BHF Heart Matters Live: High blood pressure – how to lower it

Hello and welcome to Heart Matters Live. I'm Fergle McKini, head of BHF Northern Ireland. Heart Matters Live is BHF's free expertled Q&A series. Every 3 months, we bring you a live session where you'll hear from those with specialist knowledge, whether that's a BHF funded researcher, clinician, or patient with lived experience, and get the chance to ask them your questions. Each session is centered around a different heart or circulatory condition. And today we're focusing on high blood pressure. In the UK, around 30% of adults have high blood pressure, but it often has no symptoms and if left untreated can lead to heart attacks and strokes. In just a moment, we'll be hearing from Vipan Manny, who had his first heart attack not long after receiving a health check at work, which flagged that he had high blood pressure. More on Vippen's journey shortly. We're also delighted to be joined by Professor Brian Williams, OBBE, BHF's chief scientific and medical officer, consultant physician at UCL hospitals and one of the world's leading authorities on high blood pressure research and patient care. Brian's going to offer his expertise to explain what high blood pressure actually is, everyday strategies to help you lower your blood pressure, and what the future of medicine in this area could look like. Just before I hand over to our first speaker today, if you have any questions for Vippen or Brian, please do submit them via the Q&A function throughout the session. We'll put a selection of these to our speakers at the end. And just a note to say if you have personal questions regarding your own health condition, please contact our heart helpline. Details of how to get in touch will be shared in the chat. During this session, please only submit questions that are directly for our speakers or related to high blood pressure. Thank you. Now, it's my pleasure to introduce Vipan, who's kindly going to share his personal journey with us today. Vippen, thank you very much for being here. I'd also like to introduce Rob Underwood from the BHF heart stories team who's going to interview Vippen. Over to you both, — thank you, Vippan. Good evening and thanks for being part of Heart Matters Live this evening. — You're welcome Rob. Lovely to see you. — We're not total strangers though, are we? Because we've had a number of conversations about different aspects of your heart story. And I kind of wonder how does it feel for you each time you're invited to share your journey? Well, uh, it's it's, um, it's not traumatic and it I've now it's been a few years, so I've managed to get some perspective um, and un each time there's a different element to the story actually, Rob, funnily enough. So, um, if I can be of any help to anybody and I always feel the power of sharing is really, um, powerful as it were. So, um, it's it's a privilege to be able to share the story actually. — Well, it's good to have you on board this evening. So, again, perhaps you'd be kind enough to share briefly your story. I know it's difficult to encapsulate it into a few minutes, but just tell us the journey you've been on. — Okay. Um, going back, oh, this is about 15 years ago now. So, this is when I had the first incident. him. But it started back when um when I was working at a big consultancy firm um and it just so happened I was in the office and they happened to have a an a blood pressure machine and a nurseled clinic um and I was in the middle of doing a really big project and I just went in there to have it measured and it came up something like60 odd over something else and um the nurse said that's pretty high. Um that was news to me because up until then I was just pretty stressed but it was just normal but uh um I just didn't I didn't really think much of it. I think this is a message later on. So anyway so I just went home told my wife um and she said you better go to doctor. So I went to the doctors and um it did the doctor did put me on heart medicate uh blood pressure medication. Um but unfortunately that was about November January I had my I had a big heart attack basically um and despite being on blood pressure medication so and then the story just you know it went on there. I can tell you about that later but that was the beginning of it. Rob, — let me just take you back then a moment because you you said you had this test at work. — Um you you're a pretty fit guy. I mean, Jim was your second home, wasn't it? So, can you remember kind of what was going

through your mind when you were told those blood pressure levels and what you felt it meant to you at that time? — That's an interesting question actually because I've never really thought about it and I never did at the time. That's the problem. I never envvisaged uh and I didn't understand when someone says you've got high blood pressure my immediate response then was so what and then they say oh no it's really dangerous and because I had that I was complacent to be honest Rob um because I as you said I did go to the gym a lot and I did eat well and I was only in my mid-4s and I thought well doesn't really apply to me and I'll just carry on as it were and the only person I knew who had high blood pressure was my and she's 30 years older and I thought, well, fair enough, mom. But for me, no. So, I it was bit of complacency and I'd have to say um a mis misunderstanding and also a bit of arrogance if I'm honest, Rob. — And looking back, I mean, had there been any just remind us again, signs, any sort of indication that maybe your blood pressure wasn't as it should have been? No, that's the thing. I think looking back on it, there was just no indication whatsoever other than I was feeling really stressed, but I thought that was just normal. Um, and lack of sleep and all the other things that are associated with high stress and anxiety, but I just accepted that and ignored it. So, I had it was just no indication at all. No pain, nothing. a sense from what you're saying a few moments ago uh when you were told about your blood pressure that you you kind of you