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High Blood Pressure (Hypertension): Types, Causes, Symptoms, and More

Hypertension, commonly known as high blood pressure, is a medical condition characterized by elevated pressure in the arteries (1). It is estimated that around 1.28 billion adults between the ages of 30 and 79 have hypertension worldwide, with a majority residing in low-middle-income communities (2). Shockingly, despite its widespread presence roughly 42% of adults receive proper diagnosis and treatment for this condition (3).

What is High Blood Pressure?

High blood pressure, also known as hypertension, is a condition that affects the arteries in the body. When someone has high blood pressure, the force exerted by the blood against the walls of the arteries is consistently elevated (4). This places extra strain on the heart, which must work harder to pump blood effectively.

Blood pressure is typically assessed through two numbers:

  • Systolic blood pressure: This number indicates the pressure within the arteries when the heart contracts and pumps blood. (5)
  • Diastolic blood pressure: This number reflects the pressure within the arteries when the heart is resting between beats. (6)

Blood pressure readings are expressed in millimeters of mercury (mm Hg). Generally, hypertension is diagnosed when the blood pressure reading is 130/80 mm Hg or higher. (7)

Ranges of High Blood Pressure

Blood pressure levels are categorized into four main groups by the American College of Cardiology and the American Heart Association:

  • Normal Blood Pressure: Blood pressure is considered normal when it is lower than 120/80 mm Hg. (8)
  • Elevated Blood Pressure: Elevated blood pressure is identified when the top number (systolic pressure) falls within the range of 120-129 mm Hg and the bottom number (diastolic pressure) remains below 80 mm Hg. (9)
  • Stage 1 Hypertension: Stage 1 hypertension is diagnosed when the top number ranges from 130-139 mm Hg or when the bottom number falls between 80-89 mm Hg. (10)
  • Stage 2 Hypertension: Stage 2 hypertension occurs when the top number is 140 mm Hg or more, or when the bottom number is 90 mm Hg or more. (11)
  • Hypertensive Crisis: A hypertensive crisis happens when the blood pressure reaches critical levels, with the systolic number exceeding 180 mm Hg or the diastolic number surpassing 120 mm Hg. (12)

Untreated high blood pressure significantly increases the risk of heart attack, stroke, and other severe health complications (13). Regular blood pressure checks, starting at age 18 and occurring at least every two years, are important. Some individuals may require more frequent monitoring.

Adopting healthy lifestyle habits, including abstaining from smoking, regular exercise, and a balanced diet, may help both prevent and manage high blood pressure. In some cases, medication may be necessary for effective treatment.

Symptoms of High Blood Pressure

High blood pressure is often referred to as a silent condition because it frequently presents without noticeable symptoms. In fact, many individuals may go years or even decades without experiencing any discernible signs, making it crucial to monitor blood pressure regularly. (14) Even when symptoms do manifest, they may be subtle and easily mistaken for other health issues.

Individuals with hypertensive crisis, typically registering at 180/120 or higher, may experience the following symptoms:

  • Chest pain (15)
  • Severe headaches (16)
  • Difficulty breathing (17)
  • Nausea and vomiting (18)
  • Dizziness (19)
  • Anxiety and confusion (20)
  • Blurred vision or other visual changes (21)
  • Abnormal heart rhythm (22)
  • Buzzing in the ears (23)

If you experience such symptoms, it’s crucial to seek immediate medical attention by calling emergency services.

The most effective way to detect hypertension is through regular blood pressure readings. Most medical practices routinely measure blood pressure during appointments. However, if you only have an annual check-up, it’s essential to discuss your risk factors with your doctor.

Causes of High Blood Pressure

High blood pressure, or hypertension, results from various factors influencing how efficiently your heart pumps blood and how smoothly it flows through your arteries. These factors include dehydration and arterial constriction, among others, all contributing to the elevation of blood pressure levels. (24)

Primary Hypertension

Primary hypertension, also known as essential hypertension, occurs when the root cause of elevated blood pressure isn’t readily identifiable. Approximately 95% of hypertension cases in the United States fall under this category, often developing gradually over several years. (25)

This type of hypertension is closely associated with certain dietary and lifestyle choices. Excessive salt intake, for instance, may significantly raise blood pressure, especially for individuals sensitive to sodium (26). Additionally, risk factors such as sedentary lifestyles, excessive alcohol consumption, familial predisposition, advancing age (particularly beyond 65 years), obesity, diabetes, chronic stress, and inadequate intake of essential minerals like potassium, calcium, and magnesium, contribute to primary hypertension. (27)

