High blood pressure (hypertension)
Also called: Hypertension, HTN
Persistently raised pressure in the arteries (clinic readings of 140/90 mmHg or more). It usually causes no symptoms but silently damages the heart, brain, kidneys and eyes — the leading preventable cause of stroke.
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Over 1 billion people worldwide; roughly one in three adults.
What happens in the body
Stiffer arteries, increased salt and water retention and overactivity of the renin–angiotensin and sympathetic systems raise vascular resistance. The heart muscle thickens to pump against it, and small vessels in organs are injured.
Causes
- Primary (essential) hypertension in about 90% — genetics plus lifestyle
- Secondary causes: kidney disease, renal artery stenosis, primary aldosteronism, sleep apnoea, thyroid disease, Cushing's syndrome, phaeochromocytoma, medicines (NSAIDs, decongestants, oral contraceptives)
Risk factors
- Age
- Family history
- High salt intake
- Overweight
- Physical inactivity
- Excess alcohol
- Smoking
- African or Caribbean ancestry
- Diabetes and kidney disease
Symptoms
- Usually none
- Very high levels may cause headache, visual disturbance, chest pain or confusion (hypertensive emergency)
Diagnosis — tests and examinations
- Repeated clinic readings
- Home or 24-hour ambulatory monitoring to confirm
- Tests for organ damage: urine albumin, kidney function, ECG, eye examination
- Screening for secondary causes in the young or resistant cases
Treatment
Medicines and medical treatment
- First-line: ACE inhibitor or ARB, calcium-channel blocker (amlodipine), or thiazide-like diuretic — often combined
- Add spironolactone for resistant hypertension
- Target usually below 130/80 mmHg if tolerated
Operations and procedures
- Renal denervation in selected resistant cases
- Surgery or angioplasty for specific secondary causes
Self-care, home remedies and lifestyle
- Cut salt to under 5 g a day
- DASH-style diet rich in fruit, vegetables and low-fat dairy
- Lose excess weight — each kilogram lowers pressure by about 1 mmHg
- Regular aerobic exercise
- Limit alcohol; stop smoking
- Check blood pressure at home
Possible complications
- Stroke
- Heart attack and heart failure
- Chronic kidney disease
- Retinopathy and vision loss
- Aortic aneurysm and dissection
- Dementia
Prevention
- Low-salt diet, healthy weight, regular exercise, moderate alcohol
- Regular blood pressure checks from adulthood
Outlook
Excellent when controlled; treatment cuts stroke risk by about a third to a half.
When to see a doctor
Have your blood pressure checked at least every 5 years (yearly if raised). Seek emergency care for a very high reading with chest pain, severe headache, weakness or confusion.
Sources and further reading
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