Blood pressure tablets are among the most commonly prescribed medicines in the UK — yet many patients are not taking them in the way their doctors recommend.
Prescribed to around nine million Britons each year, these drugs play a vital role in lowering the risk of life-threatening heart attacks and strokes.
But despite their proven benefits, research suggests that nearly half of people prescribed blood pressure medication do not take their daily tablets consistently. Even more concerning, about one in five do not take them at all. For some, the problem is simple but serious: remembering to take a pill every day can be difficult, especially for older adults.
For others, however, the issue is more troubling. Unpleasant side effects can make daily life uncomfortable — a problem that many Mail on Sunday readers will recognise.
Last week, after our resident GP columnist Dr Ellie Cannon addressed the side effects linked to blood pressure tablets, we received dozens of letters from readers describing their own experiences.
One 82-year-old man told how his tablets had left him with swollen ankles and diarrhoea. A 62-year-old woman described how the drugs had given her chronic coughing that felt like there was a ‘frog in her throat’ at all times. Another reader, a 74-year-old man, said how he had a constant need to go to the toilet since starting on the medication.
In some cases, readers admitted that they had stopped taking their tablets due to the severity of the side effects.
There are even some concerns that these drugs could raise the risk of other diseases. Last month, an Israeli study found that patients taking a class known as calcium-channel blockers were at a higher risk of developing kidney disease. Experts stress that, in the vast majority of cases, blood pressure pills are not only safe but life-saving. However, they admit that side effects can be challenging.
Blood pressure is measured with two numbers. The first, called systolic pressure, shows the pressure in the arteries when the heart contracts and pumps blood out. The second, the diastolic pressure, measures pressure in the arteries when the heart relaxes between beats (picture posed by model)
‘Many patients don’t like taking their blood pressure medicines because, in the short-term, they can trigger side effects and have no obvious benefit because high blood pressure is symptomless,’ says Professor Amitava Banerjee, a heart expert at University College London.
‘The problem is that, in the long-run, these drugs save lives.’
Tablets are not the only option for these patients – lifestyle changes could allow them to safely come off the medication for good.
‘Many patients assume they have to be on them for life, but that’s not always the case,’ says Professor Banerjee. ‘Yes, there are patients who will need to kee taking the pills indefinitely, but for some, lifestyle changes can get blood pressure down to a point where you no longer need to take the tablets.’
Blood pressure is the force of blood pushing against the walls of the arteries.
This pressure is created by the heart – each time it beats, it squeezes blood into the arteries so it can circulate around the body, delivering oxygen and nutrients to organs and tissues. A certain level of pressure is needed to move blood and oxygen around the body, and this naturally rises and falls throughout the day.
When blood pressure is consistently too high it puts strain on the arteries. Over time they can become damaged and narrower, making it easier for fatty deposits to build up. This raises the risk of heart attacks and strokes.
Blood pressure is measured with two numbers.
The first, called systolic pressure, shows the pressure in the arteries when the heart contracts and pumps blood out. The second, the diastolic pressure, measures pressure in the arteries when the heart relaxes between beats.
A normal reading is usually around 120 for systolic pressure and 80 for diastolic, written as 120/80. Readings that are consistently above 140/90 are classed as high blood pressure.
Worryingly, high blood pressure is on the rise in the UK. Around a third of adults are now believed to have the condition, also known as hypertension. And studies suggest that many of these patients are unaware they have the problem.
Experts say this is alarming because anyone with high blood pressure has a heightened risk of death. ‘Hypertension is one of the most common causes of death in the UK,’ says Professor Banerjee. ‘That’s why it is so important that it is treated.’
Blood pressure pills are designed to counteract this danger – usually by relaxing the walls of the blood vessels. Over the years there has been a growing number of hypertension tablets available, however, studies show that many of them have side effects.
Some of the most commonly used tablets are ACE (Angiotensin-Converting Enzyme) inhibitors – such as ramipril or lisinopril – but research has shown these can trigger dizziness, lightheadedness and a dry, tickly cough.
Another common type of blood pressure tablets are calcium-channel blockers, such as amlodipine. These are the drugs that were recently linked to a heightened risk of kidney disease. However, more commonly they can trigger headaches, facial flushing, constipation and – most often – swelling of the ankles and legs.
Then there are diuretics, such as indapamide, which reduce blood pressure by making patients urinate more. However, this can be unbearable to many people, who struggle with the constant need to go to the toilet.
Experts say that, in many cases, anyone struggling with side effects can lower their dose or swap to another drug. However, they also say that many patients do not consider another alternative: lifestyle changes.
‘If you get side effects that are tough to live with, then lifestyle changes are an option,’ says Professor Raj Thakkar, president of the Primary Care Cardiovascular Society.
‘And these changes aren’t just for those who want to come off the drugs. Everyone with high blood pressure could benefit.’
One of the most important steps to lowering blood pressure without drugs is losing weight. This is because carrying extra pounds puts additional strain on the heart, forcing it to work harder to pump blood around the body – which translates directly into higher blood pressure.
One 2013 US study found that patients who lose a tenth of their body weight can stop taking at least one hypertension drug.
‘If you are overweight or have a raised BMI, you are more likely to have high blood pressure,’ says June Davison, cardiac nurse at the British Heart Foundation. ‘Losing weight, even a modest amount, can make a real difference.’
However, weight loss can take time. In the US study it took patients about a year to lose a tenth of their body weight.
But one lifestyle change that can lead to a significant reduction in blood pressure within weeks is slashing salt consumption.
