Blood pressure (BP) is the term used to describe the pressure exerted on the arterial walls as blood flows through them, and blood pressure consistently higher than normal is referred to as hypertension. 

Blood pressure fluctuates throughout the day, rising on physical exertion or during stressful moments when the heart may pump harder. Age also influences blood pressure, as the walls of the blood vessels become harder and less elastic with age.

High blood pressure can adversely affect the heart, brain, kidneys, and eyes. The higher the BP levels, the greater the risk of developing health issues such as cardiovascular diseases, myocardial infarction, and stroke since high blood pressure can lower the elasticity of arteries which decreases the flow of blood and oxygen to the heart, leading to heart diseases, chest pain or angina, myocardial infarction, and heart failure.

High blood pressure can cause the arteries that supply blood and oxygen to the brain to burst or be blocked, resulting death of brain cells, causing a stroke and associated disabilities in speech, movement, and other basic activities and death. Having high blood pressure, especially in midlife, is linked to worsening cognitive function and dementia later in life. Hypertension can also lead to loss of vision, renal disorders and erectile dysfunction in men, and lower libido in women.

Risk factors for hypertension

Family history: Hypertension, especially essential hypertension, often has a genetic basis and may run in families. People with hypertensive first-degree relatives are at an increased risk of developing hypertension.

Medical history: Hypertension may be associated with diabetes mellitus, renal disorders, Cushing's syndrome, lupus, pheochromocytoma, or adrenal tumors.

Drugs: Drugs such as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, oral contraceptives, antidepressant medications, and drugs of abuse such as amphetamine, methamphetamine, and cocaine may cause hypertension.

Other factors: The risk of hypertension varies by age, gender, ethnicity, diet, lifestyle habits, cholesterol levels, pregnancy, inadequate sleep, stress, personality type, and presence of viral infections such as severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) and the associated coronavirus disease 2019 (COVID-19).

Diagnosis and management of hypertension

Hypertension is called the "silent killer" since it usually may not present with warning signs or symptoms; however, high blood pressure could cause shortness of breath during light physical activity, lightheadedness upon standing too fast, and falls.  Hypertension can be diagnosed by measuring BP readings using sphygmomanometers and BP monitors.

Lifestyle changes

Individuals can lower their blood pressure by making lifestyle changes such as by performing regular physical exercise (especially aerobic activities such as walking, biking, or swimming for ≥150 minutes weekly, about 30 minutes a day, five days per week), smoking cessation, diet modifications limiting sodium (salt) intake and management of alcohol, weight, stress, and blood glucose levels.

Alcohol

Men should not have more than two drinks a day, and women no more than one a day to lower their risk of hypertension. One drink is defined as one ounce of alcohol, five ounces of wine, or 12 ounces of beer. In addition, foods lower in fat, salt, and calories, such as skim or one percent milk, fresh vegetables and fruits, and whole-grain rice and pasta, are preferable for hypertensive individuals.

Diet

The optimal recommendation for salt in the diet is to have <1,500 milligrams of sodium per day.  Foods high in fat and salt such as butter and margarine, fatty meats, whole milk dairy products, fried foods, processed foods or fast foods, and salted snacks must be avoided. The DASH (dietary approaches to stop hypertension) diet may be followed to keep BP values under the normal range.