High Blood Pressure

Overview

High blood pressure, sometimes called hypertension, means the pressure of blood pushing against your artery walls is higher than is healthy. Arteries are the blood vessels that carry blood away from your heart. High blood pressure usually causes no symptoms, so it is often found during a routine check. Over time, if it is not controlled, it can put extra strain on your heart, brain, kidneys, eyes, and blood vessels.

Yes, it is very common. It becomes more common as people get older. In many countries, about 1 in 3 adults has high blood pressure, and many do not know it.

Anyone can develop high blood pressure. It is more common in older adults and in people with a family history of it. It is also more common in some ethnic groups, including people of Black African or Black Caribbean background, and in people with diabetes, kidney disease, or sleep apnoea. It can also happen during pregnancy.

Symptoms

Common symptoms

• Most people have no symptoms at all.
• Some people may have headaches, dizziness, or nosebleeds, but these are not reliable signs of high blood pressure.
• High blood pressure is usually found by a blood pressure check, not by how you feel.

Symptoms in children

• Children often have no symptoms.
• It may be found during a routine check or when looking for another health problem.
• Babies may feed poorly or be very irritable.
• Older children may have headaches, vomiting, or vision changes.
• A seizure, severe confusion, or sudden weakness needs emergency help.

Symptoms in older adults

• High blood pressure is common in older adults.
• Sometimes the top number is high while the bottom number is normal. This is called isolated systolic high blood pressure.
• Dizziness when standing up can happen, especially if blood pressure drops too much.
• Many older adults take other medicines, so regular reviews with a clinician are important.
• Home blood pressure readings can help your clinician see the full picture.

Causes

Main causes

• Most people have no single clear cause. This is called primary or essential high blood pressure.
• Genes and family history play a part.
• Kidney disease can cause high blood pressure.
• Some hormone problems can cause it.
• Sleep apnoea, a condition that causes pauses in breathing during sleep, can raise blood pressure.
• Some pregnancies cause high blood pressure.
• Some medicines and supplements can raise blood pressure.

Risk factors

• Getting older.
• Having a parent or sibling with high blood pressure.
• Being of Black African or Black Caribbean background, which raises risk at a younger age.
• Eating a lot of salt.
• Drinking too much alcohol.
• Smoking or using tobacco.
• Having overweight or obesity.
• Being physically inactive.
• Long-term stress.
• Having diabetes.
• Having kidney disease.
• Having sleep apnoea.
• Taking some medicines, such as certain pain relievers, decongestants, or hormonal medicines.

When to see a doctor

See a doctor urgently if:

• If your blood pressure is much higher than usual on repeated checks, contact your clinician the same day.
• If you have a new severe headache, visual changes, or a nosebleed that will not stop, seek same-day advice.
• If you feel very dizzy, faint, or unwell, contact your local health service urgently.

Book a routine appointment if:

• If you have not had your blood pressure checked in the last year or two, book a routine check.
• If you have a family history of high blood pressure or heart disease.
• If you have diabetes, kidney disease, or sleep apnoea.
• If you are pregnant or planning pregnancy and have concerns about your blood pressure.
• If home readings are often above the target your clinician gave you.
• If you have side effects from blood pressure medicine.
• If you want help with lifestyle changes such as diet, exercise, quitting smoking, or reducing alcohol.

Diagnosis

A clinician measures your blood pressure with a cuff around your upper arm. They may take several readings at different visits. You may be asked to check your blood pressure at home or wear a monitor for 24 hours. This gives a clearer picture than a single clinic reading. Your clinician will also ask about your health, medicines, and family history.

Tests that may be done

• Blood pressure checks in the clinic, with the right cuff size and after resting.
• Home blood pressure monitoring with a validated machine.
• 24-hour ambulatory blood pressure monitoring, where you wear a cuff that checks your pressure during normal daily life.
• Blood tests to check kidney function, cholesterol, and blood sugar.
• A urine test to check kidney health.
• An ECG, a heart tracing, if needed.
• Specialist tests if your clinician suspects a specific cause.

