Arterial hypertension

What hypertension is

Each heartbeat pushes blood into the arteries and presses on their walls. The higher pressure, when the heart contracts, is the systolic pressure; the lower one, when the heart relaxes, is the diastolic pressure. When these values stay high for a long time, the heart works harder, artery walls thicken and stiffen, and the organs they supply are slowly damaged. This is why hypertension is often called “the silent killer”: most people feel nothing for years.

Untreated, the consequences include stroke, heart attack, heart failure, atrial fibrillation, chronic kidney disease, retinal damage and vascular dementia. The good news is that controlling blood pressure sharply lowers each of these risks.

In most cases (about nine in ten) no single cause is found: hypertension is linked to age, heredity, weight, excess salt, inactivity, alcohol and stress. In a smaller share, especially in young people or when blood pressure is not controlled with several medicines, a secondary cause is sought: kidney disease, sleep apnea, hormonal disorders (such as hyperaldosteronism or thyroid disease), narrowing of a kidney artery, or certain drugs (anti-inflammatories, corticosteroids, contraceptive pills, decongestants).

When we speak of hypertension

According to European guidelines (ESC 2024), hypertension is diagnosed when blood pressure measured in the clinic is repeatedly 140/90 mmHg or higher. Pressure below 120/70 mmHg is considered non-elevated, while values in between are called elevated and are assessed according to overall risk. For home readings and for 24-hour monitoring, slightly lower thresholds are used. American guidelines use a different classification, so you may meet different definitions in different sources.

The diagnostic threshold is not the same as the treatment target, which is set individually. For most patients who tolerate treatment, the aim is a systolic value of 120 to 129 mmHg, without harmful drops to very low values and without signs of orthostatic problems such as dizziness on standing. In older and frail patients the goal is adapted to overall health.

A single reading is not enough. Blood pressure varies through the day and rises with emotion, coffee, pain or hurry. The diagnosis is confirmed with repeated readings, ideally also with:

• home measurements, taken with the correct technique (see below);
• 24-hour ambulatory monitoring (ABPM), which measures blood pressure every 15–30 minutes, day and night.

These methods help to tell white-coat hypertension (high only at the doctor’s) from masked hypertension (normal at the doctor’s but high in daily life). Both matter: the first may not need medicines, the second raises risk unnoticed. Ambulatory monitoring also shows whether blood pressure falls normally at night, which carries information about risk.

How to measure blood pressure correctly at home

Home measurement, done well, is more reliable than a single reading in the office. The steps are:

• Use a validated device with an upper-arm cuff (not at the wrist) of the right size. A cuff that is too small gives higher values than the truth.
• For 30 minutes beforehand: no smoking, no coffee, no exercise. Use the toilet first.
• Sit for 5 minutes in quiet, with your back supported, feet flat on the floor (not crossed) and your arm resting at heart level.
• Do not talk during the measurement.
• Take two readings one minute apart, morning and evening, for 7 days before the visit. Write down all the values and bring them to your doctor.

The page Measuring blood pressure at home gives more detail.

Medical assessment

Once the diagnosis is confirmed, the doctor does not look only at the numbers but assesses your overall cardiovascular risk and looks for signs of organ damage. This usually includes:

• blood and urine tests: creatinine and the kidney filtration rate (eGFR), albumin in the urine, potassium, blood glucose, a lipid profile, and sometimes uric acid and TSH;
• an ECG, which may show an irregular rhythm or signs of heart thickening;
• echocardiography, when indicated, for example when left ventricular hypertrophy or another complication is suspected;
• in some cases, an eye-ground examination and assessment for sleep apnea or secondary causes.

This determines how quickly treatment should begin and how low the target should be. A person with high blood pressure but no organ damage and no other risks is treated differently from someone with diabetes or kidney disease.

Treatment

Lifestyle is the foundation and helps everyone, even when medicines are needed:

• less salt (under 5 g a day): watch bread, white cheese, processed meat, pickles and ready-made foods, which hide most of the salt;
• a balanced diet with vegetables, fruit, legumes and whole grains, which also supplies potassium that helps lower blood pressure;
• regular physical activity, for example 30 minutes of brisk walking most days of the week;
• weight loss when overweight: every kilogram lost lowers blood pressure;
• limiting alcohol and stopping smoking, which lowers overall risk even though it does not itself lower blood pressure.

Medicines. Most patients need medicines too, because lifestyle change alone rarely reaches the target. The main families are ACE inhibitors and ARBs, calcium channel blockers and diuretics; the choice depends on age, accompanying conditions (diabetes, kidneys, heart), tolerance and side effects. Combining two drugs in a single pill is now often preferred, because it is more effective and easier to take. Side effects are well known (for example a dry cough with ACE inhibitors, ankle swelling with some calcium channel blockers), and the doctor can switch the drug when they appear.

Do not stop treatment because one reading came out normal: it is normal precisely because of the medicines. Do not take extra doses without guidance and do not change medicines on your own. If blood pressure stays high on three medicines at good doses, this is called resistant hypertension and calls for more specialized assessment. Follow-up visits are initially more frequent, until the target is reached, then usually every 6–12 months.

Very high blood pressure without symptoms

If you measure a very high value but feel well, rest for a few minutes, sit properly and repeat the measurement. If it stays very high, seek medical advice the same day. Do not try to bring it down quickly with extra medicines without an assessment: a sudden drop can be harmful, because the brain and heart are used to the high pressure. If there are also symptoms listed in the emergency box, call 127.

This information is educational and does not replace a medical visit.