Hypertension (High Blood Pressure)

Hypertension, commonly known as high blood pressure, is a chronic medical condition characterized by elevated pressure in the arteries. Blood pressure is recorded as two numbers: systolic pressure (when the heart beats) over diastolic pressure (when the heart rests). Normal blood pressure is below 120/80 mm Hg. Hypertension is defined as blood pressure consistently at or above 130/80 mm Hg. It is often called the "silent killer" because it typically causes no symptoms until significant damage to the heart, brain, kidneys, or eyes has occurred. Hypertension affects approximately 1.13 billion people worldwide and is a major risk factor for heart disease, stroke, kidney failure, and other serious health problems. With proper management through lifestyle modifications and medication when necessary, blood pressure can be controlled, significantly reducing the risk of complications.

Causes

Age - Risk increases with age due to natural stiffening of arteries
Family history - Genetic factors play a significant role in hypertension risk
Obesity - Excess weight increases blood volume and resistance in blood vessels
Physical inactivity - Sedentary lifestyle contributes to higher heart rate and blood pressure
High sodium diet - Excessive salt intake causes fluid retention and increased blood pressure
Low potassium intake - Inadequate potassium can disrupt sodium balance in the body
Excessive alcohol consumption - Regular heavy drinking raises blood pressure
Tobacco use - Smoking or chewing tobacco immediately raises blood pressure
Stress - Chronic stress elevates hormones that increase blood pressure
Certain chronic conditions - Kidney disease, diabetes, sleep apnea, and thyroid disorders
Some medications - NSAIDs, decongestants, certain antidepressants, and oral contraceptives
Illicit drugs - Stimulants like cocaine and amphetamines sharply increase blood pressure
Pregnancy - Can cause gestational hypertension in some women
Race - More common and often more severe in people of African heritage
Gender - More common in men until age 65, then more common in women

Signs and Symptoms

Most people with hypertension have no symptoms, even at dangerously high levels
Headaches - Particularly occipital (back of head) headaches occurring in the morning
Shortness of breath - During physical activity or while at rest in severe cases
Nosebleeds - Spontaneous or difficult to control
Visual changes - Blurred vision or seeing spots
Dizziness or lightheadedness - When standing up or changing positions
Chest pain - May indicate organ damage from prolonged hypertension
Irregular heartbeat - Palpitations or feeling of racing or pounding heart
Blood in urine - May indicate kidney damage from hypertension
Facial flushing - Redness in the face, not caused by temperature or exertion
Fatigue - Persistent tiredness unrelieved by rest
Confusion or cognitive changes - In severe or emergency situations
Severe anxiety - Feeling of impending doom in hypertensive crisis
These symptoms typically appear only in severe, uncontrolled hypertension or hypertensive crisis
The most reliable way to detect hypertension is through regular blood pressure measurements

Diagnosis

Office Blood Pressure Measurement

The initial screening method, using a blood pressure cuff (sphygmomanometer) in a healthcare setting. Multiple readings are taken, ideally on different days, before diagnosing hypertension. Proper technique is essential, including appropriate cuff size, patient position (seated with back supported, feet flat on floor, arm supported at heart level), and a 5-minute rest period before measurement. At least two readings should be taken, 1-2 minutes apart, and averaged. A diagnosis of hypertension is typically made when blood pressure is consistently 130/80 mm Hg or higher.

Home Blood Pressure Monitoring

Patients use validated, automated devices to measure blood pressure at home over time. This provides multiple readings in the patient's natural environment, helping to identify white coat hypertension (elevated only in medical settings) or masked hypertension (normal in office but elevated elsewhere). Patients are typically instructed to take readings twice daily, morning and evening, for at least 3-7 days. Records of these measurements help guide treatment decisions and can improve patient engagement in blood pressure management.

24-Hour Ambulatory Blood Pressure Monitoring

A portable device worn for 24 hours that automatically measures blood pressure at regular intervals (typically every 15-30 minutes during the day and every 30-60 minutes at night). This provides a comprehensive picture of blood pressure patterns throughout day and night, including during sleep, physical activity, and emotional stress. It is particularly useful for confirming borderline hypertension, evaluating treatment resistance, checking for nocturnal hypertension, or assessing blood pressure variability. This is considered the gold standard for diagnosing hypertension.

