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Arterial Hypertension: Causes, Symptoms & Treatment

Arterial hypertension refers to persistently elevated blood pressure and is one of the most common conditions worldwide. It significantly increases the risk of heart attack, stroke, and kidney damage.

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Things worth knowing about "Arterial Hypertension"

Arterial hypertension refers to persistently elevated blood pressure and is one of the most common conditions worldwide. It significantly increases the risk of heart attack, stroke, and kidney damage.

What is Arterial Hypertension?

Arterial hypertension, commonly known as high blood pressure, is a chronic medical condition in which the pressure of blood against the walls of the arteries is persistently elevated. According to current guidelines, hypertension is diagnosed when blood pressure repeatedly measures 140/90 mmHg or higher. The first number (systolic) represents pressure during a heartbeat, while the second (diastolic) reflects pressure between beats. Arterial hypertension is one of the leading risk factors for cardiovascular disease globally.

Causes

Arterial hypertension is classified into two main types:

Primary (essential) hypertension: Accounts for approximately 90–95% of all cases and has no single identifiable cause. It develops gradually due to a combination of genetic predisposition and lifestyle factors.
Secondary hypertension: Results from an underlying medical condition, such as chronic kidney disease, thyroid disorders, or hormonal imbalances (e.g., Conn syndrome, pheochromocytoma).

Common modifiable risk factors include:

Overweight and obesity
High dietary salt intake
Physical inactivity
Chronic stress
Excessive alcohol consumption and smoking
Unhealthy diet

Symptoms

Arterial hypertension is often called the “silent killer” because it frequently causes no noticeable symptoms for years. When symptoms do occur, they may include:

Headaches, especially at the back of the head in the morning
Dizziness and visual disturbances
Nosebleeds
Palpitations or rapid heartbeat
Fatigue and reduced physical performance
Shortness of breath during exertion

Severely elevated blood pressure can lead to a hypertensive emergency, which requires immediate medical attention.

Diagnosis

Diagnosis is established through repeated blood pressure measurements on separate occasions. A single elevated reading is generally not sufficient for diagnosis. Diagnostic methods include:

Office blood pressure measurement: Taken by a healthcare professional at two or more separate visits
Ambulatory blood pressure monitoring (ABPM): 24-hour monitoring to assess blood pressure patterns throughout the day and night
Home blood pressure monitoring: Regular self-measurements by the patient

Additional tests such as blood and urine analysis, ECG, echocardiography, and renal ultrasound are used to identify secondary causes and assess organ damage.

Treatment

Lifestyle Modifications

For mild to moderate hypertension and as a complement to medication, lifestyle changes are essential:

Weight reduction in overweight individuals
Low-salt diet (less than 5 g of salt per day, as recommended by the WHO)
Regular physical activity (at least 150 minutes of moderate exercise per week)
Reduction of alcohol intake and smoking cessation
Stress management techniques such as relaxation exercises or meditation
Heart-healthy diet (the DASH diet is widely recommended)

Pharmacological Treatment

When lifestyle changes are insufficient or blood pressure is significantly elevated, antihypertensive medications are prescribed. The main drug classes include:

ACE inhibitors (e.g., ramipril, enalapril): Block an enzyme that causes blood vessel constriction
Angiotensin II receptor blockers (ARBs) (e.g., candesartan, losartan): Prevent the action of a hormone that narrows blood vessels
Calcium channel blockers (e.g., amlodipine): Relax blood vessel walls and reduce vascular resistance
Diuretics (e.g., hydrochlorothiazide, torasemide): Promote excretion of water and salt through the kidneys
Beta-blockers (e.g., metoprolol, bisoprolol): Slow the heart rate and reduce cardiac output

Combination therapy with two or more drug classes is often required to achieve target blood pressure values.

Complications and Long-Term Consequences

Untreated or poorly controlled hypertension can cause serious damage to multiple organ systems:

Heart attack and coronary artery disease
Stroke
Heart failure
Chronic kidney disease or kidney failure
Hypertensive retinopathy (damage to the retina of the eye)
Peripheral artery disease

References

Williams B et al. - 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal, 2018.
World Health Organization (WHO) - Hypertension. Key Facts. Geneva, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/hypertension
Whelton PK et al. - 2017 ACC/AHA High Blood Pressure Clinical Practice Guideline. Journal of the American College of Cardiology, 2018.

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