"Essentials of High Blood Pressure You Should Never Overlook"

May 17, 2025, is World Hypertension Day. This event commemorates the 20th anniversary of the initiative launched by the World Hypertension League to enhance global awareness regarding hypertension. This year’s theme is “Measure Your Blood Pressure Accurately, Control It, Live Longer!” This highlights the significance of consistent and accurate blood pressure monitoring for effectively detecting and managing hypertension. Let us utilize this day to enhance our knowledge and that of others, cultivating a community dedicated to cardiovascular health and longevity.

High Blood Pressure (Hypertension) – The Silent Killer

Blood pressure is described as the force with which blood presses against the arterial walls while the heart is pumping. High blood pressure, or hypertension, is a medical condition where blood circulates through the arteries at an increased pressure level. Often termed as the ‘silent killer,’ high blood pressure can go unnoticed until it leads to serious events like heart attacks or strokes. According to the World Health Organization, nearly half of adults with hypertension are unaware of their condition (WHO Hypertension Fact Sheet,2023). High blood pressure represents the leading cause of death globally, with around 10.8 million lives lost annually due to this condition. (Schutte et al., 2022 ).

Thus, understanding the basics—from what regular readings look like to how lifestyle choices impact blood pressure—can help you take control early and effectively. Whether managing hypertension or aiming to prevent it, knowing the essentials of high blood pressure is your first step toward a healthier life.

High Blood Pressure (Hypertension)- Prevalence

Globally, high blood pressure or hypertension affects approximately one-third of the adult population. The population affected by hypertension increased twofold from 1990 to 2019, rising from 650 million to 1.3 billion individuals (WHO Hypertension Fact Sheet,2023). Over 82% of adults suffering from hypertension reside in low- and middle-income nations. India is home to an estimated 220 million adults living with hypertension, making it one of the countries with the highest burden of this condition globally (Varghese et al., 2023).

"Global Hypertension Statistics – WHO 2025 Insights"

[ Infographic generated with the help of ChatGPT (OpenAI)]

High Blood Pressure – Risk Factors

Recognizing the risk factors associated with high blood pressure is essential for its prevention and management. These risk factors are generally categorized into two groups:

Modifiable risk factors: These are lifestyle and environmental factors that individuals can change to reduce their risk. They include:
- 🧂 High Salt Intake
- 🍔 High Fat Intake
- 🛋️ Physical Inactivity
- ⚖️ Obesity
- 🚬 Smoking
- 🍷 Excess Alcohol
- 😰 Stress
Non-Modifiable Risk Factors: These are factors which cannot be changed. They include:
- 🎂 Increasing Age
- 🧬 Genetics/Family History
- 🌍 Race/Ethnicity (e.g., African descent has higher risk)
- 🚹 Gender (Males at higher early-life risk)
- 🩺 Chronic Kidney Disease

(WHO Hypertension Fact Sheet,2023)

✅Being aware of risk factors allows individuals to make informed decisions about their health. By addressing modifiable risks and non-modifiable factors, one can take proactive steps toward preventing and managing high blood pressure.

Understanding Blood Pressure Readings

A monitor displaying 120/80 mmHg, illustrating normal blood pressure levels

(Image Source: www.freepik.com)

A blood pressure reading has two numbers, top and bottom. For example, 120/80 mm Hg can be said as “120 over 80 millimeters (mm) of mercury (Hg)” or just as “120 over 80.”

Systolic Pressure (Top Number) – It is the force of the blood flow when blood is pumped out of the heart
Diastolic Pressure (Bottom Number)– It is measured between heartbeats when the heart is filling with blood.

✅ A normal blood pressure reading is typically <120/80 mmHg. Elevated readings can signal an increased risk of heart disease and stroke, making regular monitoring and understanding of these numbers essential for maintaining heart health.

Types of High Blood Pressure

High blood pressure, or hypertension, manifests in various forms, each with distinct causes, characteristics, and treatment approaches. Recognizing these types is, therefore, crucial for effectively managing it, and preventing complications.