were uncertain you didn't really know what it meant. So kind of following on from that based on that experience what do you feel if you like the level of awareness is generally amongst people about what constitutes high blood pressure I suppose um I don't think they [snorts] understand what high blood pressure means even today I think there's a big gap in people's knowledge um because like I said I still think um it. There's so many simple things you can do, but I don't think many people are proactive. I think that's the thing. I think people wait for something to happen before they think, "Ah, could this be high blood pressure? Could my blood pressure be affected? " I still think there's a big gap in people's knowledge. Rob, that's interesting. And that may be something that we can address a little later on. Talk to me a little bit about the time leading up to your heart attack. What do you feel maybe contributed towards that and the high blood pressure? You you're in a fairly high performing job, weren't you? For instance. — Yeah. I mean I guess lifestyle has a big impact but I think at the time people the advice was that if you eat well you you go to the gym and you you're fairly fit and that should provide some sort of armor coating around events happening to you such as heart attacks or illnesses such as um high blood pressure. But I again I think I've learned a lot from uh from my experiences about diet and the quality of diet. Um that mean that you have to adjust and make changes. But I didn't know it at the time. Um and I would take advantage of going to the gym and and just abuse what I used to eat. Overweight um over overeat perhaps too many snacks too many. So yeah. So it it is it can be um you can be complacent I think basically. How difficult was it coming to terms with the fact that you were very keen on fitness? You know, as I say, you gym was somewhere you spend a lot of time at. Um, and then coming to terms with this and also your symptoms initially being dismissed in a sense. How did you manage to sort of what sort of coping me mechanisms did you have to deal with that? — I mean, after the heart attack um I mean and it was a really difficult period. I'd have to say I mean you your whole world when you have something that is totally unexpected your whole world is turned upside down to be honest with you because um and you have a lot of raw emotions and I found it really difficult to process versus the bravado but that soon disappears and and then the realization that you have to make changes but I found the first few months going on to the first who yeah the first period maybe years very difficult Rob to try and get to grips with what happened to me um

confusion anger raw emotions fear anxiety all those and then I went into my shell and those are the mistakes I made um and it took me a long time to come to terms with that and then move on to try and understand um and accept and once you progress and you get better once you accept um what has happened but that took a period of time Rob to be honest — talk to me about the lows not just the sort of physical recovery but the sort of mental recovery as well from something like this — yeah I mean it's a good point you've just mentioned there I mean the it's quite the physical recovery isn't the problem um as but when I started feeling low and I went back to my consultant. He said, "Oh, we can fix you physically. That's no problem, but you know, the mental problem, the mental issues are a different story and we're not, you know, and I can't help you with that. " So, there's the first challenge. Who do you go to help for help? Um, and so, and at the time, mental health wasn't really talked about a, you know, 15 years ago. I think it's a lot more prominent today. — [snorts] — Um so I really struggled to and I went into my shell and I didn't talk to anybody and that also I found it even more difficult. Um so basically I went on a journey to try and understand how I'm and I was depressed. Yeah. I went into a big black hole frankly and I my personality changed and um affected my relationships with my family, my wife, my children um and I went through a and I and I tried to dismiss it all but um it there comes a low point where you have to take some action and my wife told me to go and see a GP um who basically told me to go and have some therapy. um to begin with and then that helped and talking to somebody um really helped actually Rob. Yeah. — Good. Bringing it back to the aspect of blood pressure then how did your experience shape your understanding after that um of the fact that hidden risks like blood pressure aren't always they're not visible. They're not leaping out at you are they as such. Yeah. I mean what I've learned is that you it's good to be curious. I think that was the other thing. I wasn't curious about my health and blood pressure. Someone says to you what is blood pressure or you've got a problem with your blood high blood pressure or blood pressure. Um I didn't have the inclination to go one step further to ask well why and how and what's the impact. Um, and I think that is the big mis that's something I've learned um in, you know, on my recovery journey is to be a lot more curious and about yourself mentally and physically. Um, I think that is the big takeaway for me, Rob, is to be curious about um your health and to look into things if you can and to ask for help. And I think there are a lot more sources of help um and easily available than perhaps there were the at my time during you know 15 years ago. — So tied in with that just following on from that after your heart attacks and nine stances I believe it was. — So how much just echoing what you're saying I suppose there but how much is managing your own blood pressure um your stress your lifestyle which was a big part of what you were doing before how has that become part of your day-to-day resilience in managing the whole situation? Well, you know, when you talk, you asked me earlier about my journey about recovery and um once you do the acceptance, then you start asking yourself questions as to what does that mean for me going forward? What changes um do I need to make? Um and part of it was to trying to understand who and what are important um healthwise, job-wise um and if I'm if stress was that was identified as the major factor that caused my heart attacks, I need to manage my stress a lot better. And if that means looking at my job, um I wasn't able to go back into management consultancy. But then that the issue was you have to find a purpose um and meaning and you can do that and that is part of the recovery. Your life doesn't have to stop and you can find alternatives and you can grow from what's happened to you and I managed luckily enough I found that by um trying to help other people and doing work for other charities and using what I learned about resilience to help