‘We know that if you eat too much salt it holds on to water and this pushes blood pressure up,’ says Ms Davison. ‘But the problem isn’t really the salt you add yourself at the table. The majority of it is processed foods, processed meats and ready meals.’
It’s a fact
The North West has the highest prevalence of high blood pressure in the UK – with about 16 per cent of adults registered with a GP affected.
Studies show that, for the average Briton, 80 per cent of their daily salt intake comes from processed foods, with just 7 per cent from salt added at the table.
Crucially, research also shows that for those eating too much salt, cutting intake can cause blood pressure to drop to healthy levels in less than a month.
‘Go for a really low-salt diet overall, and then it’s fine to grind a little extra on your own food if you want to,’ says Ms Davison. ‘The key is to cut out foods like pizza or ready-made lasagnes – that’s where the salt really adds up.’
Boosting fruit and vegetable consumption is also crucial to coming off blood pressure medication. ‘Eating plenty of fruit and vegetables helps circulation,’ says Ms Davison. ‘Aim for five a day.’
Studies show that switching to a diet rich in fruit and vegetables can lead to a significant reduction in blood pressure in just two months.
Another important change is cutting back on alcohol.
Research shows that for moderate-to-low drinkers – those who consume two or fewer drinks a day – lowering alcohol consumption has a marginal impact on blood pressure.
But for those consuming more than two drinks a day, eliminating alcohol has a marked impact. For those who consume six or more, the effect is even more profound. Moreover, this change can occur within a matter of weeks.
‘Ideally, have no alcohol, or keep to a minimum,’ says Ms Davison. ‘If you do drink, stay within 14 units a week [roughly six medium glasses of wine or six pints], spread out over the week rather than saved up for one or two sessions – and try to have two or three days off in between.’
One lifestyle change neglected by many hypertension patients – particularly those over-65 – is regular exercise. And this could be the difference between getting off blood pressure tablets or not.
Studies show that, in particular, regular aerobic exercise – such as running, swimming or cycling – has the most sizeable effect on blood pressure.
And, interestingly, research suggests that the physical activity does not need to be intensive to have an impact.
‘You want regular, moderate-intensity aerobic activity – about 150 minutes a week,’ says Ms Davison.
‘For older people, or those who are less active or have mobility issues, we know that anything is better than nothing. This might mean breaking down the 150 minutes into ten-minute chunks – little and often. Anything that gets your heart rate up counts. That could even be dancing.’
However, research shows that exercise does not have an instant impact but that it typically takes one to three months of consistent activity before the benefits show up in blood pressure readings.
Finally, experts say that one factor in getting blood pressure down that many patients do not think about is improving their mental health.
Studies show that tackling stress, anxiety and poor sleep can get it down to healthy levels without the need for tablets.
One major study, published by the American Heart Association in 2020, found that a six-week mindfulness programme – where patients are taught coping mechanisms to handle stress and anxiety – led to a sustained reduction in blood pressure, even after the course had been completed.
‘If you’re continually stressed or anxious, that can raise your blood pressure,’ says Ms Davison. ‘Stress creates an adrenaline response in the body, and your heart rate goes up as a result.
‘However, poor mental health can also affect other lifestyle habits. It might mean people put off going for a walk or eating well, which pushes blood pressure up. So it ends up working against you in more than one way.’
Experts stress that, while effective, lifestyle changes won’t allow everyone to quit blood pressure tablets.
For older patients, they point out, making significant adaptations to habits such as exercise and diet are more difficult.
They also add that there are some who have stubbornly high blood pressure even after making significant lifestyle changes and taking medication.
But many experts argue that more patients could come off blood pressure pills if they made these changes.
‘It can take some time and commitment but lifestyle changes really can get blood pressure down,’ says Professor Thakkar. ‘Hypertension is so prevalent in Britain and patients can’t rely on treatment from the NHS alone to get their levels down. It’s up to the individual. And with the right advice it can be done.’
‘Changing my diet got my levels healthy’
Bettina Wallace, 73, is keen to stop taking her blood pressure medication as it gives her swollen ankles as a side effect
While high blood pressure ran in her family, Bettina Wallace never expected to develop the dangerous condition.
The 73-year-old charity worker from Nottingham says that she always believed she had a healthy diet and lived an active lifestyle.
So Bettina was shocked when, in 2010, her GP said her blood pressure was dangerously high.
‘I was really surprised,’ she says. ‘I always thought I was healthy.’
Bettina was placed on blood pressure medication, but she also made lifestyle changes, such as taking up exercise classes and walking to work. However, Bettina – who is Caribbean – says the biggest shift was cutting down on her salt intake. ‘A lot of Caribbean food is very salty,’ she says. ‘It took some time to get used to not adding too much, but I knew it was important.’
Today her blood pressure is now within a healthy range.
She says she is keen to stop taking her blood pressure medication as it gives her swollen ankles as a side effect.
‘I would like to come off them eventually,’ she says. ‘I know people who have maintained their healthy blood pressure through good diet alone. It’s something I’d like to try.’
What to do when your blood pressure just won’t go down
There are some patients whose blood pressure remains stubbornly high even after lifestyle changes and medication.
This is often referred to as ‘resistant hypertension’. And, according to experts, these patients typically have a separate underlying health condition.
‘The first thing we check with these patients is whether they are taking their drugs as instructed,’ says Professor Raj Thakkar. ‘We do this by testing their urine to see if their drugs are present.
‘But if they are taking their medication, then we look for secondary causes – essentially another medical problem that is keeping the blood pressure up.
‘This might be a heart defect, a hormone condition or kidney disease. Once you identify the secondary cause, you can treat it. This should get blood pressure down.’
