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General Health

- Blood pressure
- Cholesterol and Heart Disease
- Blood Sugar
- Body Fat

Blood Pressure

According to the Blood Pressure Association, around 16m of us in the UK have high blood pressure putting us at risk of stroke, heart attack and kidney disease1. But with a reported 61% of people not knowing their blood pressure reading2, how can you tell if you are even at risk?

The problem is that high blood pressure (or 'hypertension') has no real symptoms. It is often referred to as the 'silent killer' and the only way to find out if you have it is to have your blood pressure monitored.

Your blood pressure reading reflects the pressure of the blood in your arteries. The higher the pressure is, the more strain is put on your arteries - causing them to clog up or weaken. This, in turn, can lead to narrow blood vessels and clots, which can cause damage to the heart or brain. More rarely, it can cause the blood vessels to burst.

What levels are we talking here?

To be classed as having high blood pressure you would normally have a sustained reading of 140/90mmHg or above³.

Who is at risk?

• Contrary to popular myth, high blood pressure is not a condition just reserved for the old - 30% of women and 32% of men aged under 64 have high blood pressure. However, incidence does increase with age4. More than half of those aged 75+ have high blood pressure⁴.
• Family history is also a key indicator - unfortunately you are more likely to have high blood pressure if you have a close family member who has/had high blood pressure, stroke or heart attack⁴
• Some other conditions are also linked to high blood pressure, such as diabetes, kidney disease and heart disease. If you have any of these conditions then it is even more important that your blood pressure is identified and well controlled⁴
• There is also evidence to suggest that if you are African-Caribbean you are more likely to have high blood pressure than the rest of the population in the UK; possibly because you may be more sensitive to salt in your diet and more likely to have a stroke. Similarly if you are South Asian then you are more likely to have diabetes or a heart attack which means that it is important for you to keep your blood pressure and cholesterol levels well controlled although the reasons for this are not fully understood^4.
• The only factor you really have control over is your lifestyle. If you are overweight, eat too much salt and not enough fruits and vegetables, are physically inactive and drink too much alcohol you are more likely to have high blood pressure⁴.

So why not get your blood pressure checked?

The important thing to remember is that high blood pressure can affect anyone - and the chances are you won't even know it. However, the sooner you find out you have it, the sooner you can take proactive steps to manage it (whether that be through diet, exercise, stress management or medication) and hopefully prevent or at least minimise the risk of associated conditions.

Your GP or practice nurse can read your blood pressure or many pharmacies (such as Lloydspharmacy) are now offering free tests, without the need for an appointment. If you wish to check your blood pressure on a regular basis, you can even buy a blood pressure monitor for use at home.

References

1. Forette F, Seux M, Staessen J. Prevention of dementia in randomised double-blind placebo controlled systolic hypertension in Europe (Syst-Eur) trial. The Lancet 1998;352:1346-51
2. You Gov independent survey, commissioned by Lloydspharmacy Sept 2005.
3. Williams B et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004 - BHS IV. The Journal of Human Hypertension 2004;18 :139-185 (www.bhsoc.org)
4. Blood Pressure Association

Cholesterol and Heart Disease

According to the British Cardiac Patients Association half of all people in the UK have raised cholesterol levels

What is cholesterol?

Cholesterol is a soft waxy substance and is an essential body fat (lipid) that is carried around the body in the blood and is found in all the body's cells.

We need a certain amount of cholesterol to keep us healthy, but too much cholesterol is a health risk. It can build up in the artery walls, leading to the hardening and narrowing of the arteries which can in turn slow down the flow of blood to your heart.

What level should I be aiming for?

There are differing guidelines for cholesterol targets but the National Service Framework for CHD suggests that levels should be less than 5.0 mmol/l.

However, it is not quite as simple as that. There are two types of cholesterol - LDL or 'bad' cholesterol which can build up on artery walls and increase your risk of CHD, and HDL, or 'good' cholesterol. HDL appears to do the opposite - carrying cholesterol away from the arteries (where it may otherwise build up) and back to the liver for disposal.

It is important that the body maintains the right balance of the two.

What can I do?

Cholesterol levels can be regulated by drugs (known as 'statins'), exercise and dietary changes particularly reducing intake of saturated fat and foods such as red meat, seafood and dairy products (especially egg yolks), while increasing intake of garlic and plant sterols.

Garlic appears to keep cholesterol levels in check by ensuring any excess is re-circulated to the liver for excretion rather than being deposited in the arterial tissue. Meanwhile plant sterols (naturally found in vegetable oils, grains, cereal products, nuts and vegetables) are thought to be responsible for the reduced absorption of cholesterol in the intestine where excess cholesterol is deposited as bile.

Testing, Testing...