others on that journey. Um, that's what I've learned, Rob, if that helps. — How's life for you now? — Oh, God, it's immeasurably better. I mean, um, I I appreciate things much more. Um, you're very great. I'm much I'm very grateful for everything I have. I think you tend to be on autopilot because you tend to think that, you know, good health is a given. Um, and it's almost a guarantee, but it isn't. Once you have a scare like that, it does put things into perspective a lot more. Um, and I found that I've been able to do that a lot better. I'm not saying I have great days every day, Rob. Um, and I don't want to give her that misleading impression, but I I'm I'm certainly a lot better at dealing and knowing what when I know what what's happening to me if I'm having a bad day, whether it's with my medications or mentally as well. you can I know and I'm in a lot better state to manage that. So, in every single way, Rob, I feel um a lot better. Thank you for asking. — Well, that's good to hear. So, finally, you kind of just touched on this a moment ago. You said life doesn't stop. So, just broadening that a little bit as a sort of a sum up point. What what's your message to others on a similar journey? Um I well if anything has happened to them I it doesn't have to define them and your life doesn't have to stop at that point in time. Um and I also think that you are people are a lot more stronger and resilient than they think. Um even at your lowest points you can get over this. Um and I'm sure there's things that happen in many people's lives that they've been able to overcome. Um, and I think the third message I would say is to learn to be curious about your body and about your health and not to take it for granted. — And that includes blood pressure. No doubt. — That definitely includes blood pressure. — Well, listen, thanks so much, Vipan, for sharing your story. I know it's not an easy story to recount. I know that, but uh we really appreciated that. Thanks so much indeed. And Fergle, back to you. — Thank you, — Ribbon. thanks uh for sharing your story so openly and honestly and inspiringly as well. Thank you very much indeed. And uh Rob, thank you too. Uh and we'll return to you in a while with uh some of the questions which are already flooding in. Now um technical glitch has got in the way. We had hoped at this point to introduce uh Brian, Professor Brian Williams uh but it appears that he isn't able to join us just at this moment. However, we do have a slide deck and we do have uh Rose Westp from our research engagement team who's going to take us through uh what Brian would have been saying about an overview of high blood pressure, how we can lower it, and some exciting insight into treatments that could be right around the corner. Can I hand over to you now, Rose? — You certainly can, Fergle. Good evening, everyone. So, sorry we're having some technical difficulties at the moment. So, um I'm very sorry you haven't got Professor Brian Williams, OBBE, you've got me. I'm Rose Westp and I'm the senior research engagement manager here at BHF. So, of course, we're all here to talk about blood pressure, but what is uh blood pressure? So essentially your blood pressure is the pressure of blood in your arteries, what it says on the tin. So your arteries are the vessels or tubes that carry blood from your heart to your brain and the rest of your body. And you need a certain amount of pressure to get that blood moving around your body. So your blood pressure does naturally go up and down throughout the day and night and it's normal for it to go up while you're moving about. Next slide, please, Leanne. But what is high blood pressure? So when your overall blood pressure is always high, even when you're resting, this is what's known as high blood pressure or hypertension, which is the medical term. So this means essentially that your heart is working a lot harder when pumping blood around your body. So your arteries are quite stretchy naturally to cope with your blood pressure going up and down. But if you have high blood pressure, your arteries lose their stretchiness and can become stiff or narrow. And this narrowing makes it easier for fatty materials to clog them up. And if the arteries that carry blood to your heart get damaged and clogged, that can lead to a heart attack. If it happens to the arteries that carry blood to your brain, it can lead to a stroke. So, why does this matter? Well, high blood pressure is the leading modifiable risk factor for cardiovascular disease in the UK. And around 16 million adults

