Overview
Hypertension (high blood pressure) is when the pressure in your blood vessels is too high (140/90 mmHg or higher). It is common but can be serious if left untreated.
People with high blood pressure may not feel any symptoms. The only way to find out is to have your blood pressure checked.
Things that increase the risk of high blood pressure include:
- older age
- genetically
- overweight or obesity
- are not physically active
- high salt diet
- drinking too much alcohol
Lifestyle changes, such as eating healthier, quitting smoking, and being more active, can help lower blood pressure. Some people may still need to take medications.
Blood pressure is written as two numbers. The first (systolic) number represents the pressure in the blood vessels when the heart contracts or beats. The second (diastolic) number represents the pressure in the blood vessels when the heart rests between beats.
It is diagnosed when systolic blood pressure is ≥140 mmHg on both days, measured on two different days, and/or diastolic blood pressure is ≥90 mmHg on both days.
Risk factors
Modifiable risk factors include unhealthy diet (excessive salt consumption, a diet high in saturated fat and trans fat, low intake of fruits and vegetables), physical inactivity, tobacco and alcohol use, and being overweight or obese.
Nonmodifiable risk factors include a family history of hypertension, age over 65 years, and comorbidities such as diabetes or kidney disease.
Symptoms
Most people with hypertension experience no symptoms. Very high blood pressure can cause headaches, blurred vision, chest pain, and other symptoms.
Checking your blood pressure is the best way to know if you have high blood pressure. If hypertension is not treated, it can cause other health problems such as kidney disease, heart disease and stroke.
People with very high blood pressure (usually 180/120 or higher) may experience symptoms including:
- severe headache
- chestpain
- dizziness
- breathing problems
- nausea
- vomit
- blurred vision or other vision changes
- angst
- confusion
- buzzing in the ears
- bloody nose
- abnormal heart rhythm
If you experience any of these symptoms and high blood pressure, seek help immediately.
The only way to detect hypertension is to have your blood pressure measured by a healthcare professional. Having your blood pressure measured is quick and painless. Although individuals can measure their own blood pressure using automated devices, evaluation by a healthcare professional is important to assess the risks and associated conditions.
Therapy
Lifestyle changes can help lower high blood pressure. These include:
- eat a healthy, low-salt diet
- lose weight
- be physically active
- quit tobacco.
If you have high blood pressure, your doctor may recommend one or more medications. Your recommended blood pressure goal may depend on what other health problems you have.
The blood pressure goal is lower than 130/80 if you:
- cardiovascular disease (heart disease or stroke)
- diabetes (high blood sugar)
- chronic kidney disease
- high risk of cardiovascular disease.
For most people, the goal is to have a blood pressure below 140/90.
There are several common blood pressure medications:
- ACE inhibitors, including enalapril and lisinopril, relax blood vessels and prevent kidney damage.
- Angiotensin-2 receptor blockers (ARBs), including losartan and telmisartan, relax blood vessels and prevent kidney damage.
- Calcium channel blockers, including amlodipine and felodipine, relax blood vessels.
- Diuretics, including hydrochlorothiazide and chlorthalidone, remove extra water from the body and lower blood pressure.
Prevention
Lifestyle changes can help lower high blood pressure and can help anyone with high blood pressure. Many who make these changes still need to take medications.
These lifestyle changes can help prevent and lower high blood pressure.
Doing:
- Eat more fruits and vegetables.
- Lace less.
- Be more physically active, such as walking, running, swimming, dancing, or strength-building activities such as weight lifting.
- Get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous-intensity aerobic activity.
- Do strength training exercises 2 or more days a week.
- Lose weight if you are overweight or obese.
- Take medications as prescribed by your healthcare provider.
- Keep appointments with your healthcare provider.
Do not:
- eating too much salt (try to stay below 2 grams per day)
- eating foods high in saturated fat or trans fat
- smoking or using tobacco
- drinking too much alcohol (max. 1 drink per day for women, 2 for men)
- missing or sharing medication.
Reducing high blood pressure prevents heart attacks, strokes and kidney damage, as well as other health problems.
Reduce the risk of hypertension by:
- reduce and manage stress
- regular monitoring of blood pressure
- treatment of high blood pressure
- treatment of other medical conditions.
Complications of uncontrolled hypertension
Among other complications, high blood pressure can cause serious damage to the heart. Too much pressure can harden the arteries, reducing blood and oxygen flow to the heart. This increased pressure and decreased blood flow can cause:
- chest pain, also called angina pectoris;
- heart attack, which occurs when the blood supply to the heart is blocked and the heart muscle cells die from lack of oxygen. The longer blood flow is blocked, the greater the damage to the heart;
- heart failure, which occurs when the heart cannot pump enough blood and oxygen to other vital body organs; And
- irregular heart rhythm, which can lead to sudden death.
Hypertension can also rupture or block the arteries that supply blood and oxygen to the brain, causing a stroke.
In addition, hypertension can cause kidney damage, leading to kidney failure.
Hypertension in low- and middle-income countries
The prevalence of hypertension varies between regions and income groups per country. The WHO African region has the highest prevalence of hypertension (27%), while the WHO region of the Americas has the lowest prevalence of hypertension (18%).
The number of adults with hypertension has increased from 594 million in 1975 to 1.13 billion in 2015, with the increase mainly in low- and middle-income countries. This increase is primarily due to an increase in risk factors for hypertension in these populations.
The WHO's response
The World Health Organization (WHO) supports countries to reduce hypertension as a public health problem.
In 2021, the WHO published anew guideline for the pharmacological treatment of hypertensionin adults. The publication provides evidence-based recommendations for initiating treatment for high blood pressure and recommended intervals for follow-up. The document also contains the target blood pressure to be achieved for monitoring and information on who in the healthcare system can initiate treatment.
To support governments in strengthening cardiovascular disease prevention and control, WHO and the US Centers for Disease Control and Prevention (US CDC) launched the Global Hearts Initiative in September 2016, which includes the HEARTS technical package. The six modules of the HEARTS technical package (healthy lifestyle advice, evidence-based treatment protocols, access to essential medicines and technology, risk-based management, team-based care and monitoring systems) provide a strategic approach to improving cardiovascular health in countries all over the world.
In September 2017, WHO launched a partnership with Resolve to Save Lives, an initiative of Vital Strategies, to support national governments in implementing the Global Hearts Initiative. Other partners contributing to the Global Hearts Initiative include the CDC Foundation, the Global Health Advocacy Incubator, the Johns Hopkins Bloomberg School of Public Health, the Pan American Health Organization (PAHO) and the US. CDC. Since the program was implemented in 2017 in 31 low- and middle-income countries, 7.5 million people have been placed on protocol-based hypertension treatment through person-centered care models. These programs demonstrate the feasibility and effectiveness of standardized hypertension control programs.
