High Blood Pressure (Hypertension)

1. What is high blood pressure? Your blood pressure is the force of your blood pushing against the walls of your arteries. It is recorded as two numbers: Systolic pressure / Diastolic pressure For example: 120/80 mmHg Systolic blood pressure The top number. It represents the pressure in your arteries when your heart contracts and pumps blood. Diastolic blood pressure The bottom number. It represents the pressure while your heart relaxes between beats.

2. What is hypertension? Hypertension means that your blood pressure remains abnormally high over time. According to WHO, hypertension in adults is diagnosed when measurements on two different days show: Systolic ≥140 mmHg and/or diastolic ≥90 mmHg. However, blood pressure exists on a continuum. Cardiovascular risk gradually increases as blood pressure rises rather than suddenly appearing at one particular number. The 2024 ESC guideline therefore also recognises an "elevated blood pressure" category of 120–139 systolic or 70–89 diastolic.

3. Blood pressure categories There are different classification systems. American Heart Association classification

  • Normal: below 120/80
  • Elevated: 120–129 systolic and below 80 diastolic
  • Stage 1 hypertension: 130–139 systolic OR 80–89 diastolic
  • Stage 2 hypertension: 140 or higher systolic OR 90 or higher diastolic
  • Severe hypertension: above 180 systolic and/or above 120 diastolic — seek urgent care

The European/WHO threshold for hypertension remains ≥140/90 mmHg, so don't assume that one isolated reading of 130/80 means you have established hypertension. Diagnosis requires appropriate repeated measurements and clinical assessment.

4. Why is high blood pressure dangerous? The problem isn't usually that you can feel the pressure. The problem is that persistently high pressure can gradually damage blood vessels and organs. Over time, hypertension can contribute to:

  • coronary artery disease
  • heart attack
  • heart failure
  • stroke
  • kidney disease
  • vision problems
  • peripheral arterial disease
  • cognitive impairment
  • vascular dementia
  • damage to the arteries WHO describes hypertension as a major cause of premature death worldwide and identifies heart, brain and kidney disease among its major complications.

5. Why does high blood pressure damage the heart? When blood pressure remains high, the heart has to work harder to pump blood against greater resistance. Over time this can contribute to: High blood pressure → increased workload on heart → thickening/enlargement of heart muscle → eventual impaired heart function. Hypertension also contributes to damage within the arteries, increasing the risk of atherosclerosis and coronary artery disease. This can ultimately lead to:

  • angina
  • heart attack
  • heart failure
  • abnormal heart rhythms

6. How does hypertension cause a stroke? High blood pressure is one of the major modifiable risk factors for stroke. Persistently high pressure can damage and stiffen the arteries supplying the brain. This can contribute to: Ischaemic stroke A blood vessel becomes blocked. Haemorrhagic stroke A weakened blood vessel ruptures and bleeds. This is one of the main reasons controlling blood pressure is so important.

7. How does it affect the kidneys? Your kidneys contain millions of tiny blood vessels that filter your blood. High blood pressure can damage these vessels. This can create a vicious cycle: High blood pressure → kidney damage → reduced kidney function → greater difficulty controlling blood pressure → further kidney damage. Eventually, severe or prolonged hypertension can contribute to chronic kidney disease and kidney failure.

8. Does high blood pressure cause symptoms? Usually, no. This is one of the most important things to understand. A person can have significantly elevated blood pressure and feel completely normal. That's why hypertension is often called a "silent" condition. You shouldn't use:

  • headaches
  • dizziness
  • feeling stressed
  • feeling tired as a reliable way of determining whether your blood pressure is high. The only reliable way to know is to measure it.

9. What causes high blood pressure? Most adult hypertension is primary (essential) hypertension. That means there isn't one single identifiable cause. Instead, multiple factors contribute. These can include: Age Blood pressure tends to increase with age. Genetics Having close relatives with hypertension increases your risk. Excess body weight Higher body weight can increase the workload on the cardiovascular system. High sodium intake High dietary salt can increase blood pressure, particularly in salt-sensitive individuals. Physical inactivity Regular physical activity helps regulate blood pressure. Alcohol Excessive alcohol intake can raise blood pressure. Smoking Tobacco damages blood vessels and increases cardiovascular risk. Poor diet A diet low in fruits and vegetables and high in sodium and unhealthy fats can increase risk. Chronic kidney disease Sleep apnoea Diabetes and metabolic disease Stress Chronic stress can contribute indirectly through hormonal effects and behaviours such as poor sleep, inactivity, alcohol use and unhealthy eating. WHO and AHA identify many of these as important modifiable or non-modifiable risk factors.

