Hypertension (High Blood Pressure): Causes, Symptoms, Diagnosis, and Treatment

Introduction

Hypertension, commonly known as high blood pressure, is one of the most common chronic medical conditions worldwide. It affects the heart, brain, kidneys, and blood vessels, and is a major risk factor for cardiovascular disease, stroke, and chronic kidney disease.

Many people with hypertension do not experience noticeable symptoms. As a result, high blood pressure may remain undiagnosed for years, increasing the risk of serious complications.

The good news is that hypertension can often be controlled through lifestyle changes, appropriate medication, and regular medical follow-up.

According to the World Health Organization (WHO), an estimated 1.4 billion adults aged 30–79 years had hypertension in 2024

Hypertension, commonly known as high blood pressure, is one of the most common chronic medical conditions worldwide. It affects the heart, brain, kidneys, and blood vessels, and is a major risk factor for cardiovascular disease, stroke, and chronic kidney disease.

Many people with hypertension do not experience noticeable symptoms. As a result, high blood pressure may remain undiagnosed for years, increasing the risk of serious complications.

The good news is that hypertension can often be controlled through lifestyle changes, appropriate medication, and regular medical follow-up.

According to the World Health Organization (WHO), an estimated 1.4 billion adults aged 30–79 years had hypertension in 2024.

1. What Is Hypertension?

Blood pressure is the force exerted by circulating blood against the walls of blood vessels.

It is recorded using two numbers:

• Systolic blood pressure (SBP): The pressure when the heart contracts.

• Diastolic blood pressure (DBP): The pressure when the heart relaxes between beats.

For adults, WHO defines hypertension as blood pressure of 140/90 mmHg or higher, confirmed by measurements on two different days.

For example:

The diagnosis should be based on accurate measurements and clinical assessment, rather than a single reading alone.

2. Common Causes and Risk Factors

Hypertension can develop due to a combination of genetic, lifestyle, environmental, and medical factors.

Modifiable risk factors

• High salt intake

• Overweight or obesity

• Physical inactivity

• Unhealthy dietary patterns

• Excessive alcohol consumption

• Smoking and tobacco exposure

• Poor sleep and certain sleep disorders

Non-modifiable risk factors

• Increasing age

• Family history of hypertension

• Genetic predisposition

Secondary hypertension

Some patients develop high blood pressure due to an underlying medical condition or medication.

Potential causes include:

• Chronic kidney disease

• Primary aldosteronism

• Renovascular disease

• Obstructive sleep apnea

• Thyroid disorders

• Certain medications, including NSAIDs and corticosteroids

Clinical point: Consider secondary hypertension in patients with resistant hypertension, an unusually early onset, abrupt worsening, or clinical findings suggesting a specific underlying cause.

3. Symptoms of Hypertension

Why is hypertension called a silent disease?

Most people with hypertension have no symptoms. A patient may feel completely well while their blood pressure is persistently elevated.

Possible symptoms, particularly with very high blood pressure or associated complications, include:

• Headache

• Dizziness

• Blurred vision

• Chest discomfort

• Shortness of breath

• Fatigue

However, these symptoms are not specific to hypertension. The only reliable way to identify high blood pressure is to measure it.

Do not wait for symptoms before checking your blood pressure.

4. Complications of Uncontrolled Hypertension

Persistent high blood pressure can damage blood vessels and vital organs over time.

4.1 Heart disease

Hypertension increases the risk of:

• Left ventricular hypertrophy

• Coronary artery disease

• Myocardial infarction

• Heart failure

• Atrial fibrillation and other cardiovascular complications

4.2 Stroke

High blood pressure is a major risk factor for both ischemic and hemorrhagic stroke.

Effective blood pressure control reduces the risk of stroke.

4.3 Kidney disease

Long-term hypertension can damage the renal microvasculature and contribute to chronic kidney disease.

Patients with hypertension may benefit from regular assessment of kidney function and urinary albumin.

4.4 Eye disease

Hypertension may cause retinal vascular changes and, in severe cases, hypertensive retinopathy.

4.5 Peripheral arterial disease

Vascular damage associated with hypertension contributes to atherosclerotic disease affecting arteries outside the heart and brain.

5. How Is Hypertension Diagnosed?

Accurate blood pressure measurement is essential for diagnosis and treatment decisions.