🩹 Type	🔑 Key Feature	🧪 Common Causes
Primary (Essential)	Gradual onset without identifiable cause	Genetics, age, obesity, physical inactivity, smoking, alcohol, high salt intake
Secondary	Due to an underlying condition	Kidney disease, sleep apnea, endocrine disorders, certain medications
Isolated Systolic	High systolic, normal diastolic	Age-related arterial stiffness
Resistant	Uncontrolled despite multiple medications	Secondary hypertension, medication non-adherence, incorrect BP measurement
White Coat	High readings in clinic only	Anxiety, clinical setting

(Samson, 2024; Hegde et al.,2023)

Blood Pressure – Categories

According to the American Heart Association and the American College of Cardiology, blood pressure readings are categorized as follows:

Category	Systolic (mm Hg)	Diastolic (mm Hg)
Normal	Less than 120	and less than 80
Elevated	120–129	and less than 80
High Blood Pressure (Stage 1)	130–139	or 80–89
High Blood Pressure (Stage 2)	140 or higher	or 90 or higher
Hypertensive Crisis	Higher than 180	and/or higher than 120

( American Heart Association)

High Blood Pressure – Symptoms

The majority of individuals with high blood pressure do not experience any symptoms. However, in cases of very high blood pressure, known as a hypertensive crisis, symptoms may manifest. These can include severe headaches, chest pain, shortness of breath, vision changes, or difficulty speaking. Such symptoms indicate a medical emergency requiring immediate attention. As a result, grasping the essentials of high blood pressure is key, highlighting the need for early identification of symptoms and the prevention of subsequent complications.

🩺 Symptoms	📝 Description
🧠 Headaches	Often in the morning; persistent or pounding
👀 Blurred Vision	Due to pressure on blood vessels in the eyes
💓 Chest Pain	May indicate serious cardiovascular stress
😵 Dizziness or Lightheadedness	Caused by changes in blood flow
👃 Nosebleeds	Can occur with severely high BP
🛌 Fatigue or Confusion	Reduced oxygen delivery to brain and body
💨 Shortness of Breath	May signal heart is affected
💥 Pounding in Chest, Neck, or Ears	Sensation of forceful heartbeat

[WHO Hypertension Fact Sheet,2023; Table generated with the help of ChatGPT (Open AI)]

Blood Pressure Monitoring

A) Self-Measured Blood Pressure (SMBP) Monitoring

"Man checking his blood pressure at home using a digital BP monitor, promoting self-monitoring and hypertension management."

(Image Source: www.freepik.com)

It refers to a patient’s regular blood pressure measurement outside a doctor’s clinic, typically at home or work.

Benefits:
- Provides a more accurate picture of blood pressure trends over time.
- Helps identify white-coat hypertension (elevated BP in the clinic but not at home) and masked hypertension (normal BP in the clinic but elevated at home).
- Enhances patient engagement in their care and treatment adherence.
- Allows for timelier medication adjustments.
Limitations
- Home devices have been found to be inaccurate
- Cuff placement can affect accuracy
- May induce anxiety and excessive monitoring
- Risk of treatment change by patients based on casual home measurements without doctors’ guidance
- Lack of nocturnal recording

( Centre for Disease Control and Prevention; Uhlig et al., 2012; George et al., 2015)

B) Ambulatory Blood Pressure (ABPM) Monitoring

"Ambulatory Blood Pressure Monitoring Device for 24-Hour BP Tracking"

This refers to the monitoring of blood pressure, usually carried out over a 24-hour timeframe, to assess the variability patterns of pressure. A portable automatic BP monitor worn on the body (typically on the belt and upper arm) is used. Besides this, it also has a blood pressure cuff around the arm. Tubing connects the cuff to the device. Device automatically inflates and records readings at preset intervals, that is, generally every 15 to 30 minutes during the day, and every 60 minutes at night.

