Hypertension
Hypertension (High Blood Pressure): A Comprehensive, Evidence-Based Guide
Hypertension – commonly known as high blood pressure – is one of the most widespread cardiovascular conditions in the world. Often called the “silent killer,” it rarely causes symptoms in its early stages yet silently damages the heart, arteries, kidneys, eyes, and brain over many years. In the UK and globally, hypertension remains one of the most preventable causes of heart attacks, heart failure, stroke, kidney disease, and premature death.
Hypertension is defined as persistently elevated pressure within the arteries. It occurs when the force of blood pushing against the arterial walls is too high for too long. Blood pressure is measured using two numbers:
Systolic pressure (top number): pressure when the heart contracts.
Diastolic pressure (bottom number): pressure when the heart relaxes.
Normal blood pressure for adults is typically below 120/80 mmHg.
The commonly used UK categories include:
| Category | Systolic (mmHg) | Diastolic (mmHg) |
|---|---|---|
| Normal | <120 | <80 |
| Elevated / High-normal | 120–139 | 80–89 |
| Hypertension (Stage 1) | 140–159 | 90–99 |
| Hypertension (Stage 2) | ≥160 | ≥100 |
| Severe Hypertension / Hypertensive urgency | >180 | >120 (without organ damage) |
| Hypertensive emergency | >180 | >120 with organ damage |
Most people with high blood pressure have no symptoms at all, which is why routine screening is crucial. However, when symptoms occur, they may include:
Commonly reported symptoms of hypertension (often non-specific):
- Headaches (especially at the back of the head)
- Dizziness
- Fatigue
Blurred vision
- Palpitations
- Shortness of breath
- Nosebleeds (uncommon but can occur)
Symptoms of severely elevated blood pressure:
A severe rise in blood pressure—especially above 180/120 mmHg—may cause:
- Severe headache
- Chest pain
- Breathlessness
- Confusion
- Visual changes
- Nausea and vomiting
- Weakness or numbness
These symptoms may indicate a hypertensive emergency, a life-threatening condition requiring immediate hospital treatment.
Symptoms related to long-term complications:
Chronic uncontrolled hypertension can silently lead to:
Heart failure symptoms (breathlessness, leg swelling)
Reduced kidney function (swelling, fatigue, foamy urine)
Stroke symptoms (weakness, speech difficulty)
Loss of vision due to hypertensive retinopathy
High blood pressure rarely has a single cause. In most adults it develops gradually from a mix of age, inherited factors and lifestyle. In a smaller group, a specific medical condition or medicine is responsible, which is called secondary hypertension.
Primary (essential) hypertension
Most adults with high blood pressure have primary hypertension, where no single cause is found. Blood vessels gradually stiffen with age, and the kidneys, hormones and nervous system all influence how pressure is regulated. Genes play a part, so having a parent or sibling with high blood pressure raises your risk.
Lifestyle factors you can change
A diet high in salt and low in fruit, vegetables and potassium.
Being overweight, especially around the waist.
Low physical activity.
Drinking more than 14 units of alcohol a week.
Smoking, which does not directly cause chronic high blood pressure but sharply increases the damage it does to arteries.
Poor sleep and long-term stress, which affect blood pressure mainly through their effect on habits and weight.
Factors you cannot change
Increasing age.
A family history of high blood pressure.
Ethnic background: high blood pressure is more common, and often develops earlier, in people of Black African, Black Caribbean and South Asian origin. This also influences which medicines work best.
Medical conditions that cause secondary hypertension
A specific cause is more likely if high blood pressure starts before the age of 40, is severe, comes on suddenly, or does not respond to several medicines. Causes include:
Chronic kidney disease and narrowing of the kidney arteries.
Primary aldosteronism, an overproduction of a hormone from the adrenal glands, now recognised as a common treatable cause.
Obstructive sleep apnoea.
Thyroid disease, Cushing’s syndrome and, rarely, phaeochromocytoma.
Narrowing of the aorta (coarctation), usually found in younger people.
Medicines and substances that raise blood pressure
Anti-inflammatory painkillers such as ibuprofen and naproxen.
Decongestants containing pseudoephedrine or phenylephrine.
Steroid tablets, the combined contraceptive pill and some antidepressants.
Liquorice in large amounts, and stimulant drugs such as cocaine and amphetamines.
Never stop a prescribed medicine without advice. Ask your doctor or pharmacist to review any medicine you take regularly if your blood pressure is high.