What to expect at your appointment

Your clinician will usually ask you to sit quietly for a few minutes before checking your blood pressure. They may check both arms. You may be given a target range and asked to keep home readings. Diagnosis is not based on one number alone. Your clinician will look at the pattern over time and your overall health.

Treatment

Treatment aims to lower your blood pressure to a healthier range and reduce the chance of problems later. Many people start with lifestyle changes. Some people also need blood pressure-lowering medicine. The right plan depends on your readings, age, other health conditions, and preferences.

Self-care at home

• Check your blood pressure at home if your clinician advises it, and keep a record.
• Take any prescribed medicine regularly, and do not stop it without advice.
• Reduce salt in your diet.
• Eat more fruit, vegetables, beans, and whole grains.
• Be active in a way that suits you.
• Aim for a healthy weight if this is relevant for you.
• Limit alcohol and avoid binge drinking.
• Do not smoke, and get help to quit if you do.
• Get enough sleep and manage stress where you can.
• Go for regular reviews with your clinician.

Medical treatments

If lifestyle changes are not enough, or if your blood pressure is very high, your clinician may recommend blood pressure-lowering medicine. There are several types. Your clinician will choose one that suits your health and may adjust it over time. Some people need more than one medicine. You will usually have regular checks to see how well it is working and to watch for side effects. Never change or stop medicine without talking to your clinician or pharmacist.

When is surgery considered?

Surgery is not a usual treatment for high blood pressure. Rarely, if a specific cause is found, such as a narrowed kidney artery or a hormone-producing growth, a specialist may discuss procedures or surgery. Most people are treated with lifestyle changes and medicine.

Living with this condition

High blood pressure is usually a long-term condition, but it can fit into normal life. Regular home checks, taking medicine if prescribed, and keeping healthy habits can help you stay in control. Keep a simple record of your readings and bring it to appointments. Ask your clinician what target range is right for you.

Lifestyle tips

• Build healthy meals around vegetables, fruit, beans, and whole grains.
• Choose lower-salt foods and use herbs and spices for flavour.
• Move more in ways you enjoy, such as walking, cycling, swimming, or dancing.
• Limit alcohol and avoid heavy drinking.
• Stay smoke-free.
• Get support with sleep and stress.
• Keep up with routine health checks.

Diet and exercise

A heart-healthy eating pattern can help lower blood pressure. This usually means less salt, more vegetables and fruit, and fewer highly processed foods. Regular physical activity also helps. Aim for movement most days if you can, but start where you are. Your clinician or pharmacist can advise you on safe activity if you have other health conditions.

Mental health and emotional wellbeing

Living with a long-term condition can cause worry or stress. Stress can raise blood pressure briefly, and feeling anxious about readings is common. Talking to your clinician, family, or friends can help. If you feel overwhelmed or have thoughts of harming yourself, contact your local emergency number or a local crisis service right away.

Prevention

Many cases of high blood pressure can be prevented or delayed. Healthy habits help at any age, even if you already have high blood pressure. Keeping salt low, staying active, not smoking, limiting alcohol, and keeping a healthy weight all make a difference.

Vaccines

There is no vaccine for high blood pressure. Staying up to date with recommended vaccines is still part of general health care, especially if you have heart or kidney conditions. Ask your clinician or pharmacist what is recommended for you.

Screening programmes

Adults should have their blood pressure checked regularly. In the UK, NHS health checks are offered to adults in England, and pharmacists can often check blood pressure. Ask your local health service how often you should be checked, especially if you have risk factors.

Complications

If left untreated

• Heart attack.
• Stroke.
• Heart failure.
• Kidney damage or kidney disease.
• Vision loss from damage to the eyes.
• Narrowing or damage of blood vessels in the legs.
• Vascular dementia, a type of memory and thinking problem linked to blood vessel damage.

Long-term outlook

The outlook is good for most people who keep their blood pressure in a healthy range. Regular checks, healthy habits, and medicine when needed can greatly lower the risk of serious problems. High blood pressure is a long-term condition, but it can be managed well, and small steps add up.

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