Hypertension (high blood pressure) is one of the most common and important risk factors for cardiovascular disease, stroke, kidney disease, and vision loss. It is often called the "silent killer" because it typically causes no symptoms until serious damage has occurred. An estimated 1.28 billion adults worldwide have hypertension, yet nearly half are unaware of their condition.
Understanding Blood Pressure Numbers
Blood pressure is recorded as two numbers:
- Systolic pressure (top number): The pressure when the heart contracts
- Diastolic pressure (bottom number): The pressure when the heart relaxes between beats
Blood Pressure Categories (NICE NG136)
| Category | Clinic BP (mmHg) |
|---|---|
| Normal | Below 140/90 |
| Stage 1 Hypertension | 140/90 or above (confirmed by ABPM/HBPM average of 135/85 or above) |
| Stage 2 Hypertension | 160/100 or above (confirmed by ABPM/HBPM average of 150/95 or above) |
| Severe Hypertension | 180/120 or above (seek immediate medical attention) |
Causes and Risk Factors
Most hypertension is "primary" (essential), meaning there is no single identifiable cause but rather a combination of factors:
- Age: Blood pressure tends to increase with age
- Family history: Having a parent or sibling with hypertension increases risk
- Excess weight: Obesity is strongly linked to hypertension
- High salt intake: Consuming more than 6g of salt per day raises blood pressure
- Physical inactivity: Sedentary lifestyle contributes to weight gain and higher blood pressure
- Alcohol: Regular excessive consumption raises blood pressure
- Stress: Chronic stress can contribute to sustained elevation
- Sleep apnoea: A common and underdiagnosed cause of resistant hypertension
Secondary causes (less common) include kidney disease, thyroid disorders, and certain medications.
Why Treatment Matters
Untreated hypertension damages blood vessels throughout the body:
- Heart: Coronary artery disease, heart failure, left ventricular hypertrophy
- Brain: Stroke (both ischaemic and haemorrhagic), vascular dementia
- Kidneys: Chronic kidney disease, kidney failure
- Eyes: Hypertensive retinopathy, vision loss
- Blood vessels: Peripheral arterial disease, aortic aneurysm
The WHO Global Report on Hypertension (2023) estimates that effective global treatment of hypertension could prevent 76 million deaths by 2050.
Lifestyle Modifications
These changes can lower blood pressure by 5-15 mmHg:
Reduce Salt
- Aim for less than 6g per day (about one teaspoon)
- Avoid processed foods, which account for 75% of dietary salt
- Read labels and choose low-sodium options
- Use herbs, spices, and lemon juice to flavour food
DASH Diet
The Dietary Approaches to Stop Hypertension (DASH) diet is proven to lower blood pressure:
- Rich in fruits, vegetables, and whole grains
- Includes low-fat dairy, poultry, fish, and nuts
- Limits red meat, sweets, and sugar-sweetened beverages
Exercise
- 150 minutes of moderate-intensity activity per week
- Aerobic exercise (walking, swimming, cycling) is most effective
- Resistance training also beneficial
Weight Management
- Losing 5-10 kg can significantly reduce blood pressure
- Even modest weight loss helps
Limit Alcohol
- No more than 14 units per week, spread evenly
Manage Stress
- Regular relaxation techniques
- Adequate sleep (7-9 hours)
- Treatment for sleep apnoea if present
Medication
When lifestyle changes alone are insufficient, your doctor may prescribe one or more of the following:
- ACE inhibitors (e.g., ramipril, enalapril)
- Angiotensin receptor blockers (e.g., losartan, valsartan)
- Calcium channel blockers (e.g., amlodipine)
- Thiazide diuretics (e.g., indapamide)
NICE guidelines recommend starting treatment for sustained blood pressure of 140/90 mmHg or above (or 130/80 mmHg with diabetes or kidney disease). A target of below 140/90 mmHg is recommended for most adults, or below 130/80 mmHg for higher-risk groups.
Monitoring
- Home blood pressure monitoring is recommended for diagnosis and ongoing management
- Take readings twice daily (morning and evening) for at least 4 days before a clinic visit
- Avoid caffeine, exercise, and smoking for 30 minutes before measuring
- Sit quietly for 5 minutes before taking a reading
- Use a validated, upper-arm monitor
At Jabal Sina Medical Centre, our general practitioners and internal medicine specialists provide comprehensive blood pressure assessment, 24-hour ambulatory monitoring, and personalised management plans.
This article is for informational purposes only and does not replace professional medical advice. Always consult your doctor for personalised guidance.