Hypertension — Causes, Symptoms, Diagnosis and Treatment

Most patients I diagnose with hypertension are surprised. They feel fine, they have no complaints, and they only came in for a routine check or an unrelated problem. That is exactly why hypertension is often called the silent killer.

What is hypertension?

Hypertension, or high blood pressure, means the force of blood against your artery walls stays persistently too high. BP is written as two numbers: systolic (when the heart contracts) over diastolic (when it relaxes). In most guidelines, a reading of 140/90 mmHg or higher on repeated measurements is hypertension. The American guidelines use a stricter cut-off of 130/80 mmHg.

Causes and risk factors

About 90–95% of cases are primary (essential) hypertension, with no single identifiable cause. The rest are secondary, meaning another condition is driving the pressure up. Common secondary causes include:

• Chronic kidney disease and renal artery stenosis
• Primary aldosteronism and other endocrine disorders
• Obstructive sleep apnea
• Drugs such as NSAIDs, oral contraceptives, decongestants, and steroids

Risk factors for primary hypertension include older age, family history, obesity, a high-salt diet, excess alcohol, physical inactivity, smoking, diabetes, and chronic stress.

Symptoms and complications

Most people with high blood pressure have no symptoms at all. Some report headache, dizziness, or nosebleeds, but these usually appear only when BP is severely raised. A reading above 180/120 mmHg with chest pain, breathlessness, confusion, visual changes, or weakness is a hypertensive emergency and needs immediate hospital care.

Over the years, uncontrolled hypertension damages blood vessels and organs. The main complications are stroke, heart attack, heart failure, chronic kidney disease, retinal damage, aortic aneurysm, peripheral artery disease, and cognitive decline. Hypertension is one of the biggest contributors to overall cardiovascular risk.

How is hypertension diagnosed and monitored?

One high reading is not enough. I confirm the diagnosis with repeated measurements on separate visits, taken seated after five minutes of rest with a correctly sized cuff. Out-of-office readings are even more reliable because they avoid white-coat effect:

• Home BP monitoring: an average of 135/85 mmHg or higher suggests hypertension.
• 24-hour ambulatory monitoring: an average of 130/80 mmHg or higher over the full day is considered abnormal.

Once diagnosed, I usually order baseline tests: urine analysis, serum creatinine and electrolytes, blood glucose, lipid profile, and an ECG. These look for secondary causes and for damage that has already occurred.

Lifestyle and drug treatment

Lifestyle change is the foundation of treatment, whether or not tablets are needed. The most effective steps are:

• Cut sodium intake, ideally below 2,300 mg per day.
• Follow a DASH-style diet rich in vegetables, fruit, and low-fat dairy.
• Lose excess weight; even a few kilograms help.
• Exercise at least 150 minutes per week.
• Limit alcohol and stop smoking.

When lifestyle measures are not enough, or BP is clearly in the stage 2 range, I start antihypertensives. First-line options are ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers, and thiazide-type diuretics. Many patients need two drugs, often in a single-pill combination to improve adherence. The usual target is below 130/80 mmHg if tolerated. Treatment is usually lifelong, so regular follow-up and honest conversations about side effects matter.