Secondary Hypertension

Secondary hypertension, on the other hand, arises when an underlying health issue directly causes high blood pressure. Unlike primary hypertension, this type tends to manifest suddenly and more severely. Common causes include:

  • Adrenal disorders: Tumors or abnormalities in the adrenal glands, which regulate hormone secretion, may lead to hypertension. (28)
  • Kidney disease: A leading contributor to secondary hypertension. (29)
  • Obstructive sleep apnea: Breathing disruptions during sleep, resulting in decreased oxygen levels and arterial damage. (30)
  • Thyroid disorders: Imbalances in thyroid hormone levels may impact blood pressure.
  • Congenital heart defects: Structural abnormalities in the heart or blood vessels from birth. (31)
  • Certain medications and illegal drugs: Some pharmaceuticals and substances like cocaine and amphetamines may raise blood pressure. (32)

Pregnancy-Related Hypertension

Hypertension may arise or worsen during pregnancy, a condition known as preeclampsia if it develops after 20 weeks of gestation (33). Monitoring blood pressure during pregnancy is crucial, as both high blood pressure and preeclampsia may lead to complications such as fetal growth restriction, low birth weight, preterm birth, placental abruption, and organ damage. (34)

Symptoms of preeclampsia include headaches, visual disturbances, abdominal pain, nausea, and shortness of breath (35). Testing for elevated protein levels in urine may aid in diagnosis. Treatment involves closely managing blood pressure through medications deemed safe during pregnancy, along with lifestyle modifications like regular physical activity and a balanced diet.

Managing Hypertensive Crises

While fluctuations in blood pressure are normal, excessively high levels may lead to hypertensive crises, posing serious health risks. Symptoms may include difficulty breathing, chest pain, dizziness, and vision problems, among others. (36).

In essence, understanding the multifaceted causes of high blood pressure empowers individuals to make informed lifestyle choices and seek timely medical intervention, thereby mitigating the risks associated with hypertension.

Risk Factors of High Blood Pressure

Understanding the risk factors associated with high blood pressure (hypertension) is crucial for effective prevention and management. Here are several factors that may contribute to elevated blood pressure levels and the importance of addressing them for better cardiovascular health.

  • Being Overweight or Obese: Excess weight places strain on the heart and blood vessels, increasing the risk of hypertension. Obesity is often linked to conditions such as high cholesterol, further complicating cardiovascular health. (37)
  • Smoking: When you smoke, vape, or use tobacco in any form, it leads to a temporary increase in blood pressure. Consistent smoking over time may result in damage and hardening of the blood vessels, exacerbating hypertension. (38)
  • Excessive Salt Consumption: High salt intake prompts the body to retain water, consequently elevating blood pressure levels. Monitoring and reducing salt intake may help manage hypertension effectively. (39)
  • Inadequate Potassium Intake: Potassium plays a vital role in regulating fluid balance in the body. Low potassium levels, often exacerbated by dehydration, may contribute to hypertension by disrupting this balance. (40)
  • Lack of Physical Activity: Sedentary lifestyles contribute to higher heart rates and poor cardiovascular health. Regular exercise is essential for maintaining optimal blood pressure levels and overall well-being. (41)
  • Stress: Feelings of nervousness or stress may transiently raise blood pressure levels, a phenomenon known as white coat syndrome, particularly observed in clinical settings. (42)
  • Excessive Alcohol Consumption: Consuming more than one to two alcoholic drinks per day may lead to elevated blood pressure levels, particularly among men. Moderation is key to mitigating this risk factor. (43)
  • Family History: Genetic predisposition plays a significant role in hypertension, with the condition often running in families. Awareness of family history enables early intervention and risk management. (44)
  • Race: Disparities in hypertension prevalence exist among racial groups, with Black individuals in the U.S. facing higher risks compared to white populations. Addressing these disparities is crucial for equitable healthcare. (45)
  • Age: Advancing age is associated with an increased likelihood of developing hypertension. While it primarily affects adults, there is a growing prevalence among younger populations. (46)
  • Medications: Certain medications, such as birth control pills and anti-inflammatory drugs, may elevate blood pressure levels as a side effect. Regular medication review is essential for hypertension management. (47)
  • Underlying Health Conditions: Certain medical conditions, including chronic kidney disease, adrenal and thyroid disorders, and sleep apnea, may contribute to secondary hypertension, highlighting the importance of comprehensive health assessment. (48)

Awareness of these risk factors empowers individuals to take proactive steps towards maintaining healthy blood pressure levels and reducing the risk of cardiovascular complications. By addressing modifiable risk factors and adopting a holistic approach to cardiovascular health, we can strive towards a healthier future.

