Hypertension
Hypertension is persistently elevated blood pressure. It usually causes no symptoms, but over time it increases the risk of stroke, heart disease, kidney disease and other complications.
At a glance
Quick facts
- Category
- Cardiovascular risk condition
- Symptoms
- Usually none
- WHO threshold
- ≥140/90 mmHg on repeated days
- NICE confirmation
- ABPM/HBPM ≥135/85 after clinic ≥140/90
- Main risks
- Stroke · heart · kidney disease
- Treatment
- Lifestyle + medicines when indicated
Dr. Augustine Chinemerem Anadu
Consultant Family Physician · University of Calabar Teaching Hospital
Reviewed for clinical accuracy, practical wording and general-medicine context.
Names & terminology
How this entity may be named or searched
- Canonical name
- Hypertension.
- Common term
- High blood pressure.
- Clinic blood pressure
- Measurement taken in a healthcare setting.
- ABPM / HBPM
- Ambulatory or home blood pressure monitoring used to confirm persistent elevation and reduce white-coat effects.
Structured entity profile
Clinical profile
Overview
Blood pressure is recorded as systolic pressure over diastolic pressure. WHO defines hypertension for population and clinical reference purposes as blood pressure of 140/90 mmHg or higher when elevated readings are confirmed on two different days. [1]
Guidelines differ in exact thresholds and treatment targets. NICE confirms hypertension in many adults when clinic blood pressure is at least 140/90 mmHg and the daytime ambulatory or home average is at least 135/85 mmHg. The clinical meaning of a reading also depends on cardiovascular risk, kidney disease, diabetes, age and evidence of target-organ damage. [2]
Symptoms and warning signs
Most hypertension causes no symptoms. Very high blood pressure can be associated with severe headache, chest pain, breathlessness, visual change, confusion, nausea or other symptoms, but symptoms are not a reliable way to screen for hypertension. Regular measurement is the only practical way to know the blood pressure. [1]
SYMPTOM MATRIX
Hypertension is usually detected by measurement, not symptoms
Symptoms become especially important when very high pressure is accompanied by possible acute organ injury.
- No symptoms
- Elevated reading found during routine care
- Repeated high home readings
- Long-term cardiovascular risk without warning signs
- Kidney disease
- Diabetes
- Established cardiovascular disease
- Retinal or cardiac changes
- Family history and older age
- Very high blood pressure with chest pain
- New weakness, speech difficulty or severe neurologic symptoms
- Severe breathlessness
- Confusion or major visual change
Very high blood pressure plus acute symptoms can represent a hypertensive emergency and needs immediate assessment.
Diagnosis
Accurate diagnosis starts with correct measurement technique and repeated readings. NICE recommends ambulatory blood pressure monitoring (ABPM), or home monitoring when ABPM is unsuitable, to confirm many elevated clinic readings. Home measurements are typically collected over several days rather than relying on a single value. [2]
A single high reading is not usually enough to characterize persistent hypertension. Proper measurement technique and repeat measurements are important when clinically appropriate.
Some patients have normal clinic readings but elevated blood pressure at home. This masked-hypertension pattern is one reason out-of-office measurements can be useful.
After hypertension is confirmed, assessment looks for cardiovascular risk factors and target-organ damage. This may include blood tests, urine testing, ECG and review for secondary causes when the history, age or severity makes them more likely. [1] [2]
Diagnostic pathway
Confirm persistent elevation before labeling chronic hypertension
Measurement quality and out-of-office confirmation help distinguish sustained hypertension from a one-off or white-coat reading.
Thresholds differ among international guidelines; this page identifies the source when a numeric threshold is quoted.
Why hypertension matters
Untreated hypertension damages blood vessels and organs over time. It is a major risk factor for stroke, coronary heart disease, heart failure and chronic kidney disease. WHO estimated that about 1.4 billion adults aged 30–79 were living with hypertension in 2024, and many were unaware of it. [1]
Treatment and management
Lifestyle measures include reducing excess salt, eating a balanced diet, maintaining a healthy weight, regular physical activity, avoiding tobacco and limiting excessive alcohol. These changes reduce cardiovascular risk even when medication is also needed. [1]
Common antihypertensive drug classes include ACE inhibitors or ARBs, calcium-channel blockers and thiazide-like or other diuretics. Choice and treatment targets depend on age, ethnicity, kidney function, diabetes, cardiovascular disease, pregnancy status and other factors. NICE uses a stepwise treatment pathway and recommends individualized targets and monitoring. [1] [2]
Treatment & care hub
Treat the pressure and the total cardiovascular risk
Blood pressure is one part of a broader prevention strategy.
Reduce modifiable risk
Diet, salt reduction, activity, weight management, tobacco avoidance and alcohol moderation all matter.
Use evidence-based antihypertensives
Drug choice follows age, comorbidity, kidney function, response and local guideline pathways.
Check control and adherence
Home readings and scheduled reviews help assess response and identify adverse effects.
Manage total risk
Diabetes, lipids, kidney disease and smoking can materially change cardiovascular risk and treatment priorities.
Do not stop prescribed blood-pressure medicine solely because home readings improve without discussing the plan with a clinician.
Blood pressure targets and monitoring
Targets are guideline- and patient-specific. WHO notes that lower targets may be used in people with cardiovascular disease, diabetes, chronic kidney disease or high cardiovascular risk, while NICE provides age- and setting-specific clinic and home/ambulatory targets. The treating clinician should identify which target applies. [1] [2]
Global burden
Hypertension affects about one in three adults aged 30–79
WHO estimates for 2024 show a large gap between prevalence, awareness, treatment and control.
Common questions
Frequently asked questions
Yes. Most people with hypertension feel no symptoms, which is why blood pressure measurement is essential.
Not necessarily. Diagnosis usually requires repeated measurements and often home or ambulatory confirmation.
It describes higher readings in a clinical setting than outside it; out-of-office monitoring can help identify this pattern.
Lifestyle changes are important for everyone, but many people still need medication based on blood pressure and overall cardiovascular risk.
Very high pressure with symptoms such as chest pain, severe breathlessness, neurologic deficits, confusion or major visual change requires urgent assessment.
Sources
- WHO — Hypertension fact sheet, 25 September 2025
- NICE — Hypertension in adults: diagnosis and management (NG136), updated 26 February 2026
This article is based on trusted medical sources and has undergone clinician review. It is not a substitute for personalized medical advice.
Hypertension is often asymptomatic. Feeling well does not exclude it, which is why routine and repeated blood-pressure measurement matters.