Hypertension is persistently raised arterial blood pressure. It is one of the most significant modifiable risk factors for stroke, myocardial infarction, heart failure, chronic kidney disease and vascular dementia. Because it rarely causes symptoms until damage has occurred, it is frequently described as a silent condition and is usually found through screening rather than through a patient presenting with complaints.
Blood pressure is recorded as systolic pressure over diastolic pressure in millimetres of mercury. A single raised reading is not enough to make the diagnosis. Clinic measurements are typically confirmed with ambulatory blood pressure monitoring (ABPM) over 24 hours or with a structured week of home readings, both of which reduce the effect of white coat hypertension.
Around nine in ten cases are primary (essential) hypertension, where no single cause is identified and the picture reflects genetics, age, weight, salt intake, alcohol and physical inactivity. Secondary hypertension, more common in younger patients or where blood pressure is resistant to treatment, arises from an identifiable cause such as renal disease, primary aldosteronism, renal artery stenosis, obstructive sleep apnoea or certain medications.
Management combines lifestyle measures (reducing dietary salt, moderating alcohol, increasing activity, weight loss and stopping smoking) with drug treatment guided by age and background. Common classes include ACE inhibitors, angiotensin receptor blockers, calcium channel blockers and thiazide-like diuretics, often used in combination. Treatment is titrated against a target that takes account of the person's age, frailty and comorbidities rather than a single universal number.
.svg)