Only 15% of people actually know what their cholesterol level is1. As with blood pressure, the only way to find out your cholesterol level is to have it checked. Your GP or practice nurse can usually do this for you through a simple blood test, or there are a number of tests available which can either be bought for use at home or undertaken by a pharmacist.

References:

1. British Cardiac Patients Association

Blood Sugar

What is blood sugar?

Your blood sugar level is the amount of glucose (sugar) in the blood. It is usually measured in terms of millimoles per litre (mmol/l) found in the blood.

Blood sugar levels can fluctuate during the day (often they are higher after meals and lowest in the morning) but they tend to stay within the range of 4 to 8mmol/l. This is because under normal conditions, the body produces a hormone called insulin which helps to control the amount of glucose dissolved in the blood and prevents the blood sugar level from rising too high.

When blood sugar levels deviate

Some people find that their levels deviate from this 'normal' range. This may mean that they are at risk of diabetes and its associated conditions. If identified early enough, diabetes can usually be controlled through diet and possibly medication.

However, if very high levels of blood glucose are present over a number of years and are not managed, small blood vessels can become damaged causing complications such as diseases of the eye, kidney, nerves and cardiovascular system.

Testing, Testing...

As a general guideline, ideal glucose levels should be:

• 4 to 7mmol/l before meals.
• less than 10mmol/l 90 minutes after a meal
• around 8mmol/l at bedtime.

Blood glucose levels can be identified through a simple 'pin prick' blood test. This may be conducted at your GP surgery. However, since 50% of GP surgeries don't have a formal diabetes screening policy1, many people are choosing to take matters into their own hands and either buy a home testing kit or ask their pharmacist to do it for them (some pharmacies, such as Lloydspharmacy offer this service for free).

Diabetes is reaching epidemic proportions in the UK - and there are still thought to be at least 1 million people unknowingly living with the condition1. The earlier you can detect a problem with your blood glucose level the better since Diabetes UK estimate that by the time they're diagnosed 50% of patients will have evidence of complications - nerve damage, eye damage, heart disease.

References:

1. Diabetes UK

Body Fat

We all need a certain amount of body fat, but the percentage of fat we carry not only impacts on our figure, but can have a marked effect on our health and wellbeing.

Excess weight is associated with numerous health problems such as heart disease, stroke, diabetes, certain types of cancer, gout (joint pain caused by excess uric acid) and disease of the gallbladder. However, being overweight can also cause other problems such as sleep apnoea (interrupted breathing during sleep) and osteoarthritis (wearing away of the joints). Unfortunately, the more overweight you are, the more likely you are to have these health problems.

Inevitably body fat can affect our fitness levels too which further compounds health problems. It can be difficult to reach a good level of fitness if you are carrying extra weight while if you are not storing enough fat, you may find that you lack energy, your body does not build muscle tone and you suffer from joint injuries since a certain amount of protective fat would have cushioned the joints.

What is acceptable?

The average acceptable body fat percentage is 15% for a man and 25% for a woman. That means that if a woman weighs 60kgs, then 15kgs of her body weight should be fat. Women naturally have more body fat than men.

How body fat is measured?

Until fairly recently, measuring body fat percentage required the help of professionals. They may have used a skinfold caliper which literally measures a pinch of skin when pulled away from the muscles and bones, or even suggested you be weighed while submerged under water in order to establish your underwater weight.

However, there are now a number of body fat monitors that can be used in the home. These send a very low level electrical signal through the body - normally by standing on sensors on a body fat monitor. The signal travels quickly through lean tissue, which has a high percentage of water and is therefore a good conductor of electricity, and more slowly through fat, as fat has a lower percentage of water and is therefore a poor conductor of electricity. Known as 'bioelectrical impedance devices' they then use the information from this signal to work out body fat percentage.

What about Body Mass Index?

The Body Mass Index, or BMI, is a more general measure based on height and weight - unfortunately it cannot differentiate between weight caused by fat and weight caused by muscle.

However you can establish your BMI, simply by dividing your weight in kilograms by your height in meters squared. (BMI=kg7/m²).

You can then interpret your result using these ranges, set by the World Health Organisation:

• If your BMI is less than 18.4 you are underweight for your height.
• If your BMI is between 18.5 and 24.9 you're an ideal weight for your height.
• If your BMI is between 25 and 29.9 you're over the ideal weight for your height.
• If your BMI is between 30 and 39.9 you're obese.
• If your BMI is over 40 you're very obese.



It is also worth remembering that a BMI measurement is not a reliable method for the following groups:

• children and young people - doctors use gender and age specific charts to measure young people's BMIs
• elderly people - as you age, your proportion of body fat increases and your muscles diminish
• competitive athletes and bodybuilders - BMI doesn't distinguish between muscle and fat, so heavily-muscled people with low body fat could be classified as overweight or obese
• pregnant or breastfeeding women, who need higher fat reserves than usual.

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