Hypertension (High Blood Pressure)

Hypertension, or high blood pressure, is a condition in which the force of blood pressing against the artery walls remains consistently too high. Over time, this can damage the arteries and lead to serious complications such as heart attacks and strokes.

Cardiologists often call hypertension the “silent killer” because it usually causes no symptoms, yet damage is still happening inside the body.

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What is Blood Pressure?

Blood pressure is the measurement of the force of blood pushing against the walls of the arteries. It is recorded as two numbers:

• Systolic blood pressure (top number): pressure when the heart contracts and pumps blood.
• Diastolic blood pressure (bottom number): pressure when the heart relaxes between beats.

Blood pressure is measured in millimeters of mercury (mmHg).

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How Do I Know if I Have Hypertension?

The only way to know if your blood pressure is high is to have it measured. Hypertension usually doesn’t cause symptoms, so cardiologists recommend regular check-ups, even if you feel healthy.

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What is Considered High Blood Pressure?

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Blood Pressure Categories (Egyptian Hypertension Society)

Category	Systolic BP (mmHg)	And/or	Diastolic BP (mmHg)
Normal	< 130	AND	< 85
High Normal (Prehypertension)	130–139	AND	85–89
Grade I (Mild Hypertension)	140–159	OR	90–99
Grade II (Moderate Hypertension)	160–179	OR	100–109
Grade III (Severe Hypertension)	≥ 180	OR	≥ 110
Hypertensive Emergency	≥ 210	OR	≥ 120

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How Common is Hypertension?

Hypertension is very common.

• In Egypt, about 26.3% of adults aged 25 and older have hypertension (systolic ≥ 140 mmHg and/or diastolic ≥ 90 mmHg).
• Only about 37.5% of those with hypertension are aware of their condition.
• Around 23.9% receive treatment, and just 8% have their blood pressure under control.
• Globally, the World Health Organization (WHO) estimates that over 1.2 billion people aged 30 to 79 have hypertension.

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Symptoms and Complications

Symptoms

Most people with hypertension do not experience symptoms. However, when blood pressure reaches 180/120 mmHg or higher, possible symptoms include:

• Severe headache
• Heart palpitations
• Nosebleeds
• Shortness of breath

This is called a hypertensive crisis and requires immediate medical attention.

Complications

Untreated hypertension can cause:

• Coronary artery disease
• Stroke
• Heart attack
• Peripheral artery disease
• Kidney disease and kidney failure
• Eye damage
• Vascular dementia
• Complications during pregnancy

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Types of Hypertension

• Primary hypertension: the most common type (about 90% of cases). It develops gradually due to factors such as aging, poor diet, and lack of exercise.
• Secondary hypertension: caused by an identifiable medical condition or medication.

Other patterns include:

• White coat hypertension: high in a clinic, normal at home.
• Masked hypertension: normal in a clinic, high at home.
• Sustained hypertension: high in both settings.
• Nocturnal hypertension: elevated during sleep.

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Causes

Primary Hypertension

Results from a combination of factors, including:

• High sodium diet
• Lack of exercise
• Obesity or overweight
• Aging

Secondary Hypertension

Caused by specific conditions or drugs, such as:

• Kidney disease
• Obstructive sleep apnea
• Primary aldosteronism (Conn’s syndrome)
• Certain medications (immunosuppressants, NSAIDs, oral contraceptives)
• Recreational drug use (e.g., cocaine, amphetamines)
• Renal vascular diseases (e.g., renal artery stenosis)
• Tobacco use (smoking and vaping)

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Risk Factors

You are more likely to develop hypertension if you have:

• A family history of hypertension, cardiovascular disease, or diabetes
• Age over 55
• Being Black
• Overweight or obesity
• Chronic kidney disease, metabolic syndrome, sleep apnea, or thyroid disease
• Sedentary lifestyle
• High sodium diet
• Smoking or vaping

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Diagnosis

Hypertension is diagnosed by measuring blood pressure with an arm cuff. Cardiologists confirm the diagnosis if elevated readings are recorded on two or more occasions. Home blood pressure monitoring may also be recommended.

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Treatment

Lifestyle Changes

In some cases, lifestyle changes alone can lower blood pressure, especially in mild hypertension. These include:

• Maintaining a healthy weight
• Eating a balanced diet (e.g., the DASH diet, rich in fruits, vegetables, whole grains, and low-fat dairy)
• Reducing salt intake (ideally < 1500 mg/day)
• Increasing potassium intake through foods like bananas, avocados, and potatoes with skin
• Exercising regularly (at least 150 minutes of aerobic activity per week, plus resistance training)

Medications

If lifestyle changes are not enough, cardiologists prescribe medications. First-line options include:

• ACE inhibitors
• ARBs (Angiotensin II receptor blockers)
• Calcium channel blockers
• Diuretics

Sometimes, a combination of drugs is needed.

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Outlook

• People with primary hypertension usually need lifelong management.
• In secondary hypertension, blood pressure may return to normal after treating the underlying cause.

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Prevention

You can lower your risk of developing hypertension by:

• Following a healthy diet (such as DASH)
• Reducing sodium intake
• Staying physically active
• Maintaining a healthy weight
• Not smoking

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When to See a Cardiologist

• For regular yearly check-ups, even without symptoms.
• Go to the emergency room immediately if you experience symptoms of a hypertensive crisis, including:
  • Severe headache
  • Chest pain
  • Shortness of breath
  • Blurred vision
  • Palpitations
  • Anxiety
  • Dizziness
  • Nosebleeds
  • Vomiting