Hypertension Awareness: Know Your Number, Reduce Your Risk

Hypertension or high blood pressure is a persistent elevation in the force of blood against the walls of the arteries.  It is a common condition affecting 34% of adults aged 30 to 79 years worldwide. 

It is considered a “silent” disease as it usually does not cause any symptoms and can therefore go undetected for many years.  Less than 50% of the adult population is diagnosed and treated globally, with under 25% having the condition under control.

When blood pressure is persistently elevated, it can lead to serious complications, such as heart disease, stroke, kidney damage, visual impairment and dementia. The good news is that these complications are preventable with optimal blood pressure management. 

Symptoms of hypertension

In the vast majority of cases, hypertension has no symptoms. 

When blood pressure is very high, it may cause symptoms such as headaches, nosebleeds, blurred vision, shortness of breath, chest pain or confusion.

Please note: these signs and symptoms are not specific to high blood pressure and may be related to other conditions. 

Causes of hypertension

Secondary causes of hypertension can be associated with existing medical conditions such as obstructive sleep apnoea or certain medications. 

Who should check their blood pressure?

All adults aged 18 years and above should have their blood pressure checked at least once. For individuals aged 18–29 years with normal readings and no risk factors, screening can be repeated every 3–5 years. If readings are elevated, more frequent monitoring is recommended.

Annual or regular screening is advised for individuals aged 30 years and above, as well as for those with additional risk factors, including excess weight, diabetes or kidney disease, a family history of hypertension, smoking, alcohol intake, or a sedentary lifestyle.

If blood pressure is elevated, the frequency of monitoring may increase to every 3–6 months, as advised by your doctor.

Understanding your blood pressure reading

When your blood pressure is measured, there are two measurements.  The top number, also known as systolic blood pressure (BP), measures the force that occurs when the heart contracts to squeeze blood into the arteries; the bottom number, also known as diastolic BP, reflects the force in the arteries when the heart is relaxing between beats.  Both numbers are measured in millimetres of mercury (mmHg).

Optimal (non‑elevated) blood pressure is a systolic BP of less than 120 mmHg and a diastolic BP of less than 70 mmHg.

Hypertension is diagnosed if the systolic pressure is 140 mm Hg or higher or if your diastolic blood pressure is 90 mm Hg or higher at your doctor’s office. 

Values between optimal blood pressure and hypertension are termed “elevated blood pressure”.   Elevated blood pressure is defined by either a systolic BP between 120 to 139 mm Hg and/or a diastolic BP of 70 to 89 mm Hg. Blood pressure exists on a spectrum, and even “elevated” levels are associated with increased long-term cardiovascular risk, highlighting the importance of regular monitoring and early lifestyle changes.

The table below summarises the different blood pressure categories.

In individuals with elevated blood pressure (particularly systolic BP ≥130 mmHg or diastolic BP ≥80 mmHg), your doctor will assess your overall cardiovascular risk, including conditions such as diabetes, before deciding whether treatment is needed.

Because blood pressure can vary, a single reading is not usually enough to make a diagnosis. If any of the readings are borderline, your doctor may confirm the diagnosis using one of the following methods:

1. Home blood pressure monitoring (HBPM): Using a blood pressure machine at home, you will be advised to check your blood pressure twice daily for 3 to 7 days.  At each sitting, it is recommended to take two readings and the average blood pressure is used over the course of monitoring. 

   Using HBPM, the threshold level for diagnosing high blood pressure is as follows: 
       - Systolic BP: 135 mmHg or higher
       - Diastolic BP: 85 mmHg or higher

2. 24-hour ambulatory blood pressure monitoring: You will be given a cuff to wear on your arm with a small recording device attached. This will measure your blood pressure multiple times over a 24-hour period (day and night).
   
   Using this method, hypertension is diagnosed at:
       - Systolic BP: 130 mmHg or higher 
       - Diastolic BP: 80 mmHg or higher

Using out of clinic BP measurements can also help your doctor identify “white coat hypertension”.  This refers to when your BP is elevated in a clinical setting but normal at home.