in the UK have high blood pressure. Yet up to half of them we thought they're not receiving effective treatment. Also, as many as 5 million adults in the UK have undiagnosed high blood pressure and don't even know they're at risk. Now, high blood pressure is often called a silent killer because it usually has no symptoms. The only real way to know if you have high blood pressure is to get your blood pressure checked. So, what do the numbers mean? We've all had our blood pressure taken, I'm sure. Um, and we've all seen these two numbers. What do they mean? Well, your blood pressure is measured, as I said, using two numbers. And the first one is the systolic pressure. So, this is the higher of the two numbers. And it's the pressure against your arteries when your heart is pumping blood around your body. The smaller of the two numbers is what's known as your diastolic pressure, and it shows how much pressure is in your arteries when your heart relaxes between heartbeats. Now what do the numbers mean? So this chart which you can see on our website gives you an idea. Healthy blood pressure is usually considered to be between 90 over 60 or uh to 120 over 80. Now for people who are older um people in their 80s because it's normal for your arteries to get stiffer as we get older the ideal blood pressure for that age group is under 150 over 90. High normal blood pressure, sometimes called prehypertension, is when you don't have an ideal blood pressure, but you also don't have high blood pressure. And there are three stages of high blood pressure. Stage 1, stage two, and stage three. Stage three hypertension is when your systolic blood pressure is over 180 or your diastolic 120 in the clinic. This stage is also called severe hypertension and your GP will need to assess you urgently for further investigations. So, how can high blood pressure affect the body? So, I've already said that having high blood pressure can put you at risk of having a heart attack or a stroke, but it can also lead to other um effects. So, it can lead to other symptoms like vision loss or even sexual dysfunction. Now, what can cause high blood pressure? So it's important to note that actually high blood pressure can be caused sometimes by things you cannot change or by things you can change and often a mixture of the two. So um in many cases high blood pressure doesn't have a cause and this is called primary hypertension. So it can be due to factors like your ethnicity. So um people of black African Caribbean and South Asian descent can be at higher risk. As we get older, of course, our risk increases significantly with age. And also, high blood pressure can run in families. So, if you have a high um a family history, this can put you at risk as well. But there are things we can do um and this is what we'll talk a little bit about in the next slide. So, what can you do to help lower your blood pressure? So, these are probably things that you've heard of before. They might not be groundbreaking or new, but actually they're really, really important and they're important for all of us. The first is getting regular exercise. So, you should try and do some moderate intensity activity every day, but you can do start slow and build it up to about 150 minutes per week. For some people, losing weight might be all they need to do to lower their blood pressure. Eating a healthy, balanced diet with more fruits and vegetables, eating less salt essentially by not adding any extra at the table or cutting down on processed foods that sometimes have quite a lot of salt hidden inside them. And if you drink alcohol, it's best to stick to the recommended guidelines of no more than 14 units per week. And all of us should aim to have several days a week where we don't drink any alcohol. Next slide, please, Leanne. Now, even after all of that, there are people who will still need medication to keep their blood pressure down. So, just some of the medications I've listed here, ACE inhibitors that help the blood vessels relax, calcium channel blockers that help the heart to beat with less force, and diuretics that help the kidneys to remove extra fluid and salt. Sometimes these medications are used together to help control blood pressure more effectively. And also many people um are understandably unsure about starting medication, but taking blood pressure medication is one of the best ways you can keep yourself safe if you've been prescribed them. So, I'm going to talk a little bit about research uh in just a minute, but before I do that, I just wanted to point out that was a bit of a whistle stop tour and how you can help to lower your blood pressure, but there is way more support available on our website. So you can use this QR code. There'll be links posted in the chat or you can simply

search online heart matters for lots more advice and support. But let's talk about another piece of the puzzle. So what has scientific research taught us about blood pressure and how we can manage it? So for over 60 years, BHF has been at the forefront of research into high blood pressure, helping to transform how we prevent, detect, understand, and treat this major risk factor for cardiovascular disease. Now, before the 60s, high blood pressure was really poorly understood. Treatment options were very limited and often accompanied by significant unpleasant side effects. BHF has funded more than 500 grants over the last 60 years totaling over 100 million pounds for researchers to investigate high blood pressure. Now with your support, we've helped to unravel the complex ways uh in which our body regulates blood pressure. We've supported the development of safer and more effective treatments and we've also helped to shape clinical guidelines through landmark studies. BHF funded research essentially has helped doctors around the world better understand which drugs work best and which people would benefit most, laying the foundation for more personalized approaches to care. So there are just a few trials listed here um trials that BHF funded that helped to shape clinical practice around blood pressure. So one, the highet trial showed that blood pressure medication is safe and effective for people over the age of 80. And that's really important because before this trial, it doctors were unsure whether treating this group would be safe um and at all effective. But actually the trial found that medicating this group could cut death rates by 21%. The pathway trials pioneered and personalized approaches to treatment of high blood pressure, again shaping guidelines across the globe. and one that um many of you may ask questions about today, the time trial. So that showed that taking blood pressure medication is equally effective whether you take your medication in the morning or the evening. Something we get a lot of questions about. But there is much more