High blood pressure (hypertension) affects a sizeable proportion of the general population in many countries. For many people there are few symptoms and the problem can be insidious as a result. For most people BP readings are only taken as a secondary consequence of a visit to the GP or another medical practioner. Blood pressure varies as the bodies requirement changes throughout the day and one or two readings in isolation are often of little practical value. If a problem is suspected a number of readings are normally taken and where the problem persists an ambulatory measurement ( at home) over a period of 24 hours may be required.
Where hypertension is established, the guidance and treatment of your medical professional is essential. It has already been stated that common factors such as smoking, being overweight, salt intake, etc. may well have a significance, and rectification of some of these underlying common factors might correct or partially correct the problem. However just as any inordinartly high pressure in pipework will lead to medium or long term problems, be it water pipes or hydraulic pipes, so it will cause serious problems to the owner if their blood plumbing and pump is also subject to long term and sustained periods of high pressure.
When other treatment may be insufficient or inadequate by itself to sufficiently reduce sustained hypertension a medical practioner may prescribe medication to assist in the required reduction and stabilization. This medication takes a number of forms ( and sometimes combinations) and comes in many different dosages and it may require a period of trial and error to establish a comfortable and adequate correction.
For many people hypertension medication has no, or few noticeable side effects. As such the results often far outweigh the inconvenience or resistance to such medication.
From the flying point of view any medication that effectively changes the bodies circulatory mechanism is always going to be a concern, and the aviation medical authorites will want to be involved in the monitoring of the individuals treatment. In reality and for most people this simply means that the treatment is working, stable and with no adverse side effects. For pilots starting on medication, that will normally mean liason with the doctor to establish that the medication prescribed is within the allowable ( and there are many) drug groups. They will then want the pilot to stop flying for a few weeks while it is established the individual has no adverse reaction to the medication. Again if and when dosages of medication are altered there will normally be a short grounding period to establish stable tolerance. Beyond this it simply means monitoring. This will of course be done by the AME on the pilots normal renewal medicals. It is often helpful to provide a sensible list of home readings over a given period if this is possible. It is also a good idea to make a visit to your GP on an annual basis ( or whatever is deemed sensible) to ensure that the medication and doseage remain effective and that the blood chemistry ( simple blood test) is acceptable.
All of this might sound difficult or complicated, but it usually is very straightforward. The aviation medical authorites are very used to dealing with this situation. It normally has no licensing effect on the pilot other than the short grounding for the reasons already given. The health benefits should far outweigh the inconvenience. Hypertension is a dangerous and insidious condition left untreated and nobody should be discouraged from seeking out effective treatment. Not all conditions will require prescribed medication, but those that do will normally benefit. All treatment should always be under the guidance and direction of a properly qualified health professional and sensible but regular monitoring is essential.
On the subject of home monitoring there are various brands of equipment that are reasonably accurate when used properly. At the risk of advertising ( I am not !) my own AME believes Omron produce a range of effective and easily used arm cuff monitors. Home readings are often lower than those you will achieve in a doctors office simply because you are naturally more relaxed at home, and it is a case of taking readings at your own convenience. Many of these monitors come with memories and some with attached simple printers to make the recording of your own readings extremely easy. Cuff size can be an issue, but your medical practioner can best advise you on this point. Some of the wrist measuring devices and cheaper monitors can be of very limited use with regards to accurate monitoring.
In summary, sustained high blood pressure can be a killer so get it checked and where necessary get it treated. Where treatment is desirable and recommended do not worry unduly about the implications with regards to flying, it is something the authorities deal with regularly and they well versed in certifying pilots with this underlying condition. The inconveniences are usually minor and on balance the benefits are potentially huge.