If you have been diagnosed with hypertension, your doctor will likely prescribe medication to help lower your blood pressure.  Taking medication as prescribed is crucial to reducing the risk of complications.

Lifestyle interventions for high blood pressure

Lifestyle interventions have a significant impact on blood pressure management, both in individuals with elevated blood pressure and those already diagnosed with hypertension.

Key interventions include: 

• Weight loss: If you are carrying excess weight, even a modest weight loss of around 5-10% can significantly reduce blood pressure.

• Eating a healthy diet: Focus on a plant-predominant diet, including fruits, vegetables, legumes, wholegrains, nuts and seeds. These foods are rich in folate, potassium, magnesium, and fibre, which have been shown to help lower blood pressure.  Dark green leafy vegetables and beetroot contain nitrates, which help relax blood vessels. Omega‑3 fats from walnuts, chia seeds, and flaxseeds also support blood pressure lowering.

  Avoid foods high in saturated fat, such as red meat, processed meats and full-fat dairy products. Reduce total sodium intake to less than 2 grams (equivalent to about 5 grams of salt or about one teaspoon) per day. In addition to salt added during cooking, other foods high in salt include processed meats, ultraprocessed foods, such as crisps, cheese, certain ready meals and sauces like soya sauce. 

• Physical activity: Regular exercise lowers blood pressure and improves cardiovascular health.  Aim for at least 150 minutes of moderate intensity activities, such as brisk walking over the week, which is equivalent to 30 minutes five times a week.  If you find this is too much to start with, start with as little as 10 minutes a day and work up.  Regular physical activity also helps with weight maintenance, also important for blood pressure control.  If your blood pressure is well controlled, it is also beneficial to include strength training at least twice a week for optimum health benefits.  If you are not currently physically active, you may need to discuss this with your healthcare professional prior to starting especially if you have medical conditions, are on medications, or experience activity-related discomfort.
• Limit alcohol consumption: The World Health Organization states that “no level of alcohol consumption is safe for our health.”  Evidence shows that even one drink a day increases the risk of high blood pressure compared to individuals that don’t drink at all.  Current recommendations are if you do not drink, it is best not to start and for individuals that do drink, the less, the better.   
• Quit smoking: Smoking temporarily increases your blood pressure and heart rate.  The toxins from tobacco damage the inner lining of arteries, therefore increasing the risk of hypertension and cardiovascular disease. 
• Stress reduction: Chronic (long-term) stress can further increase the risk of hypertension.  It is important to find ways to manage stress. Incorporate stress-reducing practices such as breathing exercises, yoga, and daily activities that bring enjoyment and relaxation.

By adopting these lifestyle modifications, individuals can significantly improve their blood pressure management and overall cardiovascular health.

Note: Please speak to your healthcare professional before making significant dietary changes or increasing physical activity levels.  Lifestyle interventions can have a profound impact, and you may need to lower your blood pressure or other medications.

Any questions?

If you have any questions or comments, please write to us on [email protected]

References:

1. Hypertension
2. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension | European Heart Journal | Oxford Academic
3. Screening for Hypertension in Adults: US Preventive Services Task Force Reaffirmation Recommendation Statement | Cardiology | JAMA | JAMA Network
4. Ministry of Health and Prevention (UAE). Hypertension Guidelines Update, 2019.
5. International Society of Hypertension (ISH). Global Hypertension Practice Guidelines, 2020.
6. Health and cancer risks associated with low levels of alcohol consumption - The Lancet Public Health
7. Silvia Di Federico et al. Hypertension. 2023;80:1961–1969

Disclaimer: 

The content in this article is for general informational purpose and is not meant to replace or substitute for professional medical advice, diagnosis or treatment.  Always consult a qualified healthcare professional with any questions or concerns about your health.