What Is Hypertension?
Hypertension, commonly known as high blood pressure, is one of the most prevalent chronic conditions worldwide. It is defined as a sustained elevation in arterial blood pressure — typically a systolic reading at or above 130 mmHg or a diastolic reading at or above 80 mmHg, according to current ACC/AHA guidelines.
Despite its prevalence, hypertension is often called the "silent killer" because it frequently presents with no symptoms until significant organ damage has occurred. Early diagnosis and consistent management are therefore critical.
Classification of Blood Pressure
| Category | Systolic (mmHg) | Diastolic (mmHg) |
|---|---|---|
| Normal | < 120 | < 80 |
| Elevated | 120–129 | < 80 |
| Stage 1 Hypertension | 130–139 | 80–89 |
| Stage 2 Hypertension | ≥ 140 | ≥ 90 |
| Hypertensive Crisis | > 180 | > 120 |
Diagnostic Approach
Diagnosis requires accurate, repeated blood pressure measurements. Key principles include:
- Measuring in both arms on at least two separate visits
- Using a properly calibrated, validated sphygmomanometer
- Ensuring the patient is seated, rested, and not having consumed caffeine or tobacco in the prior 30 minutes
- Considering 24-hour ambulatory blood pressure monitoring (ABPM) to rule out white-coat hypertension
Initial workup should include a comprehensive metabolic panel, urinalysis, lipid panel, ECG, and fasting glucose to assess for end-organ damage and cardiovascular risk factors.
Primary vs. Secondary Hypertension
Primary (essential) hypertension accounts for roughly 90–95% of cases and has no single identifiable cause. It is multifactorial, involving genetic predisposition, dietary habits, physical inactivity, and aging.
Secondary hypertension is caused by an underlying condition. Common causes include:
- Chronic kidney disease
- Primary aldosteronism
- Obstructive sleep apnea
- Renal artery stenosis
- Thyroid disorders
- Certain medications (NSAIDs, oral contraceptives, decongestants)
Secondary hypertension should be suspected in younger patients, those with resistant hypertension, or where clinical clues suggest an underlying cause.
Management Strategies
Lifestyle Modifications (First-Line for All Stages)
- DASH diet: Emphasize fruits, vegetables, whole grains, low-fat dairy, and reduced sodium intake (<2.3g/day ideally)
- Regular aerobic exercise: At least 150 minutes of moderate-intensity activity per week
- Weight reduction: Even modest weight loss has measurable impact on blood pressure
- Limit alcohol: No more than 1 drink/day for women, 2 for men
- Smoking cessation
Pharmacological Treatment
Drug therapy is indicated for Stage 1 hypertension with high cardiovascular risk, and for all Stage 2 hypertension. First-line agents include:
- Thiazide diuretics (e.g., hydrochlorothiazide)
- ACE inhibitors or ARBs (especially in diabetics or CKD patients)
- Calcium channel blockers (especially in older adults)
Combination therapy is often necessary to achieve target blood pressure goals. Treatment should be individualized based on comorbidities, tolerability, and patient preference.
Monitoring and Follow-Up
Patients on antihypertensive therapy should be reviewed within 1 month of initiation, then every 3–6 months once stable. Home blood pressure monitoring is encouraged to track trends and improve adherence.
Long-term uncontrolled hypertension significantly increases the risk of stroke, myocardial infarction, heart failure, and chronic kidney disease. Regular follow-up is not optional — it is essential.