Benefits
- The gold standard test to diagnose white coat, masked and nocturnal hypertension.
- Detect changes in blood pressure at different hours of day like nocturnal (night) dipping and morning surge.
- Detect blood pressure variation with different environmental and emotional changes.
- Better tool than one-time BP for assessing the effect of blood pressure medications.
- Helps to start the treatment of hypertension in patients with cardiovascular risks.
Limitations
- Pressure due to repeated inflation of the cuff may make your upper arm sore.
- Inability to accurately record blood pressure during physical activity.
- Discomfort while sleeping.
- Limited availability, high cost.

( Dadlani et al., 2018; Cleveland Clinic)

Tips for Measuring Blood Pressure Accurately at Home

Accurate home blood pressure monitoring is vital for managing hypertension and assessing cardiovascular health. Here are evidence-based tips to ensure precise readings:

A) Choose a Right Device

Choose an automatic, upper-arm blood pressure monitor validated for accuracy. Devices measuring at the upper arm are generally more reliable than wrist or finger monitors.
Choose a monitor that has been validated.
Use a cuff that fits your arm correctly. A cuff that’s too small or too large can yield inaccurate readings. Measure the arm circumference and choose a cuff size accordingly.

B) Preparation Before Measurement

Avoid smoking, consuming caffeine, or exercising within 30 minutes before measuring your blood pressure.
Pass urine before measuring, as a full bladder can temporarily raise blood pressure.
Sit quietly for at least 5 minutes before taking a reading.
Don’t talk or use the phone.
Any arm can be used for measurement
Don’t take the measurement over clothes. Remove the clothing over the arm that will be used to measure blood pressure.

C) Correct Position

Sit in a chair with your back supported and both feet flat on the floor.
Do not cross your legs.
Rest your arm on a flat surface so that the cuff is at heart level.
Remain silent during the measurement to prevent skewed results.

D) Take Multiple Readings

Record at least two readings, one minute apart, to account for any variability.
Measure your blood pressure at the same times each day, such as morning and evening, to monitor trends effectively.

E) Record and Monitor Your Readings

Keep a record of your readings, noting the date, time, and any relevant activities (e.g., medication intake, physical activity). This information is valuable for your healthcare provider.
Consider using blood pressure tracking apps or printable logs to organize your data.

F) Know Your Readings

A normal blood pressure reading is typically below 120/80 mm Hg. Readings consistently above this may indicate hypertension.
If your readings are consistently high or low, discuss them with your doctor for appropriate guidance.

( American Heart Association, Home Blood Pressure Monitoring)

Management of High Blood Pressure

Managing high blood pressure (hypertension) involves a combination of lifestyle modifications, dietary adjustments, and, when necessary, medication. Effective management is crucial to reduce the risk of heart disease, stroke, kidney problems, and other complications.

A) Lifestyle Modifications (First-line therapy for most patients)

Lifestyle Changes	Benefit
🥗 DASH diet	Reduces systolic BP by ~8–14 mmHg
🧂 Low sodium intake	Target: <1,500–2,300 mg/day
🏃 Regular exercise	30 mins/day, 5 days/week
⚖️ Weight loss	~1 mmHg BP drop per kg lost
🚭 Quit smoking	Improves heart health
🍷 Limit alcohol	≤2 drinks/day (men), 1 (women)
😌 Stress management	Reduces BP spikes

[Table: generated with the help of Chatgpt (Open AI); National Heart, Lung, and Blood Institute ; Harsha et al.,2008; World Health Organization, Nutrition Factsheet]

i) DASH Diet

Visual Guide to the Healthy DASH Diet: Recommended Foods and Foods to Avoid.

(Image Source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services.)

The DASH diet, which stands for Dietary Approaches to Stop Hypertension, is a versatile and well-rounded nutritional plan designed to promote a heart-healthy lifestyle.
The DASH diet consists mainly of fruits, vegetables, and low-fat dairy products.
It also includes whole grains, poultry, fish, and nuts while limiting red meat, sweets, and sugar-containing beverages.
Moreover, adapting the DASH eating plan has been reported to reduce blood pressure by 8–14 mmHg.

