I’ve seen countless middle-aged women who have high blood pressure without realising it – one check-up at the GP tells you nothing. Here’s how to know if you are at-risk… and what to do about it: DR TOMAS BOTHE

As a doctor, I have one piece of advice which – more than anything else – can help maximise the chances of a long and healthy life.

And while it applies to everyone, it’s especially true for women in their 40s and 50s as they head into menopause.

It’s really simple, yet incredibly powerful: check and control your blood pressure.

There’s no better way of predicting whether a person will suffer a heart attack or stroke – as blood that is consistently pumped too forcefully against the artery walls puts strain on the heart and significantly increases the risk of a potentially deadly cardiovascular event.

Most people are familiar with blood pressure readings – where two numbers, in units known as millimetres of mercury, record the increased pressure when the heart beats, and the lower pressure between the beats. Under 120 over 80 is considered ideal.

What’s less well-known is that for every 20 units above 120, the risk of stroke or heart attack doubles. To put it another way, if you have high blood pressure, you can roughly halve your risk by lowering it by 20mm. Most patients think this is a really good trade-off!

A shocking study in the British Medical Journal recently calculated that more than a third of adults in England have high blood pressure, but around 60 per cent of these – nearly 10 million people – are unaware of their condition. This is because, in many cases, there are no symptoms until it’s too late – which explains why high blood pressure, or hypertension, is often called a silent killer.

So who are the people suffering from hypertension but not being diagnosed?

In my experience, high blood pressure is most commonly detected in patients with the most obvious risk factors. They are probably male (high blood pressure is often, wrongly, considered a men’s health problem), they are obese, do no exercise, smoke or drink far too much alcohol, or else are already being treated for another condition such as high cholesterol, heart problems or kidney disease.

Sadly, however, many middle-aged women – who don’t seem like classic high blood pressure cases – are being missed, partly because they refuse to believe they have a problem. A lot of women tell me: ‘I was checked years ago – my blood pressure’s fine!’

What many don’t realise is that, yes, women typically have lower blood pressure than men… but only until the menopause.

After that, blood pressure in women increases dramatically – until the age of 70 when they catch up with men. Beyond 70, women actually overtake men in terms of hypertension.

Because their blood pressure rises so drastically in the latter stages of their life, women are actually far more likely than men to die of cardiovascular disease.

Meanwhile, they might be gradually pushing up their blood pressure, by being a little bit overweight, drinking a little bit more than they should, being stressed or not getting enough sleep.

What’s insane about this situation is that there’s an easy fix. Widely-available medications such as ACE inhibitors or calcium channel blockers provide safe and effective treatment for almost everyone, often at very low cost.

So, given that the most useful thing anyone can do to increase the chance of years and years of healthy extra life is to check their blood pressure, surely it’s as simple as going to the GP for a test?

Well, yes and no. Although a test can provide an immediate snapshot, there are a lot of complicating factors.

Everyone recognises the cuff that’s strapped to the arm for a blood pressure test. When it’s inflated, it temporarily cuts off blood flow through an artery in your arm and then measures the pressure as the flow returns.

But has the cuff been calibrated in the past year? And is it on the correct arm (most cuffs are designed to fit on the left)?

Then there’s time: doctors and nurses are always in a hurry. Yet to conduct a half-way meaningful measurement, the patient needs to sit absolutely still for five minutes beforehand.

And for the patient, drinking coffee, smoking, sitting with their legs crossed, having a full bladder – these all bump up the reading. The well-known phenomenon of white coat hypertension also comes into play: some patients are so anxious about seeing the doctor that their blood pressure jumps. But the opposite can also be true: some patients are so comfortable with their doctor, their blood pressure drops!

Having just eaten a big meal can also produce a different reading, while recent exercise, heat or cold can also skew the results.

All of these factors can send the measurements haywire, which is no good: when you’re making crucial medical decisions for a patient, you need certainty.

To get around this, a patient might be asked to use a blood pressure monitor at home and take a series of measurements over the course of a week – two in the morning, two in the evening.

This is the system recommended by the NHS for home blood pressure monitoring, using a device ratified by the British Heart Foundation.

Sadly, half of patients don’t manage to complete the whole week of measurements, while others – this happens more often than you might imagine – simply make up the numbers.

Nonetheless, if it’s carried out accurately and conscientiously, week in week out, it will definitely produce useful measurements that can help a doctor work out if their patient is at risk of a deadly heart attack or stroke.

These days, however, technology has improved. There are now wearable devices that can measure your blood pressure at all times, which means patients don’t need to remember to check themselves (and reduces the risk of them from making up the numbers).

As it happens, as well as being a medical doctor, blood pressure expert and physiologist, I’m also Chief Medical Officer for the firm Hilo by Aktiia, which makes a medical device called Hilo – a band that fits around the wrist to provide blood pressure monitoring. The initial cost is £200 – plus a £10 a month subscription after the first year.

Obviously, I believe this is the optimal system to provide continuous blood pressure monitoring which is effortless and accurate.

However, my central point remains this: there are plenty of effective treatments available for high blood pressure.

And because the damage caused by undiagnosed hypertension is compounded over the years, it’s important to do everything possible to catch it early.

So checking your blood pressure regularly really is the best way to aim for additional years of healthy life. Every year without a stroke or heart attack counts, for you and your loved ones. Don’t put it off.