Hypertension

What is hypertension?

Blood pressure is the force of blood pushing against your artery walls. Hypertension means that pressure is persistently elevated.

Most people feel completely well — which is why hypertension is often called a “silent” condition. Over time, untreated high blood pressure increases the risk of heart attack, stroke, heart failure, kidney disease, and atrial fibrillation.

What numbers matter?

Blood pressure is recorded as two numbers:

  • Systolic (top number): pressure when the heart pumps

  • Diastolic (bottom number): pressure when the heart relaxes

In general:

  • Normal blood pressure is below ~120/80 mmHg

  • Hypertension is usually diagnosed when readings are consistently ≥140/90 mmHg in clinic

  • Home blood pressure thresholds are slightly lower

Diagnosis is based on multiple readings, often including home or ambulatory monitoring — not a single measurement.

Why it matters long-term

High blood pressure gradually damages:

  • Coronary arteries (leading to coronary artery disease)

  • Brain circulation (stroke risk)

  • Heart muscle (leading to thickening and eventually heart failure)

  • Kidneys

  • The aorta and peripheral arteries

The goal of treatment is not simply to “improve a number” — it is to reduce long-term cardiovascular risk.

How we assess risk

Blood pressure is only part of the picture. We also consider:

  • Age and sex

  • Cholesterol levels

  • Diabetes

  • Smoking history

  • Kidney function

  • Family history

  • Evidence of organ effects (heart thickening on echo, protein in urine, etc.)

Treatment intensity is tailored to overall cardiovascular risk, not just a single reading.

Treatment

1. Lifestyle foundations

For many people, early changes can significantly improve blood pressure:

  • Weight optimisation

  • Regular aerobic exercise

  • Reduced salt intake

  • Limiting alcohol

  • Improving sleep (including assessment for sleep apnoea when relevant)

  • Managing stress

Lifestyle measures remain important even when medication is required.

2. Medications

If blood pressure remains elevated — or if cardiovascular risk is moderate to high — medication is recommended.

Common first-line classes include:

  • ACE inhibitors or ARBs

  • Calcium channel blockers

  • Thiazide-type diuretics

Many people require combination therapy. The aim is steady, well-tolerated blood pressure control — not rapid or excessive lowering.

Treatment is adjusted over time based on response, kidney function, electrolytes, and side effects.

A long-term strategy

Hypertension is usually a lifelong condition. The focus is:

  • Sustainable control

  • Prevention of progression

  • Reduction of cardiovascular events

Blood pressure targets are individualised, balancing benefit with tolerability — especially in older patients.

Management is a shared, evolving process, reviewed periodically as your risk profile changes.