Hypertension is a condition in which the pressure of blood against the walls of the arteries is higher than normal. It is commonly known as high blood pressure. With each heartbeat, the heart pushes blood out to the body; as the blood moves through the arteries, it presses against the artery walls. What we call blood pressure is this very pressure. When this pressure is higher than it should be, both the arteries and the heart have to work under extra strain for a long time.
Blood pressure is given as two numbers. The top number is the systolic pressure; it shows the pressure at the moment the heart pumps blood out. The bottom number is the diastolic pressure; it shows the pressure during the rest period between two heartbeats. So when we say 130/80, the 130 stands for systolic and 80 for diastolic pressure.
What should blood pressure be?
In an adult, a normal blood pressure reading is below 120/80 mmHg. Readings between 120-139/70-89 are seen as “elevated blood pressure”; this is not yet hypertension but calls for monitoring and risk assessment. Readings of 140/90 and above are accepted as hypertension.
A single high reading is not enough to diagnose hypertension. Excitement, rushing about, having had coffee, or just arriving at the office can briefly raise blood pressure. So the diagnosis calls for several readings taken at different times and under different conditions. In some patients, a 24-hour blood pressure recording is also asked for. In this recording, a small device on the patient’s arm takes readings at set intervals throughout the day. This way, blood pressure that only goes up at the doctor’s office but stays normal during the day can be told apart from blood pressure that stays high all the time.
What causes it?
In most patients, hypertension cannot be tied to a single cause. This is called primary hypertension. As age moves on, arteries stiffen and lose their flexibility. Genetic tendency, weight, eating habits, an inactive lifestyle, and stress come together and lead to a steady rise in blood pressure over time.
In a smaller group of patients, there is a clear underlying cause. This is called secondary hypertension. Kidney diseases, narrowing of the kidney arteries, certain hormone disorders, sleep apnea (repeated pauses in breathing during sleep), and some medications can raise blood pressure. These causes are looked into when hypertension shows up at a young age, comes on suddenly, or runs at very high levels.
A diet high in salt, too much alcohol, smoking, an inactive lifestyle, and excess weight are the main lifestyle factors that raise blood pressure. Long-standing stress also affects the artery walls and adds to the rise.
What are the symptoms?
The most quiet side of hypertension is that it often gives no symptoms. This is why it is also called the “silent disease.” A patient may feel perfectly fine while blood pressure has been running high for years. During this time, damage builds up quietly in the arteries, the heart, the brain, and the kidneys.
In those who do have symptoms, the most common complaints are a heavy feeling at the back of the neck, headache (especially in the morning), ringing in the ears, dizziness, blurred vision, and nosebleeds. But these symptoms usually show up only when blood pressure has gone very high. So having no symptoms does not mean “my blood pressure is normal.” The only reliable way is to take a reading.
This is why everyone over 40 is advised to have their blood pressure checked at least once a year. People with a family history of hypertension, those who carry extra weight, smokers, and those with diabetes should have it checked more often.
What is the danger?
Untreated hypertension leads to serious outcomes. Arteries that work under steady high pressure start to wear out from the inside. This wear speeds up artery hardening and sets the stage for blockages.
High blood pressure clearly raises the risk of heart attack and stroke. When the heart works against high pressure for a long time, the heart muscle thickens and over time its pumping power weakens. This can go as far as heart failure. Damage to the small vessels in the kidneys can lead to kidney failure. Damage to the vessels in the eye can cause vision loss.
The good news is this: Once hypertension is brought under control, much of this risk drops. With regular follow-up and the right treatment, patients can live long and healthy lives.
How is it diagnosed?
Diagnosis is made through readings taken at different times and by the right method. Along with readings done in the clinic, home readings are also an important part of the assessment. In some people, blood pressure goes up only in front of the doctor; this is called the white coat effect. In others, the opposite happens; readings that look fine at the clinic come out high at home. So home readings are very valuable.
After diagnosis, the patient’s overall health is also looked at. Blood tests, urine tests, an ECG, and when needed an echocardiogram are done. An ECG, also called an EKG, is a simple, painless test that turns the heart’s electrical activity into a recording. An echocardiogram is an imaging test that uses sound waves to show the structure of the heart. These tests show how hypertension has affected the heart.
How to take blood pressure correctly at home
A wrong reading leads to wrong treatment. So there are some rules to keep in mind for home readings. Sit quietly for at least five minutes before the reading. In the half hour before the reading, do not smoke, drink coffee or tea, or do heavy exercise.
