High blood pressure (Hypertension)

High blood pressure, or hypertension, is when the force of your blood against your artery walls is consistently too high. It doesn't usually cause symptoms, but over time it can lead to serious problems such as heart attacks and strokes.

Symptoms of high blood pressure

High blood pressure doesn't usually cause any symptoms, which is why it's sometimes called a “silent” condition. Many people have it for years without realising, so the only way to know for certain is to have your blood pressure checked.

Rarely, very high blood pressure can cause symptoms such as headaches, blurred vision or chest pain. Extremely high blood pressure can cause a hypertensive emergency, with symptoms including:

• confusion or sudden changes to your thinking
• a severe headache
• chest pain
• seizures
• vision changes, such as sudden blurred vision
• signs of a stroke, such as facial drooping, slurred speech, or sudden arm or leg weakness

Call 999 if you have chest pain that doesn't go away, spreads to your arm, neck, jaw or back, or comes with sweating, nausea or shortness of breath, as this could be signs of a heart attack.

Causes of high blood pressure and who is at risk

In most cases, there's no single cause of high blood pressure. Instead, several factors combine over time, such as ageing, genetics and family history. This is known as primary hypertension.

Sometimes high blood pressure has an identifiable cause, known as secondary hypertension. This can include an underlying health condition, such as sleep apnoea or narrowed kidney arteries, hormone-related conditions or certain medications and substances.

You may be more likely to develop high blood pressure if you:

• are getting older
• have close relatives with high blood pressure
• have a Black African, Black Caribbean or South Asian ethnic background
• eat an unhealthy diet, especially one high in salt
• are overweight
• smoke
• drink too much alcohol
• are under stress over a long period
• are not physically active

Are there different types of high blood pressure?

As well as primary and secondary hypertension, doctors sometimes describe blood pressure that behaves differently depending on where and when it's measured:

• White coat hypertension: where your blood pressure is normal at home but high in a clinical setting, often due to anxiety about the appointment
• Masked hypertension: the opposite pattern, where readings are normal at a clinic but high at home
• Nocturnal hypertension: where your blood pressure rises while you sleep
• Resistant hypertension: where your blood pressure stays high despite taking several different blood pressure medicines

How high blood pressure is diagnosed

A blood pressure test involves a band (cuff) being inflated around your upper arm to measure the pressure in your blood vessels. You're usually considered to have high blood pressure if your reading is 140/90 or higher when checked by a healthcare professional, or 135/85 or higher when checked at home.

If your first reading is high, you may be asked to monitor your blood pressure at home over the next few days, return to your GP surgery for another check, or wear a portable monitor that takes readings over 24 hours. This helps confirm whether you have consistently high blood pressure, rather than a one-off high reading.

How high blood pressure is treated

Healthy lifestyle changes are the first step for almost everyone with high blood pressure, even if you also need medication. Steps that can help include:

• eating a healthy, balanced diet and cutting down on salt
• getting regular exercise, aiming for at least 150 minutes a week
• losing weight if you're overweight
• limiting alcohol to no more than 14 units a week
• cutting down on caffeine
• stopping smoking
• managing long-term stress
• getting enough good-quality sleep

A GP will usually prescribe medication if your blood pressure is very high, if you're at higher risk of a heart attack or stroke, or if lifestyle changes alone haven't been enough. Common types of medicine include diuretics, beta-blockers, calcium channel blockers, ACE inhibitors and ARBs, usually taken as a tablet once a day. You may need to take more than one type of medicine to keep your blood pressure under control.

When to see a doctor

Get your blood pressure checked at a pharmacy or GP surgery if you think you might be at risk, or if you're 40 or over and haven't had it checked in the last 5 years. Many pharmacies offer free checks for people aged 40 and over.

Call 111 or get help online if:

• you often get headaches or blurred vision
• you have chest pain that comes and goes
• you have other symptoms you're worried could be caused by high blood pressure

Call 999 if you get sudden chest pain or discomfort that doesn't go away, pain spreading to your arm, neck, jaw, stomach or back, or chest pain along with sweating, nausea, light-headedness or shortness of breath. These can be signs of a heart attack.