Laboratory Tests

Blood and urine tests to assess overall health and identify possible causes or complications of hypertension. Basic workup typically includes complete blood count, fasting blood glucose, lipid profile, serum creatinine, estimated glomerular filtration rate (eGFR), serum sodium, potassium, calcium, thyroid-stimulating hormone, urinalysis, and electrocardiogram. These tests help identify kidney dysfunction, electrolyte imbalances, diabetes, high cholesterol, or thyroid disorders that may contribute to or result from hypertension.

Specialized Tests for Secondary Hypertension

When an underlying condition is suspected as the cause of hypertension, additional testing may be performed. This might include renal ultrasound or CT angiography to detect kidney abnormalities, echocardiogram to assess heart structure and function, sleep study to diagnose sleep apnea, plasma or urinary metanephrines to check for pheochromocytoma, plasma aldosterone and renin activity to diagnose primary aldosteronism, or cortisol studies to identify Cushing's syndrome. These tests are not routine but are ordered based on clinical suspicion.

Cardiovascular Risk Assessment

Evaluation of additional factors that, combined with hypertension, increase risk of heart attack, stroke, or other cardiovascular events. This includes assessment of smoking status, diabetes, dyslipidemia (abnormal cholesterol levels), obesity, physical inactivity, family history of premature cardiovascular disease, and presence of target organ damage. Tools like the Framingham Risk Score or ASCVD Risk Calculator may be used to estimate 10-year risk of cardiovascular events, which influences treatment decisions.

Treatment Options

Lifestyle Modifications

Non-pharmacological approaches form the foundation of hypertension management and are recommended for all patients. The DASH (Dietary Approaches to Stop Hypertension) eating plan emphasizes fruits, vegetables, whole grains, lean proteins, and low-fat dairy while limiting sodium, sweets, and red meats. Sodium restriction to less than 2,300 mg per day (ideally 1,500 mg) can lower blood pressure by 5-6 mm Hg. Regular physical activity (150 minutes of moderate-intensity aerobic activity weekly) can reduce systolic blood pressure by 4-8 mm Hg. Weight loss in overweight or obese individuals, limiting alcohol consumption, quitting smoking, and stress management techniques are also effective strategies. These modifications can prevent or delay the need for medication in some cases.

Diuretic Medications

Often used as first-line therapy, diuretics help the kidneys remove excess sodium and water from the body, reducing blood volume and pressure. Thiazide diuretics (like hydrochlorothiazide or chlorthalidone) are most commonly prescribed and work in the distal tubules of the kidney. Loop diuretics (like furosemide) are more potent and may be used in advanced kidney disease or heart failure. Potassium-sparing diuretics (like spironolactone) help maintain potassium levels while lowering blood pressure. Side effects may include increased urination, electrolyte imbalances, and in some cases, elevated blood sugar or uric acid levels.

ACE Inhibitors and ARBs

These medications work on the renin-angiotensin-aldosterone system, which regulates blood pressure. Angiotensin-converting enzyme (ACE) inhibitors like lisinopril or enalapril prevent the formation of angiotensin II, a potent vasoconstrictor. Angiotensin II receptor blockers (ARBs) like losartan or valsartan block the action of angiotensin II at its receptor. Both classes dilate blood vessels, reduce blood volume, and protect organs like the heart and kidneys. They're particularly beneficial for patients with diabetes, heart failure, or kidney disease. Common side effects of ACE inhibitors include dry cough and, rarely, angioedema; ARBs typically have fewer side effects.

Calcium Channel Blockers

These medications prevent calcium from entering the cells of the heart and blood vessel walls, causing relaxation of blood vessels and reducing the heart's workload. Dihydropyridines (like amlodipine or nifedipine) primarily affect blood vessels and are often used for hypertension. Non-dihydropyridines (like diltiazem or verapamil) affect both heart rate and blood vessels and may be used when rate control is also needed. Calcium channel blockers are particularly effective in older adults and people of African heritage. Side effects may include ankle swelling, headache, constipation, dizziness, or flushing. These medications are often well-tolerated and can be used alone or in combination with other antihypertensives.

