High blood pressure, also called hypertension, is one of the most common long-term conditions. It means the pressure in the arteries is permanently too high. This puts a serious strain on the heart and blood vessels, and can lead to dangerous complications such as heart attack, stroke, or kidney damage. In this detailed guide, you will learn what hypertension means, what causes it, what risk factors are involved, how it shows itself, how it is diagnosed, and what treatments and preventive steps are available.
What is high blood pressure (hypertension)?
Hypertension describes a condition where blood pressure in the arteries stays above normal levels over a long period of time. Two values are measured: the systolic blood pressure, which shows the pressure when the heart contracts, and the diastolic blood pressure, which shows the pressure when the heart relaxes between beats. Permanently high blood pressure puts strain on the walls of the blood vessels, which can damage organs over time. The heart in particular has to work harder to keep blood flowing, which raises the risk of heart failure and other cardiovascular problems.
When is blood pressure considered too high?
Doctors talk about high blood pressure, known medically as hypertension, when blood pressure readings stay above a certain threshold over time. What matters is that the readings are not just high on one occasion, but are confirmed by repeated measurements. In a doctor's surgery, a blood pressure of 140/90 mmHg or above is considered a sign of hypertension. When measured at home with an upper arm monitor, the threshold is slightly lower: readings of 135/85 mmHg or above are classed as high blood pressure. Even more precise is the 24-hour blood pressure measurement, where readings above 130/80 mmHg during the day and above 120/70 mmHg at night are considered too high. These different thresholds exist because blood pressure can vary depending on the situation. Readings at home are often lower than in a doctor's surgery, and blood pressure normally drops at night. If these thresholds are regularly exceeded, a medical assessment should take place.
Causes and risk factors of hypertension
Hypertension usually develops due to multiple factors. On one hand, genetics play an important role. Having a family history of high blood pressure increases the risk of developing it. On the other hand, unhealthy lifestyle habits also have a significant effect on blood pressure. A diet high in salt, lack of physical activity, and being overweight are among the most common causes that drive blood pressure up. Chronic stress, excessive alcohol consumption, and smoking can also damage blood vessel walls and raise blood pressure further. As people get older, the risk of hypertension increases too, because blood vessels gradually stiffen and become less flexible.
Hypertension symptoms and consequences
High blood pressure is often called a "silent killer" because it frequently causes no clear symptoms and is only noticed once organ damage has already occurred. Some people occasionally report headaches, dizziness, or nosebleeds, though these symptoms do not necessarily point to hypertension. Over time, uncontrolled high blood pressure can lead to a wide range of complications. The heart has to constantly work against increased resistance, which causes the heart muscle to thicken, and the blood vessels can be damaged by the ongoing strain. These changes significantly raise the risk of heart attacks, strokes, and kidney disease.
Diagnosis and investigations
Because hypertension often causes no symptoms for a long period of time, regular blood pressure monitoring is essential. In a doctor's surgery, blood pressure is measured routinely, often across several appointments, to establish stable average readings. In addition to blood pressure measurement, further investigations can be carried out, such as blood tests to check kidney function and cholesterol levels, as well as an electrocardiogram (ECG). These diagnostic steps help to identify any damage to the heart and blood vessels at an early stage and to determine how severe the hypertension is.
Therapy and treatment
Treating hypertension is based primarily on a combination of lifestyle changes and, where necessary, medication. A healthy diet rich in fruit, vegetables, and wholegrains with reduced salt intake can lower blood pressure noticeably. Regular physical activity, weight loss, giving up tobacco, and moderate alcohol consumption are further key steps to keep blood pressure under control. For more severe hypertension, doctors often use various classes of blood pressure-lowering medicines, such as ACE inhibitors, beta-blockers, calcium channel blockers, or diuretics, to lower blood pressure effectively and reduce the risk of cardiovascular complications.
Target values: what do the new guidelines recommend?
The current guidelines from the European Society of Cardiology (ESC), the European Society of Hypertension (ESH), and the National Care Guideline (NVL) give clear recommendations on which blood pressure levels should be reached in order to protect the heart, blood vessels, and organs as well as possible. The general rule for all adults is that blood pressure should be brought below 140/90 mmHg. For younger people and patients with additional risk factors, such as diabetes or kidney disease, a target of below 130/80 mmHg is recommended, provided it is well tolerated. In older people over 65, a target of below 140/80 mmHg is usually sufficient, while for very elderly people over 80, decisions are made on an individual basis about how strictly blood pressure should be lowered. Balance is always important here. Keeping blood pressure as low as possible does protect blood vessels in the long term, but it must not cause side effects such as dizziness or an increased risk of falls. Target values should therefore always be agreed with the treating doctor and reviewed regularly.
