--- title: Hypertension description: What high blood pressure is, why it is dangerous, and how it is detected and treated. type: disease preset: hypertension aliases: - high blood pressure - HTN sources: - tier: guideline org: esc title: 2024 ESC Guidelines for the management of elevated blood pressure and hypertension year: 2024 doi: 10.1093/eurheartj/ehae178 url: https://doi.org/10.1093/eurheartj/ehae178 - tier: guideline org: minzdrav-rf title: Артериальная гипертензия у взрослых year: 2024 doi: 10.15829/1560-4071-2024-6117 url: https://cr.minzdrav.gov.ru/view-cr/62_3 - tier: guideline org: nice title: 'Hypertension in adults: diagnosis and management (NG136)' year: 2023 url: https://www.nice.org.uk/guidance/ng136 - tier: reference org: statpearls title: Essential Hypertension year: 2023 url: https://www.ncbi.nlm.nih.gov/books/NBK539859/ sources_checked: 2026-10-11 review: null --- Hypertension is persistently raised blood pressure measured in a healthcare setting: a systolic (upper) pressure of 140 mm Hg or higher and/or a diastolic (lower) pressure of 90 mm Hg or higher. Over time, high blood pressure damages the heart, brain, kidneys, eyes and blood vessels. The European guidelines call hypertension the most important modifiable risk factor for illness and death worldwide, both from heart and blood vessel disease and from all causes.

The European guidelines class an office blood pressure below 120/70 mm Hg as non-elevated.

In hypertension, blood pressure is persistently raised and over time damages the heart and blood vessels. Target organ damage includes left ventricular hypertrophy, an increase in the mass of its muscle.

## Why it happens Most people have no single clear cause: blood pressure rises because of a combination of factors. High blood pressure becomes more common with age. Excess weight, a lot of salt in food, drinking too much alcohol, smoking and an inactive lifestyle all contribute to raised blood pressure, and family history plays a part too. Less often, blood pressure rises because of another condition, such as a hormonal disorder. This is called secondary hypertension. High blood pressure during pregnancy and pre-eclampsia are covered in the article on [hypertension in pregnancy](../hypertension-in-pregnancy/). More than 90% of patients have essential (primary) hypertension; secondary forms are found in 5–10% of patients with hypertension. The European guidelines estimate the share of secondary hypertension at about 10% and name primary aldosteronism as a common form. Among the factors associated with hypertension, the Russian Ministry of Health guideline lists age, hereditary predisposition, overweight and obesity, excessive sodium intake (more than 5 g/day), alcohol misuse, smoking and physical inactivity. Pathogenesis involves activation of the sympathoadrenal system and the renin–angiotensin–aldosterone system (RAAS), increased cardiac output and circulating blood volume, and increased total peripheral vascular resistance. Target organ damage includes left ventricular hypertrophy, albuminuria and reduced GFR, increased arterial stiffness (carotid–femoral pulse wave velocity above 10 m/s), an ankle–brachial index below 0.9 and advanced retinopathy. ## Symptoms Most of the time, high blood pressure causes no symptoms at all. It is found by chance when blood pressure is measured. Sometimes there is a headache, dizziness or a pounding heartbeat, but these complaints are not specific: they cannot tell you whether your blood pressure is high. That is why it is worth having your blood pressure checked even when you feel well. Hypertension is predominantly an asymptomatic condition; in most cases it is detected on physical examination. Complaints, if present, are non-specific (headache, dizziness, palpitations). The danger of hypertension lies mainly in its complications: stroke (ischaemic and haemorrhagic), myocardial infarction, heart failure and renal failure. ## How it is diagnosed One measurement is not enough. The doctor measures blood pressure several times and usually asks you to measure it at home or to wear a device that records it over 24 hours. To check whether the heart, kidneys and eyes have been affected, blood and urine tests and an ECG are done, and the back of the eye is examined. The 2024 ESC guidelines define three categories of office BP: non-elevated (below 120/70 mm Hg), elevated (systolic 120–139 or diastolic 70–89 mm Hg) and hypertension (confirmed systolic ≥140 or diastolic ≥90 mm Hg). The ESC prefers out-of-office measurement to confirm the diagnosis; an average home BP of ≥135/85 mm Hg is equivalent to an office BP of ≥140/90 mm Hg. NICE recommends confirming the diagnosis with ambulatory blood pressure monitoring (ABPM), or home blood pressure monitoring (HBPM) if ABPM is unsuitable, when clinic BP is between 140/90 and 180/120 mm Hg. Under the Russian Ministry of Health guideline, hypertension is diagnosed by raised office BP at two separate visits (except in severe hypertension), and ABPM and HBPM help with diagnosis but do not replace repeated measurements in a healthcare setting. Severity classifications differ between guidelines. The Russian Ministry of Health guideline distinguishes grades 1–3 by office BP level. NICE distinguishes stage 1 (clinic BP 140/90 to 159/99 mm Hg and ABPM daytime average or HBPM average 135/85 to 149/94 mm Hg), stage 2 (clinic BP 160/100 mm Hg or higher but less than 180/120 mm Hg and ABPM daytime average or HBPM average 150/95 mm Hg or higher) and severe hypertension (clinic systolic ≥180 or diastolic ≥120 mm Hg). To assess target organ damage, NICE recommends a urine albumin:creatinine ratio and a reagent strip test for haematuria, HbA1c, electrolytes, creatinine, eGFR, total and HDL cholesterol, fundoscopy and a 12-lead ECG. ## How it is treated Treatment rests on a healthy lifestyle: less salt, enough physical activity, healthy eating, drinking alcohol in moderation and stopping smoking. Many people also need medicines that lower blood pressure. Which medicines are needed and how far to lower blood pressure is decided by the doctor together with the patient, taking into account age, other conditions and how well the treatment is tolerated. Lifestyle advice is recommended for everyone with suspected or diagnosed hypertension: sodium restriction, regular exercise, a healthy diet, reducing alcohol intake in those who drink excessively, stopping smoking and avoiding excessive caffeine. NICE advises against calcium, magnesium or potassium supplements as a method for reducing blood pressure. For step 1 drug treatment, NICE recommends an ACE inhibitor or an angiotensin II receptor blocker (ARB), or a calcium-channel blocker (CCB), depending on the patient's characteristics. The Russian Ministry of Health guideline stresses that combining drugs with different mechanisms lowers BP more effectively than monotherapy. Blood pressure targets differ between guidelines. The 2024 ESC guidelines recommend a target systolic BP of 120–129 mm Hg for adults receiving BP-lowering medication, provided treatment is well tolerated; for some patients (aged 85 or over, with moderate-to-severe frailty, limited life expectancy or symptomatic orthostatic hypotension) more lenient targets can be considered. NICE sets a clinic BP target below 140/90 mm Hg under the age of 80 and below 150/90 mm Hg from the age of 80. The target for an individual patient is chosen by their doctor. ## When to call an ambulance Very high blood pressure together with acute organ damage is a hypertensive crisis (also called a hypertensive emergency). It can be life-threatening and needs immediate medical care. Call your local emergency number (112 in the EU, 911 in the US and Canada, 999 in the UK) if, with high blood pressure, you develop chest pain, severe shortness of breath, sudden confusion or signs of a stroke. For more, see the article on [hypertensive crisis](../hypertensive-crisis/).