Hypertension (High Blood Pressure)
Persistently elevated blood pressure that increases long-term cardiovascular risk.
Overview
Hypertension is sustained blood pressure of 140/90 mmHg or higher (or 130/80 by some guidelines). It is usually asymptomatic and is detected on routine measurement. Long-term control reduces stroke, heart attack, kidney disease and dementia risk.
Symptoms
- • Often silent — most people have no symptoms
- • Occasional headache, especially in the morning
- • Visual disturbance in severe cases
- • Chest discomfort or breathlessness if complications develop
Risk factors
- • Age over 45
- • Family history of hypertension
- • High salt intake
- • Excess body weight
- • Physical inactivity
- • Excess alcohol
- • Chronic kidney disease or diabetes
Causes
- • Primary (essential) — no single cause; combination of genetics and lifestyle
- • Secondary — kidney disease, endocrine disorders, certain medications, sleep apnea
🚨 Red flags — seek urgent care
- • BP ≥180/120 with chest pain, breathlessness, weakness, or visual change — emergency
- • Sudden severe headache with very high BP
- • New neurological symptoms (weakness, slurred speech)
When to seek care
- • Repeated readings ≥140/90 over several days
- • Symptoms suggesting end-organ damage
- • Side effects from BP medication
Diagnosis
- • Clinic BP ≥140/90 mmHg confirmed with ambulatory (ABPM) or home (HBPM) monitoring
- • Stage 1 (clinic ≥140/90, ABPM ≥135/85), Stage 2 (clinic ≥160/100), Severe (clinic ≥180/120)
- • Baseline tests: U&E, eGFR, urine albumin:creatinine, HbA1c, lipids, ECG, fundoscopy
- • Consider secondary causes if young, treatment-resistant, or features suggest endocrine/renal disease
Treatment
- • Lifestyle: salt <6 g/day, weight loss, ≥150 min/week activity, alcohol reduction, DASH-style diet
- • Step 1 (<55 / not Afro-Caribbean): ACE inhibitor or ARB; otherwise CCB
- • Step 2: add the other of ACEi/ARB + CCB, or add thiazide-like diuretic
- • Step 3: ACEi/ARB + CCB + thiazide-like diuretic
- • Step 4 (resistant): add spironolactone if K+ ≤4.5, or alpha/beta blocker; specialist referral
- • Targets: <140/90 in clinic (<135/85 ABPM/HBPM); <130/80 if diabetes or high CV risk
Prevention
- • Maintain healthy weight (BMI 18.5–24.9)
- • Limit sodium and processed foods; increase potassium-rich fruit and vegetables
- • Regular aerobic activity and resistance training
- • Limit alcohol (≤14 units/week, spread across the week)
- • Avoid tobacco; manage stress and sleep apnoea
Complications
- • Stroke and transient ischaemic attack
- • Heart attack and heart failure
- • Chronic kidney disease
- • Aortic aneurysm and dissection
- • Hypertensive retinopathy and vision loss
- • Vascular dementia
Education & self-care
Lifestyle: reduce salt to <5 g/day, aim for 150 minutes of moderate activity weekly, limit alcohol, maintain a healthy weight, manage stress, and stop smoking. These steps can reduce systolic BP by 10–20 mmHg.
Frequently asked questions
Is hypertension curable?
Primary hypertension is managed, not cured — but it can be controlled with lifestyle changes and medication when needed.
Do I need medication?
It depends on your overall cardiovascular risk and BP level. Lifestyle changes are the first step for most stage 1 hypertension.
How often should I check my BP?
If newly diagnosed, daily for 1–2 weeks then weekly. Once stable, monthly home checks are reasonable.