Complications of High Blood Pressure

High blood pressure often progresses silently, causing gradual harm to the body over time. If left untreated, it may lead to severe and potentially fatal complications.

  • Damage to the Brain: The brain relies on a consistent and ample supply of oxygen-rich blood to function optimally. However, untreated high blood pressure may disrupt this vital supply. Temporary interruptions in blood flow to the brain, known as transient ischemic attacks (TIAs), may occur, signaling an increased risk of more severe events such as strokes, wherein brain cells suffer permanent damage or death due to restricted blood flow. Moreover, uncontrolled hypertension may impair cognitive functions, including memory, learning, speech, and reasoning abilities. While treatment may mitigate the risks associated with high blood pressure, it may not fully reverse existing damage to the brain. (49)
  • Damage to the Heart: Hypertension forces the heart to exert excessive effort to pump blood throughout the body. The heightened pressure within the blood vessels places an added strain on the heart muscles, compelling them to contract more frequently and forcefully than normal. Consequently, this strain may lead to the enlargement of the heart, significantly elevating the risk of various cardiovascular complications, including heart failure, irregular heartbeats (arrhythmias), sudden cardiac arrest, and heart attacks. (50)
  • Damage to Arteries: In a healthy state, arteries are supple and resilient, allowing blood to flow smoothly and unimpeded throughout the body. However, hypertension may result in the arteries becoming stiffer, narrower, and less flexible. This deterioration increases the likelihood of dietary fats accumulating within the arteries, leading to reduced blood flow. Over time, this damage may elevate blood pressure levels, contribute to the formation of blockages, and eventually culminate in heart attacks and strokes. (51)

Hypertension poses significant threats to overall health by compromising the integrity of vital organs and systems within the body. Early detection, lifestyle modifications, and appropriate medical interventions are crucial in managing blood pressure levels and mitigating the risk of associated complications.

Diagnosis of High Blood Pressure

Identifying hypertension is a straightforward process that usually begins with a blood pressure reading. Typically, during routine visits, healthcare professionals measure blood pressure. If this isn’t done at your next appointment, it’s advisable to request it.

If your blood pressure readings are elevated, your healthcare provider might suggest further readings over a span of days or weeks. It’s uncommon to receive a hypertension diagnosis based solely on one reading.

To accurately diagnose hypertension, your healthcare provider looks for consistent evidence of elevated blood pressure. This is because various factors, such as the stress associated with medical environments, may influence blood pressure readings. Additionally, blood pressure naturally fluctuates throughout the day.

Should your blood pressure persistently remain high, additional tests may be conducted to rule out underlying conditions. These tests may include:

  • Screening for cholesterol and other blood components. (52)
  • Evaluating your heart’s electrical activity through an electrocardiogram (EKG or ECG). (53)
  • Performing ultrasound scans of your heart or kidneys. (54)

Furthermore, your healthcare provider may recommend monitoring your blood pressure over a 24-hour period at home using a specialized blood pressure monitor. These assessments aid in identifying any secondary issues contributing to elevated blood pressure and assessing potential organ damage caused by high blood pressure.

At this stage, your healthcare provider might initiate treatment for hypertension. Early intervention may help mitigate the risk of long-term complications.

Treatment of High Blood Pressure

High blood pressure affects millions of people worldwide. The good news is that there are effective ways to manage and reduce high blood pressure.

Lifestyle Changes

Making changes to your lifestyle may significantly reduce high blood pressure and improve your overall health. Here are some practical steps you may take:

  • Quit Smoking: Smoking is a major risk factor for high blood pressure and heart disease. If you smoke, seek support and resources to quit. Quitting smoking may significantly improve your blood pressure and overall health. (55)
  • Limit Alcohol Consumption: Excessive alcohol consumption may raise blood pressure and contribute to other health problems. If you drink alcohol, do so in moderation. Men should limit their intake to no more than two drinks per day, while women should aim for no more than one drink per day. (56)
  • Cut Back on Caffeine: While caffeine may temporarily raise blood pressure, excessive consumption may contribute to long-term hypertension. Limit your intake of caffeinated beverages like coffee, tea, and cola. Opt for decaffeinated versions or herbal teas as alternatives. (57)
  • Achieve a Healthy Weight: If you’re overweight or obese, losing weight may help lower your blood pressure. Use a BMI healthy weight calculator to determine your ideal weight range and set realistic weight loss goals. Focus on making gradual, sustainable changes to your eating habits and physical activity levels. (58)
  • Follow a Balanced Diet: Adopt a low-fat, balanced diet rich in fresh fruits and vegetables. These foods are packed with essential nutrients and fiber, which may help lower blood pressure and support heart health. Consider consulting a dietitian for personalized dietary recommendations. (59)
  • Reduce Salt Intake: Aim to consume less than 6g (0.2oz) of salt per day, equivalent to about a teaspoonful. High salt intake may contribute to high blood pressure, so be mindful of the amount of salt you add to your food. Explore ways to flavor your meals with herbs and spices instead. (60)
  • Stay Active: Regular physical activity is key to maintaining a healthy blood pressure. Aim for at least 30 minutes of moderate exercise most days of the week. Simple activities like brisk walking, cycling, or swimming may make a significant difference. Find activities you enjoy and make them a regular part of your routine. (61)

It’s important to note that these lifestyle changes may have a positive impact on your blood pressure regardless of whether you’re taking medication. In fact, adopting healthy habits early on may help you avoid the need for medication altogether.

Medicines for high blood pressure

Several classes of medications are employed to help regulate high blood pressure. Often, a combination of drugs may be required to achieve optimal blood pressure control.

  • ACE Inhibitors and ARBs: ACE inhibitors (Angiotensin-Converting Enzyme Inhibitors) and ARBs (Angiotensin II Receptor Blockers) are commonly prescribed medications for hypertension management. Individuals under 55 years of age or those with type 2 diabetes typically receive ACE inhibitors or ARBs. ACE inhibitors work by relaxing blood vessels, thereby lowering blood pressure. Common examples include enalapril, perindopril, lisinopril, and ramipril. A persistent dry cough is a common side effect of ACE inhibitors. ARBs, such as irbesartan, losartan, candesartan, valsartan, and olmesartan, are often recommended if ACE inhibitors cause adverse effects. (62)
  • Calcium Channel Blockers: Calcium channel blockers are another class of medications used to reduce blood pressure by widening blood vessels. Individuals aged 55 or older, or those of African or Caribbean origin without type 2 diabetes, are typically prescribed calcium channel blockers. Common examples include felodipine, amlodipine, and nifedipine. Side effects may include swollen ankles, headaches, and constipation. Grapefruit juice consumption while on certain calcium channel blockers may heighten the risk of side effects. (63)
  • Diuretics: Diuretics, also known as water pills, assist in lowering blood pressure by eliminating excess water and salt through urine. These are often used when calcium channel blockers cause undesirable effects or in cases of heart failure. Common examples include indapamide and bendroflumethiazide. Side effects may include dizziness upon increased thirst,standing, frequent urination, and rashes. Long-term use may lead to low potassium and sodium levels, necessitating regular blood tests. (64)
  • Beta Blockers: Beta blockers reduce blood pressure by slowing the heart rate and decreasing its force of contraction. While once popular for hypertension treatment, beta blockers are now typically reserved for cases where other medications have proven ineffective. Common examples include atenolol and bisoprolol. Side effects may include headaches, fatigue, dizziness, and cold extremities. (65)

It is essential for individuals prescribed blood pressure medication to stick to their treatment regimen diligently. Missing doses may compromise the effectiveness of the medication. It’s important to note that while medications may not necessarily cause noticeable changes in how one feels, they are still working to manage blood pressure.


While high blood pressure may seem like a silent condition, its effects may be profound and even life-threatening if left unchecked. Fortunately, there are numerous lifestyle changes and medical interventions available to help control and reduce high blood pressure.

By adopting a healthy diet, engaging in regular physical activity, managing stress levels, and adhering to prescribed medications, individuals may significantly lower their blood pressure and reduce the risk of complications such as heart disease, stroke, and kidney damage.

Seeking regular medical check-ups and monitoring blood pressure levels may aid in early detection and prompt intervention when necessary. It’s important for individuals to take an active role in managing their blood pressure, working closely with healthcare providers to develop personalized treatment plans and maintain optimal health.

Remember, managing high blood pressure is not just about adding years to your life, but about adding life to your years. With dedication, awareness, and support, individuals can take control of their blood pressure and enjoy a healthier, more vibrant life.