Beta Blockers

These medications reduce the heart's workload by blocking the effects of adrenaline, resulting in slower heart rate and less forceful contractions. Examples include metoprolol, carvedilol, and atenolol. While no longer considered first-line treatment for uncomplicated hypertension, beta blockers are valuable in specific situations, particularly for patients with coronary artery disease, heart failure, previous heart attack, or certain arrhythmias. They're also useful in younger patients with hyperkinetic circulation or anxiety-related hypertension. Side effects may include fatigue, cold extremities, sexual dysfunction, or worsening of asthma symptoms. Some newer beta blockers have additional vasodilatory properties that improve their blood pressure-lowering effect.

Combination Therapy

Many patients require multiple medications from different classes to achieve blood pressure goals. Combination therapy is often more effective than maximizing the dose of a single drug and may reduce side effects. Fixed-dose combinations (two or more medications in a single pill) improve convenience and adherence. Common combinations include ACE inhibitor or ARB plus calcium channel blocker, ACE inhibitor or ARB plus diuretic, or calcium channel blocker plus diuretic. Three-drug combinations may be necessary for resistant hypertension. The choice of combinations depends on individual patient factors including age, ethnicity, comorbidities, and previous response to medications. Regular monitoring of blood pressure and adjustment of therapy is essential to achieve and maintain target blood pressure.

Home Remedies

Dietary Approaches

Adopt the DASH (Dietary Approaches to Stop Hypertension) eating plan, which emphasizes fruits, vegetables, whole grains, and low-fat dairy products. Reduce sodium intake to less than 2,300 mg per day (about one teaspoon of salt); ideally aim for 1,500 mg if you have hypertension. Increase potassium intake through foods like bananas, oranges, potatoes, spinach, and tomatoes, unless you have kidney problems. Limit processed foods, which typically contain high amounts of sodium and unhealthy fats. Read food labels carefully to track sodium content. Consider keeping a food diary to identify areas for improvement in your diet.

Physical Activity

Aim for at least 150 minutes of moderate-intensity aerobic activity per week, such as brisk walking, swimming, or cycling. Add muscle-strengthening activities on two or more days per week. Break up exercise into manageable sessions of 10-15 minutes if necessary. Incorporate more movement into daily routines by taking stairs instead of elevators, parking farther from entrances, or taking short walking breaks during the workday. Consistency is more important than intensity—regular, moderate exercise is better than occasional vigorous workouts. Check with your healthcare provider before beginning a new exercise program, especially if you have other health conditions.

Stress Management

Practice stress-reduction techniques such as deep breathing exercises, meditation, yoga, or tai chi for at least 10-15 minutes daily. Progressive muscle relaxation (tensing and then releasing each muscle group) can help reduce physical tension. Identify and address sources of stress in your life when possible. Maintain social connections and seek support from friends, family, or support groups. Consider mindfulness-based stress reduction programs, which have been shown to help lower blood pressure. Adequate sleep (7-8 hours nightly) also helps manage stress and blood pressure; establish a regular sleep schedule and create a relaxing bedtime routine.

Home Blood Pressure Monitoring

Invest in a validated, automated upper arm blood pressure monitor for home use (wrist monitors are generally less accurate). Measure at the same time each day, typically in the morning before taking medications and in the evening. Ensure proper positioning: sit with back supported, feet flat on floor, arm supported at heart level, legs uncrossed. Rest for 5 minutes before measuring. Take 2-3 readings, 1 minute apart, and record the average. Keep a log of readings to share with your healthcare provider. Learn what your target blood pressure should be and contact your provider if readings are consistently above this target or if you notice significant fluctuations.

Medication Adherence

Take blood pressure medications exactly as prescribed, even if you feel well. Use pill organizers, smartphone reminders, or daily routines to help remember medications. Never stop taking medications without consulting your healthcare provider, as sudden discontinuation can cause dangerous blood pressure spikes. Keep a list of all medications, including dosages and schedules, and bring it to all medical appointments. If you experience side effects, discuss them with your provider—alternative medications may be available. Ensure you have enough medication on hand, especially when traveling. If cost is a barrier, ask about generic alternatives or patient assistance programs.