to be done of course and BHF continues to fund research into this incredibly important risk factor. So what does the future hold? Next slide, please, Leanne. So this is just a few um sort of examples because research into blood pressure as I said is continuing on and people have very different ideas brilliant ideas that they come to BHF with and we fund the very best and brightest ones. But let's just talk about a few of them. So for example, personalized medicine. Now this isn't just something that we're talking about um when we talk about high blood pressure. Many illnesses will be treated using a more personalized approach. And this is all about understanding the link between an individual's genetics, their environment, their lifestyle, and how that affects their blood pressure and which treatments would work better for them versus using a blanket approach. New digital tools and advanced data analysis probably unsurprising. We talk about AI a lot. You see it in the news. But these tools be really important to help doctors spot who might be at risk much sooner so they can step in and get people the right treatment as quickly as possible. And researchers are also studying the complexity of what causes high blood pressure. So for example, whether it develops differently in men and women, how the immune system might be involved, and how our environment and life experiences can affect our health over time. So with continued innovation, BHF is working towards a future where high blood pressure is detected earlier, treated more precisely and prevented more widely. Thank you all very much for joining. Um and I'll hand back over to Fergle — Rose. Thanks very much indeed and for stepping in so very aly. Thank you uh very much indeed. Now it's over to your questions and can welcome back Vipen. Can also welcome Joan Whitmore, clinical nurse lead with BHF. We'll still struggle with the technology and see if we can get Brian back. But in the meantime, you've been peppering the uh Q&A uh box with loads of your questions. So uh just one first for you, Vip. And uh somebody was inquiring, was there a family connection at all relation was a history? um my mother's side, yes, but I didn't know that. I only knew a little bit of it, but subsequently my mother did have a heart attack after I was diagnosed and then my brother as well. So, yes, there was definitely a familial history. — Okay. Thanks very much indeed. So, I'm just going to take these in order. Um uh what advice do you have for someone Joan who has been told that their BP is

fine but the reading was higher than what was considered normal? — I mean there are cut off points for different levels of hypertension. So and there are UK guidelines on that. So it is you know relatively clear as to what the guidelines are. Now it does change if you've got other conditions like diabetes and things like that can alter it. So the threshold might be lower. Um so it may be that the GP is taking into account other issues or you know other health conditions that might alter it or what medication they're already on. So there are a number of different reasons why. But I think for you, I think getting um a good diary, good documentation of all your blood pressure readings and doing it regularly over a week is really important to get the overall um idea of what your blood pressure is, not just a one-off when you're going to see your GP when it might be a bit higher than normal. So, it's getting a good baseline of your normal routine over the whole week. — Yeah. Another questioner here um says that their blood pressure is a lot higher first thing in the morning much lower in the evening. Is this common and how does this affect the average figure used to decide on medications? I mean it can get higher. Um and everybody's sort of blood pressure will change a little bit but if you imagine throughout the day you're doing things you're working you know you're exert you're tired so your blood pressure could well go up um when you're relaxed and asleep it will go down and it's normal to have like a nighttime dip. — Yeah. and can ask this of both of you. Maybe just you could reflect upon your own experience anxiety and how it affects your blood pressure readings. Was that something you found? — Yeah, for sure. Fergle. Um, you know, if there are stresses and I'm feeling anxious, particularly anxious, I will go and measure my blood pressure and I can see um it does shoot up a bit. So um and now I've realized um when I am feeling a bit more anxious or stressed that I need to be more mindful of my blood pressure. Yeah, for sure. — Yeah, maybe I'll just turn that question a we bit differently then for you Joan. How do you how can you calculate the the accuracy of blood pressure if an anxiety factors coming into it or from a nursing perspective does that not matter? You just got to deal with the figures. No, I mean that does matter and it's really important actually and that's why how to measure blood pressure has changed quite significantly over the last few years. Um it is inaccurate just having a one-off blood pressure reading in a GP surgery or in your dentist or you know wherever. Um it's good to just get a one-off view you know just to see you know and if it if it's very high then the likelihood is that it is going to be high when you look at it um properly over the course of a week. But um just making sure that you do your blood pressures morning and evening, not just doing one as well. I mean it is all about getting rid of this stress and um make sure that you're completely relaxed. So it's important to keep your arm relaxed so that and you're sat down in a chair and you're relaxed for 5 minutes beforehand. Um do at least two readings and dis discard the first one in general because the first one is likely to be higher than the other ones. — Yeah. So there there's so many sort of little nuances with taking a blood pressure, you know, not moving your arm, not talking, making sure you do it on the right arm. So I think for from a you know, a patient, a member of public's perspective, that's the most important thing