10. Can another medical condition cause high blood pressure? Yes. This is called secondary hypertension. Potential causes include:

  • kidney disease
  • renal artery disease
  • obstructive sleep apnoea
  • primary aldosteronism
  • thyroid disorders
  • certain adrenal disorders
  • some medications
  • certain hormonal conditions Secondary hypertension is particularly important to consider when blood pressure:
  • develops suddenly
  • is unusually severe
  • is difficult to control
  • occurs at an unusually young age
  • becomes resistant to several medications Your doctor may investigate these possibilities when appropriate.

11. How is hypertension diagnosed? One blood-pressure reading usually isn't enough to establish a diagnosis. Your healthcare professional may use: Office measurements Blood pressure measured during a consultation. Home blood-pressure monitoring You measure your BP repeatedly at home. Ambulatory blood-pressure monitoring A portable device measures your blood pressure at regular intervals over approximately 24 hours. This can help identify: White-coat hypertension Blood pressure is high in a medical setting but normal outside it. Masked hypertension Blood pressure appears normal in the clinic but is elevated outside. NICE recommends confirming suspected hypertension using ambulatory blood-pressure monitoring where appropriate, or home monitoring when ambulatory monitoring is unsuitable or declined.

12. How should you measure your blood pressure at home? For a more reliable reading:

  • Avoid exercise, caffeine and smoking shortly beforehand.
  • Empty your bladder.
  • Sit quietly for several minutes.
  • Keep your back supported.
  • Keep both feet flat on the floor.
  • Rest your arm at approximately heart level.
  • Use an appropriately sized cuff.
  • Don't talk while measuring.
  • Take repeated readings rather than relying on one number.
  • Record the results. Your healthcare professional can advise you on the exact home-monitoring schedule.

13. What tests might your doctor perform? If hypertension is diagnosed, your doctor may assess: Cardiovascular risk Looking at your overall risk of:

  • heart attack
  • stroke
  • cardiovascular disease Kidney function Blood and urine testing can look for kidney damage. Blood glucose To identify diabetes or impaired glucose metabolism. Cholesterol To assess cardiovascular risk. ECG An electrocardiogram may be used to assess the heart. Eye examination Long-standing hypertension can damage small blood vessels in the retina. NICE specifically recommends assessing cardiovascular risk and looking for target-organ damage in people with hypertension.

14. How is high blood pressure treated? Treatment generally combines lifestyle measures and medication when indicated. Lifestyle measures These include:

  • reducing sodium/salt intake
  • eating a healthy diet
  • increasing physical activity
  • achieving/maintaining a healthy weight
  • limiting alcohol
  • stopping smoking
  • addressing sleep problems
  • managing other conditions such as diabetes and high cholesterol WHO recommends at least 150 minutes of moderate-intensity aerobic activity per week or 75 minutes of vigorous activity, plus muscle-strengthening activity on at least two days per week.

15. What medications are used? Several major medication groups are used. ACE inhibitors Examples include:

  • enalapril
  • lisinopril
  • ramipril They reduce the activity of the renin-angiotensin system and help relax blood vessels. ARBs Examples:
  • losartan
  • telmisartan
  • valsartan Calcium-channel blockers Examples:
  • amlodipine
  • felodipine Thiazide/thiazide-like diuretics Examples:
  • hydrochlorothiazide
  • chlorthalidone
  • indapamide Different people respond differently, and medication selection depends on factors such as age, kidney function, diabetes, cardiovascular disease, pregnancy status and other medications. WHO lists ACE inhibitors, ARBs, calcium-channel blockers and diuretics among common antihypertensive medicines.

