Hypertension (High Blood Pressure)
What is hypertension?
Hypertension means that pressure in the arteries remains persistently elevated. Blood pressure is expressed as systolic pressure, measured during heart contraction, and diastolic pressure, measured during relaxation.
Under the 2024 European Society of Cardiology guideline, office measurements of 140/90 mmHg or higher indicate hypertension when confirmed appropriately. An average home blood pressure of 135/85 mmHg or higher is also significant. Diagnosis should not be based on symptoms or a single routine measurement alone.
Does high blood pressure cause symptoms?
Many people have no symptoms. Some report headache, dizziness, palpitations, blurred vision, tinnitus, breathlessness or chest discomfort. These complaints are not specific to hypertension. Regular measurement matters even when a person feels well.
What causes hypertension?
Primary hypertension
Most cases reflect a combination of genetic susceptibility, ageing, excess salt intake, excess weight and lifestyle factors rather than one single cause.
Secondary hypertension
Possible causes include kidney disease, renal artery narrowing, primary aldosteronism, sleep apnoea, thyroid disease, pheochromocytoma, Cushing syndrome and certain medicines or stimulants. Secondary causes may be investigated particularly in young-onset, suddenly worsening or resistant hypertension.
What are the risk factors?
Family history, older age, obesity, excess dietary salt, inactivity, excessive alcohol intake, diabetes, chronic kidney disease and sleep apnoea are important. Smoking adds substantial cardiovascular risk.
How is it diagnosed?
Correct office measurement
Use an appropriate cuff, sit correctly and rest for at least five minutes. Repeated measurements on different occasions are usually needed.
Home blood pressure monitoring
Morning and evening readings over several days help establish the average pressure and its usual pattern. Follow the measurement schedule recommended by your clinician.
24-hour ambulatory monitoring
A blood pressure monitor records day and night values. It can help identify white-coat hypertension, masked hypertension and night-time hypertension, and assess treatment effectiveness.
Other tests
Blood and urine tests assess kidney function, electrolytes, glucose, cholesterol and urinary albumin when appropriate. ECG and, when indicated, echocardiography evaluate the effects on the heart.
How is it treated?
Treatment aims to reduce the risk of stroke, myocardial infarction, heart failure and kidney disease, as well as lower the measured pressure.
Lifestyle measures
- Reduce salt intake.
- Lose excess weight.
- Exercise regularly at an appropriate level.
- Choose a diet rich in vegetables, fruit and whole grains.
- Stop smoking and limit alcohol.
- Maintain regular sleep and treat sleep apnoea when present.
Medication
Common groups include ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, thiazide or thiazide-like diuretics, and beta blockers for appropriate indications. Many patients require more than one medicine. Selection depends on kidney function, other conditions, age and tolerance.
What should the treatment target be?
The 2024 ESC guideline generally targets 120–129/70–79 mmHg in most treated adults when well tolerated. Targets are individualised for frailty, advanced age, orthostatic hypotension or treatment-related symptoms. Do not change medication without advice.
White-coat, masked and resistant hypertension
White-coat hypertension means elevated office readings but normal readings outside the clinic. Masked hypertension is the reverse. Home or ambulatory monitoring helps distinguish them.
Persistently uncontrolled pressure despite an appropriate three-drug regimen including a diuretic warrants assessment for resistant hypertension. Measurement error, adherence, white-coat effect and secondary causes must be considered first.
Can hypertension damage organs?
Longstanding uncontrolled hypertension can affect the heart, brain, kidneys, eyes and arteries. Successful control reduces these risks. Normal readings while taking medication do not mean the underlying condition has disappeared.
What if the reading is very high?
For a reading of 180/120 mmHg or higher, rest briefly and repeat correctly. Chest pain, breathlessness, loss of vision, weakness, speech difficulty or confusion with severe hypertension requires emergency care: call 112. Repeated very high readings without symptoms still need prompt medical assessment.
Assoc. Prof. Sezen Bağlan Uzunget, MD — Cardiologist
This information is educational. Diagnosis, medication and targets must be individualised.
Türkçe: Hipertansiyon