for your GP or for your health care professional is to have those accurate readings from a validated blood pressure machine as well. Um and then there obviously you can go on to the treatment choices then after that. And another questioner wants to know, can I naturally lower my blood pressure or do you always need medication? — You don't always need medication. Obviously, when you're starting to get to the higher levels of normal, um you might want to be, you know, taking into consideration other things, but all the risk factors that, you know, we commonly talk about, smoking, alcohol, um diet, um you know, activity, not doing, you know, not doing enough physical activity. All of these things are risk factors that can impact your blood pressure as well as, you know, like your overall risk for cardiovascular disease. So looking after yourself, you know, making sure that you eat healthily, that you take the stairs instead of the lift, you know, just all these little things could can all help with keeping your blood pressure nice and low. And I think that's probably one of the important things to say. Don't wait for it to get high. you know, we can be looking after our blood vessels and our blood pressure much earlier before, you know, before we get signs of um your blood

pressure being high and there might be a problem. — Yes. Um, one question here wants to know the impact of being overweight on blood pressure and is that a factor? — Yeah. Yeah, it could be. Yeah. um you've got more weight in general. So your heart has to work harder and your heart's a muscle and you know the blood going around your blood vessels. So it does exert you know some more pressure on your on your arteries on your blood vessels. Yeah. — And uh very practical question Rose touched on it in terms of the slides and the numbers. What do the top and bottom numbers mean uh for this questioner? — Yeah. So there there's systolic and diastolic. So you've got your your top number is your systolic and that's um the amount of pressure that is needed to force the blood round your system and then your diastolic is when the blood vessel relaxes. So it's the highest number of the highest um pressure going through your arteries and then your lowest one when your heart's relaxed. — Okay. Um, Brian has managed to arrive and defeated all of the technology. No worries, Brian. — Hi. Yeah, it's good to see you. I was having teams gremlins, but I've managed to join. But uh, — well, listen, fantastic that you can. So, we're just on the questions now, Brian. And, uh, we've been through some very practical ones um, as well, and Joe's been answering those. Um, I'll just continue with those questions, but if you could maybe focus in on this. There's one person said, "I have heart failure. Can I have a normal active life? " — Yeah, we should be able to. I mean obviously if you've got heart failure you might be limited by breathlessness and issues like that but I think with the medications we're able to give these days many people are able to live a much more active life than they um would have done in the past and some of the medicines that were now using are terrific actually not only improving symptoms but also improving longevity in people with heart failure. So that's great news. There's still a lot to do. of research that we're doing trying to continue to make improvements. But if you look at the situation maybe only 5 years ago and you look at it today, then the prognosis for people with heart failure is much better than it was. But of course, the ultimate treatment of heart failure is to try and prevent it. And uh one of the real problems with high blood pressure is that untreated it is one of the most common causes of heart failure because of the extra work the heart is having to do throughout your life. Eventually it originally responds to that by the muscle of the heart getting thicker uh as you would find if you went to the gym and had to work harder to do the work. But eventually that fails over time just as you'll fail in the gym if you keep having to try and lift weights. Eventually you just have to, you know, you can't keep it up. And that's what's happening to the heart. It's having to work a lot harder every day if it's having to pump blood at a higher pressure. And eventually it starts to fail as you get older. And as our populations are aging, then untreated blood pressure or poorly treated blood pressure is becoming a real epidemic of heart failure because it's one of the main causes. So, it's another good reason to get your blood pressure checked and if it's elevated, make sure you get treated and try and get it controlled. — Yeah. Um, another question here. Uh, it talks about ethnicity, age, and sex are important variables as is diabetes. they say and they're saying that some of these are hormonal related. Insulin itself is a hormone and do we know the actual specific pathways they're asking in the body of these hormones. So diabetes is a particular problem because very rarely will you ever find a diabetic particularly type two diabetes which happens as you get older and is much more common. Very rarely do you find a diabetic who doesn't have high blood pressure. So their blood pressure goes up for a whole variety of reasons. It's not so much the hormones. It's the fact that they tend to retain more salt. So they have difficulty in getting rid of salt from the body. And also diabetic patients often have earlier onset of kidney problems. So uh this can make blood pressure quite difficult to treat. And also the glucose, the high glucose damages the walls of the arteries and makes them stiffer. So all of these things conspire to increase the risk of getting hypertension. Now the good news is that treatment of blood pressure in people with diabetes is particularly effective in terms of preventing not only heart disease and kidney disease but also eye disease and you know