16. Can lifestyle change lower blood pressure? Yes. Lifestyle changes can produce meaningful reductions in blood pressure. The most important areas are: Salt Reducing excessive sodium intake can lower blood pressure. WHO recommends keeping salt intake low, with a target of less than approximately 5 g of salt per day (equivalent to less than 2 g sodium) for adults. Exercise Regular aerobic and resistance exercise can help. Weight If someone is overweight, even modest weight loss can improve blood pressure. Diet A diet rich in:

  • vegetables
  • fruit
  • legumes
  • whole grains
  • nuts
  • healthy proteins and lower in excess sodium and highly processed foods can help. Alcohol Reducing excessive alcohol consumption can lower blood pressure. Smoking Stopping smoking is extremely important for cardiovascular risk, although the relationship between smoking and an individual BP reading is more complicated than simply saying smoking causes hypertension.

17. What happens if you leave high blood pressure untreated? Hypertension can gradually cause target-organ damage. Over years, untreated hypertension can increase the risk of: Heart → coronary artery disease → heart attack → heart failure Brain → stroke → transient ischaemic attacks → cognitive impairment Kidneys → chronic kidney disease → kidney failure Eyes → hypertensive retinal damage → vision problems Arteries → atherosclerosis → peripheral arterial disease The good news is that treating hypertension substantially reduces cardiovascular risk.

18. What is a hypertensive emergency? This is very important. If your blood pressure is around or above 180/120 mmHg, repeat the measurement after resting briefly. If it remains that high, you need urgent medical assessment, even if you feel okay. If extremely high blood pressure is accompanied by symptoms suggesting acute organ damage, this can be a hypertensive emergency. Seek emergency medical care immediately if you have very high BP with symptoms such as:

  • chest pain
  • shortness of breath
  • severe headache
  • weakness or numbness
  • difficulty speaking
  • confusion
  • sudden vision changes
  • severe back pain
  • loss of consciousness These can indicate stroke, heart problems or other acute organ damage.

19. High blood pressure and menopause Since you've been asking about menopause, this is particularly relevant. Blood pressure often increases during midlife and after menopause. This isn't simply because "menopause causes hypertension." Ageing, weight changes, reduced physical activity, changes in vascular function and the loss of oestrogen all occur around the same period. The menopause transition is therefore an important time to start paying closer attention to:

  • blood pressure
  • cholesterol
  • blood glucose
  • waist circumference
  • weight
  • physical activity
  • sleep
  • cardiovascular risk This is particularly important because cardiovascular disease becomes a major health concern after menopause.

20. What should you track? If you're monitoring your health during perimenopause/menopause, I would keep a record of: Blood pressure

  • systolic
  • diastolic
  • date/time
  • resting heart rate
  • whether the measurement was at home or clinic Weight/body composition
  • weight
  • waist circumference
  • physical activity Lifestyle
  • exercise
  • salt intake
  • alcohol
  • smoking
  • sleep Medical factors
  • cholesterol
  • HbA1c/glucose
  • medications
  • family history of cardiovascular disease This gives your doctor a much better picture than a single BP reading.

Key takeaway High blood pressure is usually silent, but it can gradually damage the heart, brain, kidneys, eyes and blood vessels. The most important things are: Measure it → confirm it properly → assess your cardiovascular/kidney risk → make lifestyle changes → use medication when indicated → monitor regularly. And because you're looking at this in the context of menopause, blood pressure is one of the health markers worth monitoring throughout perimenopause and postmenopause, alongside weight/waist, cholesterol, glucose, bone health and sleep.

Medical sources World Health Organization (WHO) — Hypertension Excellent primary source for definition, diagnosis, risk factors, symptoms, complications, prevention and treatment. The current fact sheet was updated 25 September 2025. WHO — Hypertension fact sheet NICE — Hypertension in Adults: Diagnosis and Management (NG136) Major evidence-based clinical guideline covering diagnosis, home/ambulatory monitoring, treatment, BP targets, cardiovascular risk and lifestyle management. It was updated 26 February 2026. NICE — Hypertension in adults: diagnosis and management European Society of Cardiology — 2024 Hypertension Guidelines Current major European guideline covering the diagnosis and management of elevated BP and hypertension. ESC — 2024 Guidelines for Elevated Blood Pressure and Hypertension American Heart Association — Blood Pressure Categories Useful explanation of BP categories, diagnosis and what different readings mean. American Heart Association — Blood Pressure Readings American Heart Association — High Blood Pressure Overview of causes, risk factors, complications and prevention. American Heart Association — What is High Blood Pressure?