(National Heart Lung and Blood Institute Dash-eating-plan.; World Health Organization, Nutrition Factsheet)

ii) Low Sodium Intake

[Infographic generated with the help of ChatGPT (Open AI)]

Limiting sodium intake plays a key role in managing high blood pressure.
As sodium promotes water retention in the body, it potentially leads to an increase in blood volume and pressure.
The American Heart Association advises a maximum sodium intake of 2,300 milligrams daily.
For the majority of adults, particularly those with hypertension, the optimal sodium limit is 1,500 milligrams per day.
But, reducing daily sodium intake by 1,000 milligrams can significantly enhance blood pressure and cardiovascular health.

( American Heart Association , Shaking the Salt Habits )

iii) Healthy Lifestyle

Adopting a healthy lifestyle can greatly lower blood pressure by implementing various strategies such as dietary changes, physical activity, weight control, stress management, cessation of smoking, and minimizing alcohol consumption.
Aim for at least 150 minutes (30 mins/day, 5 days/week ) of moderate-intensity exercise per week (e.g., brisk walking, cycling).
Weight loss is one of the best ways to control blood pressure. In general, blood pressure might go down by about 1 mm Hg with each kilogram of weight lost.
It is advisable to refrain from all types of tobacco and exposure to secondhand smoke. This practice can lower your risk of experiencing a heart attack or stroke. Additionally, it can enhance your general health.
Scientific research indicates that it is advisable to restrict alcohol consumption. The American Heart Association suggests that individuals who consume alcohol should limit their intake to a maximum of two drinks daily for men and one drink daily for women.
Stress contributes to high blood pressure. Practice ways to enhance your ability to handle stress, like meditation, breathing exercises, and Yoga.

B) Medication

When lifestyle interventions are not enough to achieve the target blood pressure, there are several medicinal options for the effective management of high blood pressure.
The three classes of three classes of medications are considered first-line agents for the treatment of hypertension:
- Angiotensin-converting enzyme (ACE )inhibitors
  - Angiotensin is a compound that narrows arteries in the body. ACE inhibitors assist in lowering the levels of angiotensin, which promotes the relaxation and widening of blood vessels, resulting in reduced blood pressure.
  - Examples: Lisinopril, Enalapril, Perindopril
- Calcium channel blockers (CCBs)
  - CCBs prevent calcium from entering the muscle cells of the heart and arteries, promoting relaxation and lowering blood pressure.
  - Examples: Amlodipine, Nifedipine, Felodipine
- Diuretics or water pills
  - Promote the excretion of excess salt and water, contributing to blood pressure control.
  - Examples: Hydrochlorothiazide, Indapamide, Chlorthalidone

(National Heart , Lung , and Blood Institute, Blood Pressure Treatment. ; American Heart Association, Manage Blood Pressure)

✅ Key Takeaways

High blood pressure often has no symptoms, thus also known as the “silent killer.”
Persistent headaches, blurred vision, chest pain, or shortness of breath may indicate elevated blood pressure.
Dizziness, nosebleeds, and fatigue can also be warning signs in some individuals.
Regular blood pressure monitoring is the only reliable way to detect hypertension early.
Lifestyle factors such as stress, poor diet, and inactivity can contribute to elevated BP levels.
Uncontrolled hypertension increases the risk of heart disease, stroke, kidney failure, and vision loss.
Self-Measured Blood Pressure Monitoring (SMBP) and Ambulatory Blood Pressure Monitoring (ABPM) help detect abnormal patterns missed in clinics.
Seek medical attention if you experience symptoms combined with high readings (≥180/120 mmHg).
Lifestyle changes are considered the first-line therapy for managing high blood pressure.

“Essentials of High Blood Pressure You Should Never Overlook”

Published by Medical Pharma Lifestyle Pulse on May 16, 2025May 16, 2025