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:
Blurred vision
A severe rise in blood pressure—especially above 180/120 mmHg—may cause:
These symptoms may indicate a hypertensive emergency, a life-threatening condition requiring immediate hospital treatment.
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
You should seek medical advice if:
Consistently above 140/90 mmHg at home
Above 180/120 mmHg even without symptoms
Above 180/120 mmHg with symptoms — this is an emergency
Chest pain or pressure
Breathlessness
Sudden weakness on one side
Difficulty speaking
Severe headaches
Vision changes
Palpitations or fainting
Family history of high blood pressure or heart disease
Diabetes
Obesity
High cholesterol
Sedentary lifestyle
Smoking
Excessive alcohol intake
High-salt diet
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:
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
Your doctor may check for:
Heart murmurs
Enlarged heart
Kidney enlargement
Narrowed arteries
Swelling
Eye changes (hypertensive retinopathy)
Assesses for:
Left ventricular hypertrophy (LVH)
Arrhythmias (e.g., atrial fibrillation)
Previous silent heart attacks
A heart ultrasound may be used to assess:
Heart muscle thickness
Pump function
Valve abnormalities
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)
A heart ultrasound may be used to assess:
Heart muscle thickness
Pump function
Valve abnormalities
Treatment aims to lower blood pressure safely and reduce long-term complications. The best approach combines lifestyle measures and medication when required.
• 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
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.
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.
Hypertension is a manageable condition. The prognosis varies depending on:
With good control:
With poor or no control:
The good news: Even modest reductions in blood pressure significantly improve life expectancy and reduce complications.
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