Proper blood pressure measurement

1. Rest quietly for at least 5 minutes.

2. Sit with your back supported and feet flat on the floor.

3. Use an appropriately sized upper-arm cuff.

4. Keep your arm supported at heart level.

5. Avoid talking during the measurement.

6. Take repeated readings when appropriate and record the results.

Additional assessment

A clinician may recommend:

• Repeated office blood pressure measurements

• Home blood pressure monitoring

• 24-hour ambulatory blood pressure monitoring

• Cardiovascular risk assessment

• Serum creatinine and estimated GFR

• Electrolytes

• Urinalysis and urine albumin-to-creatinine ratio

• ECG

• Additional investigations when secondary hypertension is suspected

Home or ambulatory monitoring can help identify white-coat hypertension and masked hypertension.

6. Lifestyle Changes to Control Blood Pressure

Lifestyle modification is an important part of hypertension management, whether or not medication is required.

6.1 Reduce salt intake

Excessive sodium intake can contribute to increased blood pressure.

Practical recommendations:

• Reduce salty sauces and processed foods.

• Limit instant noodles and highly salted snacks.

• Choose fresh foods more often.

• Avoid adding excessive salt during cooking and at the table.

WHO recommends limiting salt consumption to less than 5 g per day for adults, equivalent to less than 2 g of sodium per day.

6.2 Maintain a healthy weight

Weight reduction in people who are overweight or obese can help lower blood pressure and improve overall cardiovascular risk.

6.3 Exercise regularly

Aim for at least 150 minutes of moderate-intensity physical activity per week, when medically appropriate.

Examples include:

• Brisk walking

• Cycling

• Swimming

• Aerobic exercise

Strength training can also be incorporated into a balanced exercise program.

6.4 Stop smoking

Smoking increases cardiovascular risk. Quitting tobacco is beneficial for overall heart and vascular health.

6.5 Manage sleep and stress

Adequate sleep, stress management, and evaluation for sleep apnea when clinically indicated may support blood pressure management.

7. Medications for Hypertension

Some patients can improve their blood pressure through lifestyle changes, while many patients require long-term medication.

The choice of medication depends on blood pressure levels, cardiovascular risk, kidney function, comorbidities, age, adverse effects, and patient preferences.

Common antihypertensive medication classes

Important: Do not start, stop, or change blood pressure medication without consulting a qualified healthcare professional.

The 2024 European Society of Cardiology guidelines recommend combination therapy for many patients requiring treatment, with individualized choices for specific populations and clinical circumstances.

8. What Is the Target Blood Pressure?

Blood pressure targets should be individualized.

The target depends on:

• Age

• Cardiovascular disease

• Diabetes

• Chronic kidney disease

• Orthostatic symptoms

• Frailty

• Medication tolerance

The 2024 ESC guidelines recommend a systolic blood pressure target of 120–129 mmHg for most adults receiving antihypertensive medication, when tolerated, with exceptions requiring individualized management. Other guidelines and clinical circumstances may use different targets.

Your doctor should establish an appropriate target based on your clinical condition and monitor for adverse effects, including hypotension.

9. When Is Hypertension an Emergency?

Severely elevated blood pressure may be associated with acute organ damage and requires urgent medical assessment.

Seek emergency medical care if you have high blood pressure with:

• Chest pain

• Severe shortness of breath

• New weakness or numbness

• Difficulty speaking

• Sudden visual changes

• Confusion or altered consciousness

• Severe headache with neurological symptoms

A blood pressure reading around 180/120 mmHg or higher, especially with symptoms, warrants immediate assessment. Do not delay emergency care while waiting for blood pressure to improve at home.

The management of severe hypertension depends on the presence or absence of acute target-organ damage and the overall clinical picture.

10. How Can You Prevent Hypertension?

Although some risk factors cannot be changed, many lifestyle measures can reduce the risk of developing hypertension or help improve control.

Five practical recommendations:

1. Check your blood pressure regularly.

2. Reduce salt intake and eat a balanced diet.

3. Maintain a healthy body weight.

4. Exercise regularly.

5. Follow prescribed treatment and attend medical follow-up.

Early detection and consistent management can help reduce the risk of cardiovascular and kidney complications.

Frequently Asked Questions (FAQs)

Conclusion

Hypertension is a common but potentially serious medical condition. Because it often causes no symptoms, regular blood pressure screening is essential.

Early diagnosis, healthy lifestyle choices, appropriate medication, and regular medical follow-up can help protect your heart, brain, kidneys, and overall health.

If you are concerned about your blood pressure or have difficulty controlling hypertension, consult a qualified healthcare professional for individualized assessment and treatment.

Chandarith Clinic

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