Written by Dimitrios Vrachatis, Specialist Cardiologist, PhD, National and Kapodistrian University of Athens.
What is hypertension?
Hypertension is abnormally high pressure in the body’s arteries. Blood pressure is the force exerted by flowing blood against arterial walls.
How common is it?
Worldwide estimates suggest 30–45% of people have hypertension, rising to over 60% above age 60.
The University of Athens ATTICA study estimated prevalence in Greece at approximately 38% of men and 24% of women.
Unhealthy lifestyles and population ageing are expected to increase these figures.
What causes hypertension?
In most cases, no specific cause is found. This is called primary or essential hypertension, usually appearing after age 35–40.
Earlier onset prompts investigation for conditions such as kidney disease, sleep apnoea or adrenal or thyroid disorders. If one is found, the condition is called secondary hypertension.
Can hypertension be prevented?
Most cases reflect genetic predisposition combined with lifestyle. Adopting healthy habits early, before disease appears, can prevent or delay it. These are the same lifestyle measures used in treatment, described below.
Why is high blood pressure harmful?
The higher the pressure, the harder the heart must work to supply the body. High pressure also accelerates vascular ageing, reducing elasticity through atherosclerosis or arteriosclerosis.
A simple analogy is the wear on car tyres from continually driving along a rough dirt road rather than a modern motorway.
Is blood pressure constant throughout the day?
The heart receives deoxygenated blood, pumps it to the lungs and then sends oxygenated blood into the arterial circulation. Arteries are not passive pipes: they adjust dynamically to maintain smooth flow to their smallest branches. Pressure therefore changes naturally with daily activities.
What symptoms does high blood pressure cause?
Contrary to common belief, hypertension has no specific symptoms, such as headache or facial redness, except when marked organ injury occurs, for example acute pulmonary oedema or hypertensive encephalopathy. It is therefore called a silent killer.
What are optimal and normal values?
Blood pressure has two values, measured in mmHg: systolic, the upper value, and diastolic, the lower value. Levels are classified as:
- Optimal: systolic below 120 and diastolic below 80 mmHg
- Normal: systolic 120–129 and/or diastolic 80–84 mmHg
- High-normal: systolic 130–139 and/or diastolic 84–89 mmHg
How is hypertension diagnosed?
Accessible methods allow timely, reliable diagnosis:
- Measurements under defined conditions at the clinic on two separate visits
- 24-hour ambulatory blood pressure monitoring
- Home measurements recorded in a diary
At what level is blood pressure considered high?
The threshold reflects the level at which treatment, with or without medication, is expected to provide more benefit than risk.
The cited European Society of Cardiology guidelines (2018) define:
- Clinic measurements: systolic at least 140 and/or diastolic at least 90 mmHg
- 24-hour monitoring: average systolic at least 130 and/or diastolic at least 80 mmHg. Daytime thresholds are 135/85 and night-time thresholds 120/70 mmHg.
- Home measurements: average systolic at least 135 and/or diastolic at least 85 mmHg
What are the risks and complications?
A temporary rise within limits is a normal response to exercise or stress. Persistently high pressure increases the risk of organ damage, including:
- Coronary disease and myocardial infarction
- Stroke
- Heart failure
- Atrial fibrillation
- Aneurysms
- Kidney failure
- Retinal damage
- Dementia
- Death
Hypertension is directly and indirectly one of the leading causes of death in the Western world.
What should I do if I have hypertension?
The first step is lifestyle change:
- Immediate, permanent smoking cessation
- Improve diet and limit salt to less than 5 g daily
- Eat more fruit, vegetables, fish, unsalted nuts and raw extra-virgin olive oil
- Eat less red meat
- Lose excess weight
- Exercise, ideally moderate aerobic activity for 30 minutes on 5–7 days each week
- Limit alcohol
- Reduce daily stress
If these measures do not work within 3–6 months, appropriate medication is needed.
If cardiovascular risk or blood pressure is particularly high, medication may start immediately alongside lifestyle measures.
How long will I need treatment and lifestyle changes?
Blood pressure control is a marathon, not a sprint.
Lifestyle measures advised by your cardiologist remain central and should continue lifelong.
Medication is also usually lifelong, protecting the cardiovascular system from chronic wear.
Occasional high readings can occur and should not cause alarm. Equally, the need for long-term treatment should not lead to inaction or poor adherence.
Strictly followed lifestyle changes can sometimes reduce medication, or even allow it to be stopped in very mild hypertension.
How is the right medicine chosen?
Several drug classes are available. They may be combined from the start or added gradually. Maximum effect can take 1–2 months, so discuss the plan with your cardiologist rather than becoming anxious.
The cardiologist selects the medicine or combination and gradually adjusts the dose to the target. Medical history and individual tolerability guide changes.
Even when more than two medicines are needed, single-tablet combinations can make adherence easier.
What is the treatment target?
For people receiving hypertension treatment, targets are set for both values:
Systolic Blood Pressure Target
- Age 65 or over: 130–139 mmHg
- Under 65: 120–129 mmHg
Diastolic Blood Pressure Target
- Generally below 80 mmHg.
What happens if I stop taking my medicines?
Pressure gradually returns towards its pretreatment level. Hypertension is not permanently cured like a bacterial infection: it is controlled and requires consistent treatment.
Should I take my medicines in the morning or evening?
Decide this with your doctor. The important point is taking treatment regularly without missed doses. Studies indicate that, in general, the exact time, morning or evening, does not determine the benefit of antihypertensive treatment.