High blood pressure, also known as hypertension, is one of the most common medical conditions worldwide and a major risk factor for heart disease, stroke, kidney disease, and other vascular problems. It often causes no symptoms, which means many people are unaware they have it until it is detected during a routine check or as part of an assessment for another concern.
Understanding what high blood pressure is, why it matters, and how it is managed helps patients make informed decisions and reduces confusion around monitoring, treatment, and long term risk.
What blood pressure actually measures
Blood pressure is a measure of the force that circulating blood exerts against the walls of the arteries. It is recorded using two numbers.
The first number, known as the systolic pressure, reflects the pressure in the arteries when the heart contracts and pumps blood out.
The second number, the diastolic pressure, reflects the pressure in the arteries when the heart relaxes between beats.
Blood pressure is not static. It varies throughout the day depending on physical activity, stress, posture, pain, and even temperature. Because of this natural variation, a diagnosis of high blood pressure is never based on a single reading.
What is considered high blood pressure
High blood pressure is usually diagnosed when readings are consistently above the normal range on repeated measurements.
In general terms:
- clinic readings persistently above 140 over 90 are considered high
- home readings persistently above 135 over 85 are considered high
However, these thresholds are not rigid. Targets may be lower in people with diabetes, kidney disease, or established cardiovascular disease. In older patients, targets may be adjusted to balance benefit against side effects such as dizziness or falls.
This individualised approach is central to modern blood pressure management.
Why high blood pressure is important
High blood pressure matters because of the effect it has on blood vessels and organs over time. Persistently raised pressure causes gradual damage to artery walls, making them stiffer and more prone to plaque build up.
- heart attacks
- strokes
- heart failure
- kidney disease
- vascular dementia
- peripheral arterial disease
Because this damage develops slowly, high blood pressure is often described as a silent condition. People may feel completely well while harm accumulates in the background. Treatment is therefore aimed at preventing future problems rather than improving current symptoms.
Common causes of high blood pressure
In most people, there is no single identifiable cause. This is known as primary or essential hypertension. It develops gradually with age and is influenced by a combination of genetic and lifestyle factors.
Common contributors include excess body weight, lack of physical activity, high salt intake, alcohol excess, stress, and family history.
In a smaller number of people, high blood pressure is secondary to another condition. These secondary causes include kidney disease, certain hormonal disorders, sleep apnoea, and the effects of some medications. Secondary causes are considered when blood pressure is very high, difficult to control, or develops at a young age.
Symptoms and common misunderstandings
Most people with high blood pressure have no symptoms at all. This often leads to confusion, particularly when medication is recommended despite feeling well.
Headaches, dizziness, or tiredness are frequently blamed on high blood pressure, but these symptoms are usually not reliable indicators. Treating blood pressure is about reducing future cardiovascular risk rather than alleviating day to day symptoms.
Occasionally, very high blood pressure may cause symptoms such as headaches or visual disturbance, but this is uncommon and usually reflects more severe elevation.
How high blood pressure is diagnosed
Accurate measurement is essential. Blood pressure should be measured after a period of rest, using an appropriately sized cuff, and ideally on more than one occasion.
Home blood pressure monitoring is commonly used and provides valuable information about readings in a normal environment. Ambulatory blood pressure monitoring, which records readings over 24 hours, may also be used to confirm the diagnosis and identify patterns such as raised night time pressure.
These approaches help avoid misdiagnosis due to anxiety related to clinic visits and ensure that treatment decisions are based on representative readings.
High blood pressure and overall cardiovascular risk
Blood pressure is rarely considered in isolation. It is one of several factors that contribute to overall cardiovascular risk.
Age, sex, cholesterol levels, smoking status, diabetes, and family history all influence how much weight is given to blood pressure readings. Two people with the same blood pressure may have very different levels of risk depending on these other factors.
This broader assessment helps determine when lifestyle changes alone are sufficient and when medication is likely to be beneficial.
Lifestyle changes and blood pressure control
Key measures include regular physical activity, weight management, reducing salt intake, moderating alcohol consumption, improving diet quality, and addressing sleep issues. Stress management can also be helpful for some people.
Even modest changes can lead to meaningful reductions in blood pressure. For some individuals, these measures are enough to avoid medication altogether.
Medication for high blood pressure
Medication is recommended when blood pressure remains consistently high despite lifestyle measures, or when overall cardiovascular risk is significant.
There are several classes of blood pressure medication, each working in different ways. The choice depends on age, ethnicity, other medical conditions, side effect profile, and response to treatment.
It is common for treatment to be adjusted over time. Finding the right medication or combination often requires monitoring and fine tuning rather than a single decision.
The aim is to reduce long term risk while maintaining quality of life and avoiding unnecessary side effects.
Effects of high blood pressure on the heart
Long standing high blood pressure increases the workload of the heart. Over time, this can lead to thickening of the heart muscle and reduced efficiency of pumping.
High blood pressure also accelerates the development of coronary artery disease and increases the likelihood of heart failure and rhythm problems. Early identification and appropriate treatment significantly reduce these risks.
Monitoring and follow up
Blood pressure management is an ongoing process rather than a one off intervention. Regular monitoring helps ensure that treatment remains effective and appropriate as circumstances change.
Follow up also allows side effects to be identified early and treatment adjusted if needed. For many people, blood pressure control improves with time as lifestyle changes take effect and medication is optimised.
When to seek advice
It is sensible to seek assessment if blood pressure readings are repeatedly high, if high blood pressure is detected at a young age, or if there is a strong family history of cardiovascular disease.
Advice is also appropriate if blood pressure remains poorly controlled despite treatment, or if medication side effects are problematic.
If you would like to discuss blood pressure readings, understand whether treatment is necessary, or review current management, you can get in touch with me to arrange an assessment and talk through your situation in a clear and measured way.
High blood pressure is common, often silent, and usually manageable. With careful assessment, appropriate monitoring, and proportionate treatment, most people can significantly reduce their long term cardiovascular risk while continuing to live full and active lives.