High Blood Pressure
A practical guide to accurate blood-pressure measurement, diagnosis, cardiovascular risk, treatment and long-term control.
High blood pressure, or hypertension, is diagnosed when blood pressure remains above the relevant threshold on repeated, properly performed measurements. It often causes no symptoms, yet over time it can contribute to stroke, heart attack, heart failure, kidney disease and damage to the blood vessels and eyes.
Key Points
A single high reading does not usually establish the diagnosis. Technique, cuff size, rest before measurement and readings obtained on different occasions matter. Home measurements or 24-hour ambulatory monitoring may help distinguish sustained hypertension from a white-coat effect and may also detect masked hypertension.
Does High Blood Pressure Cause Symptoms?
Most people have no reliable warning symptom. Headache, dizziness or a feeling of pressure may occur but cannot confirm or exclude hypertension. Regular measurement is therefore more useful than waiting for symptoms.
Accurate Measurement
- Avoid exercise, smoking and caffeine shortly before measurement
- Sit quietly for at least five minutes with the back and arm supported
- Use a validated upper-arm device and a cuff suited to arm size
- Keep the cuff at heart level and do not talk during the reading
- Take two readings one to two minutes apart and record the results
The first assessment may include both arms. The healthcare team can advise which arm to use for future home measurements.
Risk Assessment and Tests
Blood pressure is interpreted with age, smoking, cholesterol, diabetes, kidney function, weight, family history and existing cardiovascular disease. Blood and urine tests, an ECG and sometimes echocardiography may be used to look for organ effects or another cause. Secondary hypertension is considered more strongly in resistant, severe or unusually early-onset cases.
Treatment
Sustainable changes include reducing excess salt, following a balanced Mediterranean-style eating pattern, regular activity, weight management, avoiding tobacco, moderating alcohol and improving sleep. Medicines are chosen according to the blood-pressure level, total cardiovascular risk, age, kidney function, pregnancy potential and other illnesses. Many patients need more than one medicine. Treatment should not be stopped when readings improve unless the prescribing clinician advises a change.
Follow-up
Home records can help assess response and reduce decisions based on isolated readings. Monitoring may include kidney function and electrolytes after starting or adjusting certain medicines. Targets are individualised, especially in older or frail people and in those who experience dizziness on standing.
When to Seek Emergency Help
An isolated high value without severe symptoms should be repeated after quiet rest and discussed with a healthcare professional; it should not lead to unsupervised extra medication.
Frequently Asked Questions
Can hypertension be present when I feel well?
Yes. Most hypertension is asymptomatic.
Are wrist devices reliable?
A validated upper-arm monitor is generally preferred. Device validation, cuff fit and correct technique are essential.
Is treatment lifelong?
Long-term management is often required, but the plan can change with weight, lifestyle, age, other illnesses and repeated measurements.