You should seek medical advice if:
You have a blood pressure reading:
Consistently above 140/90 mmHg at home
Above 180/120 mmHg even without symptoms
Above 180/120 mmHg with symptoms — this is an emergency
You experience new symptoms:
Chest pain or pressure
Breathlessness
Sudden weakness on one side
Difficulty speaking
Severe headaches
Vision changes
Palpitations or fainting
You have risk factors for hypertension:
Family history of high blood pressure or heart disease
Diabetes
Obesity
High cholesterol
Sedentary lifestyle
Smoking
Excessive alcohol intake
High-salt diet
Pregnant individuals:
Seek urgent review if you experience high readings, headaches, swelling, vision issues, or abdominal pain—this may indicate pre-eclampsia, a serious condition.
Diagnosing hypertension involves more than a single reading. UK and European guidelines recommend:
Blood Pressure Measurement
Clinic Blood Pressure
Measured by your GP or nurse. If elevated for the first time, it must be confirmed by home or ambulatory monitoring.
Home Blood Pressure Monitoring (HBPM)
You take two readings morning and evening for 7 days using a validated monitor. Helpful for:
Confirming diagnosis
Monitoring response to treatment
Detecting white coat hypertension (high BP only in clinic)
Detecting masked hypertension (normal in clinic, high at home)
24-Hour Ambulatory Blood Pressure Monitoring (ABPM)
Considered the gold standard for diagnosis. The device measures BP every 20–30 minutes during the day and night. It identifies:
Night-time hypertension
Dipping patterns
True uncontrolled hypertension
Physical Examination
Your doctor may check for:
Heart murmurs
Enlarged heart
Kidney enlargement
Narrowed arteries
Swelling
Eye changes (hypertensive retinopathy)
ECG (Electrocardiogram)
Assesses for:
Left ventricular hypertrophy (LVH)
Arrhythmias (e.g., atrial fibrillation)
Previous silent heart attacks
Echocardiogram
A heart ultrasound may be used to assess:
Heart muscle thickness
Pump function
Valve abnormalities
We offer a private echocardiogram in Peterborough, Corby and London.
Additional Tests for Secondary Hypertension
Requested when hypertension is severe, early-onset, or resistant to treatment:
Renal ultrasound
Renal artery Doppler
CT/MRI for adrenal or renal disease
Sleep studies (for sleep apnoea)
Echocardiogram
A heart ultrasound may be used to assess:
Heart muscle thickness
Pump function
Valve abnormalities
Tests and services that may help
We can arrange the assessments used to check how high blood pressure is affecting your heart:
ECG reporting, UK-wide, to look for thickening of the heart muscle and rhythm problems
Echocardiogram to assess heart muscle thickness, pumping function and valves
Cardiac monitoring if you have palpitations or suspected atrial fibrillation
Exercise ECG or stress echocardiogram if you have chest pain or breathlessness on exertion
Consultation by telephone, video or face to face
If your blood pressure is very high with symptoms, call 999 rather than waiting for an appointment.
Treatment aims to lower blood pressure safely and reduce long-term complications. The best approach combines lifestyle measures and medication when required.
Lifestyle Modifications for high blood pressure
• Reduce salt intake
<6 g per day (one teaspoon total)
Avoid processed foods high in sodium
• Achieve a healthy weight
Losing 5–10% of body weight can dramatically lower BP.
• Regular exercise
150 minutes of moderate activity per week
Include brisk walking, cycling, swimming, or resistance training
• Healthy diet
Adopt the DASH diet, rich in:
Fruits
Vegetables
Whole grains
Lean protein
Low-fat dairy
Nuts and legumes
Avoid:
Excess sugar
Saturated fats
Processed foods
• Limit alcohol: Men & women: ≤14 units per week, spread across several days
• Quit smoking: Smoking accelerates arterial damage.
• Reduce caffeine intake: Some people respond strongly to caffeine.
• Manage stress
Medications (Antihypertensives)
Most patients with Stage 2 Hypertension or high cardiovascular risk require medication.
Even after achieving good blood pressure control, hypertension requires lifelong attention. Many people live long, healthy lives with well-controlled blood pressure.