During the reading, the back should be supported, and the feet should rest flat on the floor. Legs should not be crossed. The cuff (the part of the device that wraps around the arm) should be placed directly on the skin or over a thin layer of clothing. A reading taken over a thick sweater gives a wrong result. The cuff should be at heart level, that is, around chest height. No talking or phone use during the reading.
The first reading is always a bit higher than the second. So taking two or three readings in a row, with one or two minutes between them, and using the average is the right way. Blood pressure should be measured ideally in the morning after waking up and at night before bed, and recorded in a notebook or a phone app. These records are very valuable for the doctor.
Devices that measure from the upper arm are more reliable than those that measure from the wrist. If a wrist device is used, the wrist must be held at heart level.
Treatment approach
Hypertension treatment runs on two main legs: lifestyle changes and medication. These two approaches are not alternatives to each other; in most patients, they go hand in hand.
Lifestyle changes are a basic step for every patient with hypertension. Cutting back on salt is one of the most important steps. Daily salt intake should not go above 5 grams, about a teaspoon. This includes not just the salt added to food but also the hidden salt in processed foods. Salami, sausage, ready-made soup, chips, and pickles hold large amounts of salt.
Regular physical activity lowers blood pressure. A 30-minute brisk walk on at least 5 days a week is a good start for most patients. Swimming and cycling are also suitable. Steady, moderate exercise is more useful than overly hard workouts.
Losing extra weight clearly brings blood pressure down. Even a few kilograms make a difference. Quitting smoking, cutting back on alcohol, and managing stress are also important parts of treatment. A diet rich in vegetables, fruit, whole grains, and legumes adds to blood pressure control.
Medication is needed for most patients. If lifestyle changes do not bring blood pressure to target, or if the starting readings are very high, medication is started. Hypertension medications fall into different groups, and each group works through a different mechanism. Some loosen the arteries, some reduce the work the heart has to do, and others help the body remove extra fluid. The choice of which medication for which patient is made based on age, other health conditions, and how the blood pressure has been running. For some patients, a single medication is enough; for others, two or three different medications used together may be needed.
The most important rule of medication is regularity. Hypertension medications are not given to make the patient feel better; they are given to protect the heart and arteries in the long run. So having no symptoms does not mean the medication is unnecessary. Stopping the medication on your own or changing the dose can lead to serious outcomes.
Is lifelong medication a must?
This is one of the most common questions patients ask. The answer depends on the person. For most patients with primary hypertension who do not get enough drop with lifestyle changes alone, medication continues for many years.
But in some patients, weight loss, less salt, and regular exercise bring blood pressure down clearly, and the medication dose can be reduced or, rarely, stopped. This decision belongs entirely to the doctor. In patients with secondary hypertension, once the underlying cause is dealt with, blood pressure may return to normal; in such cases, medication can be ended.
When to call the doctor
If your reading is above 180/110 and comes along with headache, blurred vision, chest pain, shortness of breath, or speech trouble, go to the emergency room without delay. This picture calls for prompt care.
For someone on regular medication, readings that start running differently from usual, or that go very high or very low often, also call for review. New headaches, sudden dizziness, and chest tightness should also be brought to the doctor.
Frequently asked questions
Does one high reading mean hypertension?
No. The diagnosis is not made on a single reading. Excitement, rushing, or coffee, among many things, can cause a one-time high. The diagnosis calls for several readings at different times.
Will salt-free meals fix my blood pressure?
Cutting salt brings blood pressure down clearly but on its own may not be enough for every patient. Salt is an important part of treatment, but if your doctor has prescribed medication, that should continue too.
I take medication and my blood pressure reads normal. Can I stop?
No. A normal reading shows that the medication is working. Once the medication is stopped, blood pressure usually rises again within days or weeks. The decision must always be made together with your doctor.
Can someone on regular medication still have a sudden high reading?
Yes. Stress, pain, intense activity, certain foods, or missed doses can lead to brief highs. This is why the medication routine should not be broken.
Can a young person have hypertension?
Yes. Hypertension is not a disease of old age. It can show up at a young age. Family history, weight, inactivity, and stress raise the risk in particular.
Does hypertension run in families?
A tendency toward hypertension can run in families. But the tendency alone is not enough; lifestyle plays a key role in whether this tendency turns into the disease.
My blood pressure is not coming down despite medication. What should I do?
Talk to your doctor. Sometimes the dose is too low, sometimes a switch to a different medication is needed, and sometimes there is an underlying secondary cause. Adding or changing medication on your own is not the right path.
How is high blood pressure managed during pregnancy?
During pregnancy, blood pressure is followed closely for both mother and baby. Some hypertension medications are not suitable during pregnancy, so the doctor must be told if a pregnancy is being planned or has been confirmed.