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Hypertension – High Blood Pressure: Causes and Treatment

Hypertension, or high blood pressure, is a condition where blood pressure is persistently elevated. If left untreated, it significantly raises the risk of heart attack and stroke.

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Things worth knowing about "Hypertension"

Hypertension, or high blood pressure, is a condition where blood pressure is persistently elevated. If left untreated, it significantly raises the risk of heart attack and stroke.

What Is Hypertension?

Hypertension, commonly known as high blood pressure, is a chronic medical condition in which the force of blood against artery walls is consistently too high. It is defined as a blood pressure reading of 140/90 mmHg or above, measured on multiple occasions. Blood pressure is recorded as two numbers: the systolic pressure (when the heart beats) and the diastolic pressure (when the heart rests between beats). Hypertension is one of the most prevalent chronic conditions worldwide and a major risk factor for cardiovascular disease.

Causes

There are two main types of hypertension:

Primary (essential) hypertension: Accounts for approximately 90–95% of all cases. It develops gradually over many years without a single identifiable cause. Key risk factors include genetic predisposition, obesity, physical inactivity, a high-salt diet, excessive alcohol intake, smoking, and chronic stress.
Secondary hypertension: Caused by an underlying condition such as kidney disease, thyroid disorders, obstructive sleep apnea, or the use of certain medications (e.g., oral contraceptives, non-steroidal anti-inflammatory drugs).

Symptoms

Hypertension is often called the silent killer because it typically produces no noticeable symptoms for many years. When symptoms do occur -- usually at very high blood pressure levels -- they may include:

Headaches, especially at the back of the head
Dizziness and visual disturbances
Nosebleeds
Palpitations or shortness of breath
Ringing in the ears (tinnitus)

Because these symptoms are non-specific, hypertension is frequently discovered incidentally during routine medical check-ups.

Diagnosis

Hypertension is diagnosed through repeated blood pressure measurements taken at different times. A single elevated reading is not sufficient for diagnosis. Common diagnostic approaches include:

Office measurement: Blood pressure measured by a healthcare provider using a sphygmomanometer placed on the upper arm.
Home monitoring: Regular self-measurements at home over several days.
Ambulatory Blood Pressure Monitoring (ABPM): An automated device records blood pressure every 20–30 minutes over 24 hours, including during sleep.

Additional tests such as blood and urine analyses and an electrocardiogram (ECG) are performed to detect potential organ damage or secondary causes.

Classification

The European Society of Cardiology (ESC) classifies blood pressure as follows:

Optimal: below 120/80 mmHg
Normal: 120–129 / 80–84 mmHg
High normal: 130–139 / 85–89 mmHg
Grade 1 Hypertension: 140–159 / 90–99 mmHg
Grade 2 Hypertension: 160–179 / 100–109 mmHg
Grade 3 Hypertension: 180/110 mmHg or higher

Treatment

Lifestyle Modifications

For mild hypertension, or as a complement to medication, doctors recommend lifestyle changes as a first step:

Reducing salt intake (less than 5 g per day, as recommended by the WHO)
Regular physical activity (at least 150 minutes of moderate exercise per week)
Weight reduction in overweight individuals
Limiting alcohol consumption and quitting smoking
Stress management and relaxation techniques

Pharmacological Treatment

When lifestyle changes are insufficient, antihypertensive medications are prescribed. The main drug classes include:

ACE inhibitors (e.g., Ramipril): Block an enzyme that causes blood vessels to narrow.
Angiotensin II receptor blockers (ARBs) (e.g., Losartan): Prevent the action of a hormone that raises blood pressure.
Calcium channel blockers (e.g., Amlodipine): Relax the smooth muscle of blood vessel walls.
Diuretics (e.g., Hydrochlorothiazide): Increase the excretion of salt and water through the kidneys.
Beta-blockers (e.g., Metoprolol): Reduce heart rate and lower blood pressure.

Treatment is tailored to the individual patient. A combination of two or more medications is often required to achieve sustained blood pressure control.

Complications

Uncontrolled hypertension causes progressive damage to blood vessels and vital organs. Potential long-term complications include:

Heart attack and coronary artery disease
Stroke
Heart failure
Chronic kidney disease
Hypertensive retinopathy (damage to the blood vessels of the retina)
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. Fact Sheet. Geneva, 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/hypertension
Whelton P.K. et al. - 2017 ACC/AHA High Blood Pressure Clinical Practice Guideline. Journal of the American College of Cardiology, 2018.

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