Living With Hypertension
1. Monitor at home
Use a validated upper-arm BP monitor
Keep a log to share with your GP
2. Take medications exactly as prescribed: Missing doses increases the risk of stroke and heart attack.
3. Follow a heart-healthy diet: Maintain the DASH diet or Mediterranean diet.
4. Stay physically active: Consistent moderate exercise is more effective than occasional high-intensity workouts.
5. Maintain a healthy sleep routine: Poor sleep can raise blood pressure.
6. Limit stress: Chronic stress contributes to hypertension.
7. Avoid smoking and recreational drugs: Substances such as cocaine can cause dangerous spikes.
8. Attend regular check-ups
Blood tests
Kidney function
Electrolyte monitoring
Medication review
9. Reduce alcohol and caffeine: Helps stabilise blood pressure.
10. Educate yourself: Understanding your condition empowers you to make better lifestyle choices.
Driving, work and travel
Based on DVLA guidance last updated 7 November 2025:
Car and motorcycle (Group 1): you may drive and need not tell the DVLA about high blood pressure, unless you have malignant hypertension (very high blood pressure with progressive organ damage), in which case you must not drive until it is controlled.
Bus, coach and lorry (Group 2): if your resting blood pressure is consistently 180 systolic or higher and/or 100 diastolic or higher, you must stop driving and tell the DVLA until it is controlled.
Do not drive if your medicines make you dizzy, light-headed or drowsy, particularly after starting a new tablet or changing a dose.
Work and travel: well-controlled high blood pressure rarely limits work or travel. Carry your medicines in hand luggage, take them at your usual times across time zones, and keep a home monitor reading log. If your job is safety-critical, see our DVLA cardiac assessment page.
Prognosis (long-term outlook) of hypertension
Hypertension is a manageable condition. The prognosis varies depending on:
- How early it is diagnosed
- How well it is controlled
- Co-existing conditions (diabetes, kidney disease, high cholesterol)
With good control
- Risk of stroke drops by 30–40%
- Risk of heart attack drops by 20–25%
- Reduced risk of heart failure and kidney disease
With poor or no control
- Higher risk of heart attack, stroke and heart failure
- Faster progression of kidney disease
- Damage to small arteries in the eyes and brain
- Reduced life expectancy
The good news
Even modest reductions in blood pressure significantly improve life expectancy and reduce complications.
- Hypertension is called the “silent killer” because it usually causes no symptoms.
- It affects 1 in 3 adults globally.
- Lowering blood pressure by just 10 mmHg reduces stroke risk by ~27%.
- Home blood pressure monitoring is more accurate than single clinic readings.
- Lifestyle changes alone can reduce BP significantly.
- Most patients require long-term medications.
- Uncontrolled hypertension damages the heart, brain, kidneys, and eyes.
- Secondary hypertension accounts for about 5–10% of cases.
- Hypertension increases the risk of atrial fibrillation.
- Good control allows you to live a normal and healthy life.
Guidelines and sources
This page follows current UK and European guidance:
NICE NG136: Hypertension in adults: diagnosis and management.
McEvoy JW et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. European Heart Journal 2024;45:3912-4018.
NICE NG133: Hypertension in pregnancy: diagnosis and management.
DVLA: Cardiovascular disorders: assessing fitness to drive (GOV.UK).
These are the questions patients most often ask about high blood pressure.
What is a normal blood pressure?
A healthy reading is usually between 90/60 and 120/80 mmHg. UK guidance (NICE) diagnoses high blood pressure at 140/90 or higher in the clinic, or 135/85 or higher when measured at home or over 24 hours. The 2024 European guideline calls readings of 120 to 139 over 70 to 89 elevated, and advises lifestyle measures at that level.
Can I have high blood pressure and feel completely well?
Yes. Most people have no symptoms, which is why it is often called the silent killer. Headaches, dizziness and nosebleeds are not reliable signs, so regular checks are the only way to know.
Why is my blood pressure high at the clinic but normal at home?
This is called white coat hypertension, and it is common. The reverse, normal in clinic but high at home, is called masked hypertension. Because both occur, UK guidance asks for a high clinic reading to be confirmed with home or 24-hour ambulatory monitoring before the diagnosis is made.
How should I measure my blood pressure at home?
Use a validated upper-arm monitor with the right cuff size. Sit quietly for five minutes with your back supported and your arm resting at heart level. Take two readings a minute apart, morning and evening, for 4 to 7 days, discard the first day and average the rest. Write the readings down and bring them to your appointment.
What should I do if my reading is 180/120 or higher?
Rest and recheck. If it is still 180/120 or higher, contact your GP or NHS 111 the same day. Call 999 if you also have chest pain, breathlessness, confusion, weakness on one side, or speech or vision changes, as these may mean a hypertensive emergency, a heart attack or a stroke.
Can I lower my blood pressure without tablets?
