Hypertension

What is hypertension?

Hypertension is persistently elevated pressure in the arteries. It rarely causes symptoms, which is why it is called the silent killer, yet it is the single largest contributor to stroke and a major cause of heart and kidney disease. Because it is symptomless, diagnosis depends on measurement and treatment depends on adherence rather than on feeling unwell.

Causes

• Primary hypertension with no single identifiable cause
• Kidney disease
• Primary aldosteronism and other endocrine causes
• Obstructive sleep apnoea
• Medicines including steroids, decongestants and some contraceptives
• Excess salt, alcohol and inactivity

Symptoms

• Usually no symptoms at all
• Headache in severe elevation
• Visual disturbance in hypertensive emergency
• Shortness of breath
• Nosebleeds, which are uncommon and non specific
• Chest pain if heart disease has developed

Risk factors

• Increasing age
• Family history
• Obesity and physical inactivity
• High salt intake
• Excess alcohol
• African or Caribbean ancestry
• Chronic kidney disease and diabetes

Diagnosis

• Repeated clinic blood pressure measurements
• Ambulatory or home monitoring to confirm and exclude white coat effect
• Blood tests for kidney function, electrolytes, glucose and lipids
• Urine albumin to creatinine ratio
• ECG to look for left ventricular hypertrophy
• Screening for secondary causes in young or resistant cases

Treatment

• Salt reduction, weight loss and regular aerobic activity
• Limiting alcohol and stopping smoking
• ACE inhibitors or angiotensin receptor blockers
• Calcium channel blockers
• Thiazide like diuretics
• Spironolactone for resistant hypertension
• Treating obstructive sleep apnoea where present

Self care

• Take medicines at the same time daily, even feeling well
• Reduce salt, including in bread, sauces and processed food
• Aim for 150 minutes of moderate activity weekly
• Lose weight if overweight
• Limit alcohol and stop smoking
• Measure blood pressure at home correctly and keep a record
• Manage stress and prioritise sleep

When to see a doctor

Book an appointment if:

• Home readings consistently above your target
• Side effects from medication
• Readings that remain high on three or more medicines
• Planning pregnancy, since some medicines must be changed
• Dizziness on standing
• Very variable readings

Some symptoms need emergency care rather than an appointment. See the warning signs listed above.

Prevention

• Keep salt intake low from early adulthood
• Stay physically active and maintain a healthy weight
• Limit alcohol
• Eat plenty of fruit, vegetables and potassium rich foods
• Do not smoke
• Have blood pressure checked at least every five years, more often with risk factors

Outlook

Hypertension is usually lifelong but very controllable. Lowering blood pressure substantially reduces stroke, heart attack, heart failure and kidney disease risk, and the benefit continues for as long as control is maintained. Some people achieve normal readings through weight loss and lifestyle change alone, though monitoring should continue.

Related conditions

Common questions