Treatment: lifestyle changes are the foundation
Before medication is considered, lifestyle changes are the most important foundation for lowering high blood pressure. Studies show that consistent changes to daily habits can often improve blood pressure significantly, and in the early stages may even be enough to reach normal readings. A healthy diet plays a central role here. A low-salt, balanced diet with plenty of fruit, vegetables, wholegrains, and unsaturated fats is recommended. Those who want to lower their blood pressure also benefit from being mindful of fluid intake and avoiding heavily processed foods. Many people ask: Can high blood pressure be lowered without medication? The answer is yes. In many cases, blood pressure can be improved considerably through diet and exercise.
Regular exercise for high blood pressure is particularly effective. The ESC guideline recommends at least 150 minutes of aerobic exercise per week (for example brisk walking, cycling, or swimming) or alternatively 75 minutes of more intensive activity. In addition, 2 to 3 sessions of strength training per week are recommended, for example with simple exercises such as planks, sit-ups, or light weights. Small changes in daily life, such as taking the stairs instead of the lift, also help to lower blood pressure.
Alongside diet and exercise, stress reduction is also a key factor. Relaxation techniques such as yoga, meditation, or breathing exercises can help to stabilise blood pressure over the long term. Stopping smoking is equally important, as smoking directly damages blood vessels and further increases the risk of heart attack and stroke.
Those who actively adjust their lifestyle therefore have the best chance of lowering blood pressure naturally and significantly reducing the risk of further illness, often without needing to start medication straight away.
Hypertensive crisis - first aid
A hypertensive crisis is an acute emergency in which blood pressure suddenly reaches extremely high levels, raising the risk of life-threatening complications such as stroke or heart attack. Typical warning signs can include severe headache, nausea, chest pain, or shortness of breath. In this situation, it is essential to call the emergency services immediately. Until medical help arrives, the affected person should sit or lie down calmly to avoid additional strain, and try to relax. It is important not to underestimate the emergency, and to pass on all known information to the emergency responders, such as the most recently measured blood pressure readings and any medication being taken.
Living with high blood pressure (chronic hypertension)
Living with hypertension requires conscious and ongoing attention to health. Regular blood pressure checks and close communication with the treating doctor are essential to keep blood pressure stable and to detect possible complications early. Many people benefit from individual consultations that cover not only dietary changes but also stress management and exercise therapy. Through targeted measures and consistent lifestyle changes, a noticeable improvement in blood pressure can often be achieved, significantly reducing the risk of serious further illness. Building a supportive environment, for example by connecting with others in self-help groups, can also help to better manage the challenges of a long-term condition.
Hypertension is a widespread condition that, although it often causes no symptoms, carries serious health risks. With a combination of healthy eating, regular exercise, stress reduction, and medication where needed, blood pressure can often be well controlled. Early diagnosis and ongoing monitoring are of central importance to avoid long-term damage and to maintain quality of life. Keep yourself informed about your health, work closely with your doctor, and take proactive steps to look after your body. That way, even with hypertension, you can live an active and fulfilling life.
Scientific Sources
Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2023 ESH Guidelines for the management of arterial hypertension. Journal of Hypertension. 2024;42(1):194. DOI: https://doi.org/10.1097/HJH.0000000000003621
Meher M, Debnath N, Kadu NR, Ahmed B, et al. Risk Factors Associated With Hypertension in Young Adults. Journal of Multidisciplinary Healthcare. 2023. URL: https://pubmed.ncbi.nlm.nih.gov/37187665/
Andriolo V, Silva S, Chaves T, et al. Traditional risk factors for essential hypertension: analysis in the EPIC-Potsdam cohort. Scientific Reports. 2019. DOI: https://doi.org/10.1038/s41598-019-38783-5
Zhang Y, Wang Y, Wu J, et al. Distribution of risk factors of hypertension patients in different age groups: a community-based study in Tianjin, China. BMC Public Health. 2021;21:10250. DOI: https://doi.org/10.1186/s12889-021-10250-9
