High Blood Pressure: Causes, Risks, and Treatment

High blood pressure (hypertension) is often called the "silent killer" because it usually has no symptoms until serious damage occurs. In the UAE, studies estimate that around 28–30% of adults have hypertension, with many unaware of their condition.

What Is High Blood Pressure?

Blood pressure is the force of blood pushing against the walls of your arteries. It is measured in millimetres of mercury (mmHg) and recorded as two numbers:

• Systolic pressure (top number): Pressure when your heart beats
• Diastolic pressure (bottom number): Pressure when your heart rests between beats

Blood Pressure Categories (ACC/AHA 2017 Guidelines)

Risk Factors

Several factors increase your risk of developing high blood pressure:

• Age: Risk increases with age
• Family history: Hypertension tends to run in families
• Being overweight or obese: Excess weight increases heart workload
• Physical inactivity: Sedentary lifestyle contributes to weight gain
• High sodium diet: Excessive salt intake raises blood pressure
• Excessive alcohol consumption
• Smoking: Damages blood vessel walls and accelerates arterial hardening
• Chronic stress
• Chronic kidney disease or diabetes

Why Hypertension Is Dangerous

Untreated high blood pressure damages your blood vessels and organs over time. According to the WHO, hypertension is a major risk factor for:

• Heart attack and heart failure
• Stroke (a leading cause of death and long-term disability)
• Kidney disease and kidney failure
• Vision loss
• Peripheral artery disease

The Lancet published a major study (NCD Risk Factor Collaboration, 2021) finding that the number of people with hypertension worldwide doubled from 1990 to 2019, reaching 1.28 billion adults.

Treatment and Management

Lifestyle Modifications

NICE guideline NG136 and the AHA both recommend lifestyle changes as the foundation of hypertension management:

1. 1Reduce sodium intake: Aim for less than 2,300 mg per day (ideally 1,500 mg). Avoid processed foods, canned soups, and adding extra salt
2. 2Follow the DASH diet: Rich in fruits, vegetables, whole grains, and low-fat dairy; low in saturated fat and sodium
3. 3Exercise regularly: At least 150 minutes per week of moderate activity (brisk walking, cycling, swimming)
4. 4Maintain a healthy weight: Even losing 5–10 kg can significantly reduce blood pressure
5. 5Limit alcohol: No more than 14 units per week, spread over several days
6. 6Stop smoking: Smoking cessation reduces cardiovascular risk within weeks
7. 7Manage stress: Regular relaxation techniques, adequate sleep, and social connection

Medications

If lifestyle changes alone are not sufficient, your doctor may prescribe one or more medications:

• ACE inhibitors (e.g., ramipril, enalapril)
• Angiotensin II receptor blockers (ARBs) (e.g., losartan, valsartan)
• Calcium channel blockers (e.g., amlodipine)
• Thiazide diuretics (e.g., indapamide)

NICE guideline NG136 recommends starting medication when clinic blood pressure is consistently 140/90 mmHg or higher. For Stage 1 hypertension (ambulatory/home readings of 135/85 mmHg or higher), treatment is offered if the patient has diabetes, kidney disease, target organ damage, or a 10-year cardiovascular risk of 10% or more.

Monitoring Your Blood Pressure at Home

Home blood pressure monitoring is recommended by most guidelines. Tips for accurate readings:

• Sit quietly for 5 minutes before measuring
• Use a validated upper-arm cuff monitor
• Take two readings 1–2 minutes apart
• Measure at the same time each day
• Keep a log to share with your doctor

When to Seek Immediate Medical Help

A hypertensive crisis (blood pressure above 180/120 mmHg) requires urgent medical attention, especially if accompanied by:

• Severe headache
• Chest pain
• Difficulty breathing
• Vision changes
• Confusion
• Numbness or weakness

This article is for informational purposes only and does not replace professional medical advice. Always consult your doctor for personalised guidance.