getting your blood pressure down. People with diabetes seem to be uniquely vulnerable to the pressure problem. So even at the same level of blood pressure you'll get more complications if you have diabetes. So, it's really, really important if you have diabetes to get your blood pressure checked and don't take it complacently. If it's elevated, make sure you get it lowered because that's one of the most important things you can actually do in diabetes to protect the vital organs including the eyes, the kidneys, the blood vessels, and stop the complications of diabetes developing. And we often try and lower blood pressure even more aggressively in people with diabetes because they seem to be particularly vulnerable to the effects of blood pressure. — Yes. And uh what is the future? Rose obviously touched in the slides and the research. What is the future of hypertension research? — Well, it's really exciting. I mean I think um over the years we've done a lot of work trying to understand why people become hypertensive and Rose probably showed the slide where you know we're now trying to work out better ways to predict who's going to become hypertension much earlier. Genetics clearly plays a part because one of the questions I ask every patient in my clinic is are your parents hypertensive and invariably they they are and was your parents hypertensive if yeah — yes I suspect and particularly your mother there seems to be a particular — particularly linked to the mother so it's all your mother's fault and uh so you know you're um link with the mother's very strong. So there's something in the genetics now. You know in the UK we are building genetic tests that maybe we can begin to apply much earlier and it's not a single gene it's a multiple of genes. So we call this polygenic risk score. You may have seen this being mentioned and there is an ambition that um earlier in life before you even become hypertensive it might be possible to predict who is going to become hypertensive in the future and therefore start the lifestyle interventions a lot earlier. Get them to eat a more healthy diet, take a bit more exercise and try and stop the onset of hypertension. But also as soon as blood pressure tracks up, start treatment earlier so that we can prevent the rise in blood pressure which often means that you end up on three drugs, four drugs rather than potentially being treated with one drug if you could treat it much earlier and stop any of the damage that blood pressure does which causes a vicious cycle and just drives up blood pressure even more. So if you leave it too long then you get damage to the blood vessels which then makes the blood pressure more difficult to treat and therefore you end up on two drugs, three drugs and whatever. So these genetic tests which you know there's a vision that like you have a heel prick at birth to look for various genetic disorders that give rise to rare diseases. We may be able to also start profiling people at a very early age uh to offer them more effective advice and also more frequent monitoring. If you have a particular genetic predisposition, you might get your blood pressure checked every year uh just to make sure it's not drifting up. So that's on that side. Then of course on the diagnostic side, you know, with the digital and AI and wearables, there's a lot of new information. Um, not all of these wearables that are not standard blood pressure measurements are that effective at making a diagnosis, but what they can do is alert you to whether you might be hypertensive um and therefore prompt you to go and get tested uh and get a proper diagnostic um test. And then drug development. We thought the drug thing was done. Many of the pharmaceutical industries thought we already had enough drugs. We just need to get patients on these drugs and then we can control blood pressure. But in my own research actually, we're still doing quite a lot of research in new drug development and there are three or four new classes of drugs coming down the track which look particularly exciting. Um and there's still billions being poured into drug development for hypertension. One of the reasons of course why the industry is interested in drug development for hypertension is such a common problem um and therefore they know that if they produce a blockbuster that's going to be more effective than what we have now there's likely to be a huge market for it. But of course they also have to factor in that they can't make these drugs too expensive because they're not treating a rare disease where you can charge a much bigger price to get an effect. They're treating an incredibly common disease that affects over a billion people around the world and therefore the drugs have to be reasonably cheap, but they go for a volume effect because so many people are being treated. So, we're

exploring new targets and uh I'm pretty optimistic we're going to see two or three completely new types of blood pressure drugs coming onto the market in the next um couple of years, which is quite exciting. Um, one of those drugs is an injectable uh which actually uh uses a genetic type therapy to bring down the levels of a hormone called andotensinogen which actually is one of the drivers of hypertension. And the vision here is that you would get this injection almost like a vaccination once every six months bit like we now have for lipid lowering. Um and that might help. It may not do it all on its own. may need another drug as well, but at least it would give a background of blood pressure lowering from a single jab um once every six months and potentially once a year depending on how these treatments work. So, so quite an exciting field now drug development in hypertension and a much needed one because still around 50% of people on treatment don't get blood pressure control to optimal targets. Some of that is the fact that sadly sometimes people can't take their treatment or forget to they're not being put on the right treatments by their doctors. But um for the most part um I think these new therapies should enable us to control most people eventually. — Okay. Thank you very exciting horizon. — Yeah. Vipan, could I just turn to you again? Before your first heart attack, you were extremely fit and active. And how did having high blood