Preventive Care

Maintain healthy weight or lose weight if overweight; even a 5-10% weight reduction can significantly lower blood pressure
Limit alcohol consumption to no more than one drink per day for women and two drinks per day for men
Quit smoking and avoid secondhand smoke; nicotine raises blood pressure and damages blood vessels
Reduce caffeine intake, particularly if you're sensitive to its effects or have uncontrolled hypertension
Monitor blood pressure regularly at home with a validated device and keep records to share with healthcare providers
Schedule regular check-ups with your healthcare provider to monitor blood pressure and adjust treatment as needed
Take medications exactly as prescribed, even when feeling well, and never stop without medical guidance
Manage other health conditions that increase cardiovascular risk, such as diabetes and high cholesterol
Know your family history of hypertension and related conditions, as genetic factors influence risk
Consider the DASH eating plan and Mediterranean diet, both proven to help lower blood pressure
Reduce sodium intake to less than 2,300 mg daily (about one teaspoon of salt), ideally 1,500 mg if you have hypertension
Increase potassium intake through fruits and vegetables, unless contraindicated by kidney disease
Stay physically active with at least 150 minutes of moderate-intensity exercise weekly
Practice stress management techniques such as meditation, deep breathing, or yoga
Ensure adequate sleep (7-8 hours nightly) as sleep deprivation can raise blood pressure

Surgical Options

Renal Denervation

A minimally invasive procedure that uses radiofrequency ablation or ultrasound energy to disrupt the nerve signals between the kidneys and the brain that contribute to high blood pressure. A thin catheter is inserted through the femoral artery in the groin and advanced to the renal arteries, where energy is delivered to the nerve tissue surrounding the arteries. The procedure is performed under local anesthesia with mild sedation and typically takes about an hour. Initially showing mixed results in clinical trials, newer-generation devices and improved patient selection have demonstrated more consistent blood pressure reduction. Currently considered primarily for patients with resistant hypertension who have not achieved target blood pressure despite multiple medications.

Learn More About This Procedure

Baroreflex Activation Therapy

An implantable device-based therapy that stimulates the carotid baroreceptors, which are pressure sensors in the carotid arteries that regulate blood pressure. A small pulse generator (similar to a pacemaker) is implanted under the skin near the collarbone, with lead wires connected to small electrodes placed near the carotid sinus in the neck. The system delivers electrical impulses that activate the baroreflex, signaling the brain to reduce sympathetic output and increase parasympathetic activity, resulting in lower blood pressure. The procedure requires general anesthesia and is more invasive than renal denervation. This therapy is reserved for patients with severe resistant hypertension who have failed multiple medication regimens.

Learn More About This Procedure

Central Iliac Arteriovenous Anastomosis

A procedure that creates a small connection (anastomosis) between the external iliac artery and vein using a specialized coupler device. This reduces peripheral vascular resistance and creates a low-pressure bypass circuit, effectively lowering blood pressure. The procedure is performed under local anesthesia with conscious sedation. A catheter is inserted through the femoral vein, and the coupler device is deployed to create a precise 4 mm connection between the artery and vein. While showing promising results in some studies, this approach is still considered investigational in many countries and is generally reserved for carefully selected patients with resistant hypertension who have not responded to multiple medications.

Learn More About This Procedure

Surgery for Secondary Hypertension

Surgical procedures may be curative for specific causes of secondary hypertension. Adrenalectomy (removal of one or both adrenal glands) may be performed for conditions like pheochromocytoma, Cushing's syndrome, or primary aldosteronism when confined to one adrenal gland. Renal artery angioplasty and stenting may be performed for renal artery stenosis, though medical management is often preferred unless severe stenosis is present. Removal of parathyroid adenomas can resolve hypertension related to hyperparathyroidism. Surgical correction of coarctation of the aorta is performed for this congenital cause of hypertension. These procedures address the underlying cause rather than the hypertension directly.

Learn More About This Procedure

Important Considerations Regarding Surgical Options

Device-based and surgical interventions for hypertension are generally considered only after comprehensive evaluation confirms true resistant hypertension, meaning blood pressure remains above target despite optimal doses of at least three medications including a diuretic (or documented intolerance to medications). Secondary causes of hypertension should be ruled out before considering these procedures. Most of these interventions are still considered investigational or second/third-line approaches, with varying levels of evidence supporting their efficacy and safety. Long-term outcomes data are still being collected for many of these procedures. Medication therapy remains the mainstay of treatment for the vast majority of patients with hypertension.

Learn More About This Procedure

Schedule a Consultation

If you're experiencing symptoms of hypertension (high blood pressure), our expert team is here to help you find the right treatment approach for your specific needs.

Book Appointment Call (040) 4402 0000