For mildly raised blood pressure, lifestyle changes may be enough. Cutting salt to under 6 g a day, losing excess weight, being active for at least 150 minutes a week, eating a DASH or Mediterranean-style diet and keeping alcohol within 14 units a week can each lower blood pressure by several mmHg, and the effects add up. Many people still need medicines as well, particularly if their overall cardiovascular risk is high.
Which medicines are usually used first?
NICE recommends an ACE inhibitor or an angiotensin receptor blocker for people under 55, and for people of any age with type 2 diabetes. A calcium channel blocker is recommended first for people aged 55 and over, and for people of Black African or Caribbean origin. A second and third medicine, such as a thiazide-like diuretic, may be added. Treatment is individualised, so follow the plan agreed with your own doctor.
Will I need to take tablets for life?
Most people with confirmed hypertension need long-term treatment. Blood pressure rises again if medicines are stopped. Some people can reduce their dose after sustained weight loss and lifestyle change, but this should only be done under medical supervision.
What blood pressure should I aim for?
NICE suggests a clinic target below 140/90 for adults under 80 and below 150/90 for those aged 80 and over, with home targets 5 mmHg lower (135/85 and 145/85). The 2024 European guideline advises that, if treatment is well tolerated, a systolic pressure of 120 to 129 is a reasonable goal for many adults. Your own target depends on your age, other conditions and tolerance of treatment.
What damage can high blood pressure cause to the heart?
Over time, high blood pressure thickens the heart muscle (left ventricular hypertrophy), can lead to heart failure, atrial fibrillation and coronary artery disease, and also harms the kidneys, eyes and brain. Good control substantially reduces these risks.
Does stress cause high blood pressure?
Stress and anxiety raise blood pressure temporarily. Long-term stress may contribute indirectly through poor sleep, weight gain, alcohol and smoking. Relaxation and good sleep are useful, but they do not replace measuring blood pressure and treating it when needed.
When should I see a cardiologist about my blood pressure?
Specialist assessment is helpful if your blood pressure remains high despite three medicines including a diuretic, if you developed high blood pressure under the age of 40, if a secondary cause is suspected, if you have symptoms such as chest pain, palpitations or breathlessness, or if tests show thickening of the heart or other heart disease. You can arrange a telephone, video or face-to-face consultation.
- What is the target blood pressure I should aim for?
- Should I monitor my blood pressure at home, and how often?
- Which lifestyle changes will make the biggest difference for me?
- Do I need medication now, or can we try lifestyle changes first?
- Which medication is best for my condition and why?
- What side effects should I watch for with my medication?
- How will we assess whether my treatment is working?
- Could my high blood pressure be caused by another condition?
- What symptoms should prompt urgent medical attention?
- How can I reduce my long-term risk of heart attack or stroke?
What do the numbers mean?
Blood pressure is written as two numbers. The top number is the pressure when your heart beats, and the bottom number is the pressure between beats. Home readings are usually a little lower than clinic readings, so the thresholds differ.
Confirming the diagnosis
Because blood pressure changes through the day and many people have higher readings in clinic, a 24-hour monitor gives the most reliable picture and helps avoid both over-treatment and under-treatment.
Blood Pressure Checker
Enter your blood pressure numbers below to see whether your reading is normal, elevated, or high. If your blood pressure is elevated or high, you can arrange a telephone consultation with Dr Salloum to discuss blood pressure management.
This tool is for general information only and does not replace medical advice. If you have chest pain, severe shortness of breath, weakness on one side, difficulty speaking, or feel acutely unwell, seek urgent medical help immediately.
How the checker works
This page uses simple blood pressure ranges for patient guidance:
- Normal: below 120 systolic and below 80 diastolic
- Elevated: systolic 120–129 and diastolic below 80
- High blood pressure: systolic 130 or above, or diastolic 80 or above
A single reading does not always diagnose hypertension. Blood pressure should ideally be checked correctly and repeated over time.
If your blood pressure is 180/120 or higher and you have chest pain, breathlessness, confusion, weakness on one side, or speech or vision problems, call 999 immediately.
If you have high blood pressure or a family history of it, you may benefit from a telephone consultation or video consultation to review your readings and treatment, or a face-to-face consultation in Peterborough or Corby for a more comprehensive assessment.
Investigations such as ECG reporting, echocardiography and cardiac monitoring may be recommended to check for effects of high blood pressure on your heart.
Book Your Heart Health Check Today
Medically reviewed by Dr Salam Salloum, Consultant Cardiologist. Last updated: . This page is for general information and does not replace personal medical advice.