What is hypertension?
Hypertension (high blood pressure) is a chronic condition where the force of blood against your artery walls is consistently too high. Blood pressure is measured in two numbers: systolic (pressure when your heart beats) and diastolic (pressure between beats). A reading of 130/80 mmHg or above is classified as hypertension.
Often called the "silent killer," hypertension rarely causes symptoms until it has caused serious damage. Left uncontrolled, it significantly increases the risk of heart attack, stroke, kidney disease, and vision loss. Fortunately, it is one of the most manageable chronic conditions — most people achieve control through lifestyle changes and/or medication.
Normal: below 120/80 · Elevated: 120–129/<80 · Stage 1 Hypertension: 130–139/80–89 · Stage 2 Hypertension: 140+/90+ · Hypertensive Crisis: 180+/120+ (seek emergency care)
What causes high blood pressure?
Primary hypertension (the most common type) develops gradually over years with no single identifiable cause. Secondary hypertension results from an underlying condition. Key risk factors include:
Lifestyle Factors
High sodium diet, physical inactivity, excess alcohol, smoking, and chronic stress are the leading modifiable risk factors for hypertension.
Weight & Metabolic Health
Obesity significantly increases blood pressure. Insulin resistance and metabolic syndrome are closely linked to hypertension development.
Age & Genetics
Risk increases with age as arteries stiffen. Family history is a strong predictor. Race is also a factor — Black adults have higher prevalence.
Secondary Causes
Kidney disease, thyroid disorders, sleep apnea, adrenal gland tumors, and certain medications (NSAIDs, decongestants, hormonal contraceptives) can cause secondary hypertension.
Managing high blood pressure
Hypertension treatment combines lifestyle modification with medications when necessary. Most patients achieve blood pressure control — the goal is typically below 130/80 mmHg for most adults.
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First-Line
Lifestyle Changes
The DASH diet (Dietary Approaches to Stop Hypertension), regular aerobic exercise (150+ min/week), weight loss, sodium reduction (<2,300 mg/day), limiting alcohol, and quitting smoking. Together, these changes can reduce systolic BP by 10-20 mmHg.
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First-Line Medication
ACE Inhibitors / ARBs
ACE inhibitors (lisinopril, enalapril) and ARBs (losartan, valsartan) block hormones that narrow blood vessels. Particularly beneficial for patients with diabetes or kidney disease. ARBs cause less cough than ACE inhibitors.
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First-Line Medication
Calcium Channel Blockers
Medications like amlodipine relax blood vessels by preventing calcium from entering arterial cells. Effective monotherapy and widely tolerated. Often combined with ACE inhibitors or ARBs.
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First-Line Medication
Diuretics (Thiazide)
"Water pills" like hydrochlorothiazide and chlorthalidone reduce blood volume. Often used as initial therapy or in combination. Chlorthalidone has stronger evidence for cardiovascular outcomes than HCTZ.
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