pressure challenge the belief that fitness alone was protecting your heart? — Um I think it gives you a false sense of confidence. I think Virgo, this is why um I misunderstood what fit and healthy meant. I mean there's lifestyle factors as well that you have to f take into account and at that time I was led to believe that if I trained a significant amount of time and kept fit that would be um a barrier to getting ill and having these issues. Um but of course what I didn't realize was the impact of uh stress and you know the tests that I've done because I don't drink, I don't smoke and I don't have the other risk factors. So the biggest risk Fergle is stress. So to manage that um has been the biggest learning point for me actually Fergle. Yeah. So it's an important factor definitely to stay fit. But I think um there's there's many other things that I needed to understand as well. — Are you on a statin as well? — I am. I am Brian. Yes. — Yeah. I mean the the other thing I do in my clinic quite a lot is um you know particularly as you get over the age of about 50 then um if you're at enough risk to be treated for your blood pressure you're probably also at enough risk to be on a statin and uh you know most people don't have a completely normal cholesterol. So all of my patients when I treat them for blood pressure, particularly if they're middle-aged and above, I will say to them, look, your cholesterol is not particularly abnormal, but because you're hypertensive and we're treating your blood pressure, we may as well get your cholesterol down to an optimal level as well because the two act in concert. So if your cholesterol is even mildly elevated, um if you have high blood pressure, the that accentuates the effect of the cholesterol. So treating the both together actually is much more powerful than treating either alone. And so most of my patients um are on statins as well as blood pressure lowering treatment. And that's incredibly powerful. We showed in trials some years ago actually that you know if you look at somebody who goes on treatments for blood pressure and you get them down to a decent level of control but then you add in a statin you get an extra 25% um reduction in stroke and you get an extra 30% and about a third further reduction in heart attack risk. So, it is absolutely essential that if you're high risk or you've had a cardiovascular event that you get your blood pressure and your cholesterol lowered simultaneously. — Yeah, I did have um high cholesterol as well to be honest. So, that's a good point, Brian. — That's a pretty bad combination. So, yeah, as you discovered, but actually now that they're both treated, your risk has been reduced very substantially of any anything happening again. — Yeah. Okay. We kind of ranged over the future etc. And just a very practical question for on in terms of blood pressure right or left arm or does it matter is that — well actually when you first get it measured you should really get it measured in both arms because sometimes

there's a difference in blood pressure between arms. Um and that can be up to about 10 millmters of mercury and that's normal. Um, if it's more than that, it might be that you've got a narrowing on one side of the blood vessel, which in itself might be indicative of disease in the arteries around the body. But more importantly, you don't want to be going around thinking your blood pressure is controlled because you've got it measured in the lower arm and the blood pressure is higher in the other arm. because if it's arm, that's probably the real blood pressure and that's the pressure that's perusing the rest of your body. So, what doctors should really be doing is checking it in both arms and always using the arm with the highest pressure as the marker of your blood pressure um so that you get the highest level reduced because otherwise you can get false assurance particularly if you've got a big difference between the two arms. uh and actually a very big difference between the two arms might be a marker that you've actually already got some arterial disease which is affecting caused a narrowing on one side in one of the arteries that goes down to the arm and that actually gives you a lower pressure because it's oluding the blood flow and that might be a marker in itself of risk because you've got um so if it's up to 10 difference in the top number that's okay but if it's more than that it probably means you've got some arterial disease and therefore that's another reason why you need to be looked at more closely. So that's why we recommend measuring in both arms initially, not every time. Once you've established what the high arm is, use the high arm. — Yeah. Okay. Thanks you very much indeed. Well guys, we've just about run out of time. Uh it's now time to thank everybody. Vippen, can I thank you? [snorts] Um uh Rose, can I also thank you for stepping in soyly? Uh Joanne uh thank you to and Brian thanks for joining. So um so that's all we have time for today. If we haven't managed to answer your question then we encourage you to call our heart helpline and speak directly to one of our cardiac nurses. Heart matters live is a free quarterly Q&A series and we strive to produce the best live events possible. Your feedback and comments are crucial to help plan and develop future events. So, we ask if you can please complete the survey that uh you'll receive in an email in the coming days, please do so. All of our incredible research is funded 100% by you, the public. If you took something away from this session or were inspired by what you heard, then all donations to support our life-saving work are very much welcomed and appreciated. There's a link to donate in the chat box should you wish to do so. This edition of Heart Mothers Live was recorded and will be available on our YouTube channel from next week. Our next event will be focused on high cholesterol and how to lower it. That'll be on Tuesday the 5th of May at the earlier time of uh 1 to 2 p. m. Don't miss out. Register now using the link in the chat box. Thanks again for joining us and goodbye.