The positive relationship between blood pressure (BP) and CAD has been well established by large-scale population studies. Raised BP, or hypertension, is also a precursor of stroke, heart failure as well as brain and kidney damage.

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Generally BP has two major components:

• the systolic BP (SBP) representing the maximum pressure obtained when the heart contracts, and
• the diastolic BP (DBP), the lower pressure obtained during when the heart relaxes

These figures are usually expressed in mm of mercury (mmHg) as SBP/DBP. Both these figures are important and there is a gradient of increasing risk with a SBP of > 120 mmHg and a DBP > 70 mmHg in the general population. BP generally increases with age and, for middle-aged individuals, 140/90 is taken as the lower threshold for a significant increase in risk.

The SBP - the top measurement - used to be regarded as unimportant. But, increasingly, in middle-aged and older people the SBP is regarded as a significant predictor of CAD.

Hypertension may rarely be due to kidney, genetic or hormonal disorders but in the vast majority of cases the mechanism is not known – so-called "essential" hypertension. This used to be thought to be due to excess salt intake but it seems that for the majority of individuals the impact of salt on hypertension may be limited.

Nevertheless, emerging evidence indicates that salt has actions which go beyond blood pressure: excess salt has adverse effects directly on the heart, the platelets, the kidneys and the arterial wall. While still only partly understood, most authorities recommend that you limit salt in the diet.

Hypertension is often associated with the cluster of conditions making up the “insulin resistance syndrome” and is more common in:

• smokers
• in the obese
• the sedentary
• those with insulin resistance
• or type 2 diabetes

Significantly, an improved lifestyle profile can reduce BP and the risk associated with its associated disorders. Emotional stress also increases BP and holistic treatment would address all these factors. A new generation of anti-hypertensive agents offer hope to those who are unresponsive to lifestyle and behavioural modification.

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