced Chronic Kidney Disease (Stage 4 or 5) or Heart Failure, blood pressure management becomes much more specialized. In these scenarios, the body struggles significantly to clear fluid, which rapidly worsens hypertension.
To manage this, we often prescribe powerful medications called Loop Diuretics (such as Furosemide) to help pull fluid out of the tissues and bloodstream. In some instances, your clinical team might combine this with a strict 1.5-litre fluid restriction. It is absolutely crucial that you never restrict your fluids like this unless you are explicitly instructed to do so by your doctor. Furthermore, in advanced CKD, an inability to control blood pressure can sometimes be a direct clinical indicator that it is time to discuss starting dialysis.
We don’t just want to lower your blood pressure slightly; we want to guide it into a specific, optimized target zone where your statistical risk of a stroke or heart attack drops dramatically.
The General Target: For most standard patients, we aim to keep readings below 130/80 mmHg.
The Diabetic Target: If you have diabetes, we try to safely get your numbers closer to 120/70 mmHg, provided your body tolerates it well without making you feel dizzy.
Top Tip: When you start or adjust blood pressure medications, make use of your local nurse- or pharmacist-led clinics to get regular U&E (Urea and Electrolytes) blood tests. You should have these checked at least every 6 months to ensure your kidneys are staying completely healthy and processing your medications perfectly.
It is very common to need a combination of two or even three different medications working together to get your blood pressure down into a safe, healthy range. However, if you are taking three or more distinct blood pressure medications at their maximum doses and your numbers are still remaining high, you have what we call Resistant Hypertension.
If you fall into this category, you should not try to manage this alone. Your GP will need to refer you to a hospital specialist—such as a Nephrologist (kidney specialist), Cardiologist (heart specialist), or Endocrinologist (hormone specialist). Seeing a specialist allows us to perform deeper diagnostic testing to hunt for hidden secondary causes or introduce highly advanced, specialised medications to finally get your pressure under control.
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