High blood pressure, or hypertension, is often called the ‘silent killer’ because it rarely shows symptoms until significant damage is done.
Whether you’ve just received a high reading or are looking to optimise your cardiovascular health, understanding the numbers is the first step toward control.
Blood pressure is measured in millimeters of mercury (mmHg) and consists of two numbers: systolic (the pressure when your heart beats) and diastolic (the pressure when your heart rests).
Whilst ‘normal’ BP varies by age and health status, the general clinical categories are:
| Category | Reading (mmHg) | Action Required |
| Healthy/Normal | <135/85 | Maintain healthy lifestyle |
| Stage 1 Hypertension | ≥140/90 | Repeat checks; lifestyle changes; possible meds |
| Stage 2 Hypertension | ≥160/100 | Medical treatment recommended promptly |
| Severe Hypertension | ≥180/120 | Seek urgent medical attention |
Note: For adults under 70, a consistent home reading of 135/85 mmHg or higher is the threshold for a formal medical assessment.
Effective management requires a multi-pronged approach combining lifestyle, diagnostics, and, if necessary, pharmacology.
1. Evidence-Based Lifestyle Changes
Lifestyle modification is the first-line treatment for everyone. Small changes can lead to a significant drop in mmHg.
Reduce Salt Intake Significantly: Aim for less than 5g per day. Excess sodium causes the body to retain fluid, increasing pressure. Do not put salt in or on your food. Use no salt stock if recipe needs it.
DASH Approach: Focus on fruit, vegetables, whole grains, and lean proteins while minimising saturated fats.
Move More: Aim for 180 minutes of moderate aerobic activity (brisk walking, cycling) per week.
Lose weight if you are overweightor obese: Achieving a BMI under 30 kg/m² significantly reduces the strain on your heart.
Limit Alcohol & Quit Smoking: Alcohol should be kept under 14 units/week. Smoking cessation is vital as nicotine damages vessel walls and spikes BP instantly.
2. Identifying Secondary Causes
Sometimes (in 10% of people), high blood pressure is a symptom of another condition.
Treating the root cause can often resolve the hypertension. Common causes include:
Chronic Kidney Disease (CKD): Particularly Stage 3B or worse.
Pregnancy: Preeclampsia requires specialist obstetric monitoring.
Hormonal Imbalances: Conditions like Cushing’s or Conn’s syndrome or other adrenal issues.
3. Medication (Pharmacotherapy)
If 2-3 months of lifestyle change isn’t enough, your doctor may prescribe one or more of the following:
ACE Inhibitors (e.g. Ramipril): Often the first choice for those under 55 or people with diabetes.
Calcium Channel Blockers (e.g. Amlodipine): Typically preferred for those over 55 or of Afro-Caribbean descent.
ARBs (e.g. Losartan): An alternative if ACE inhibitors cause side effects like a dry cough.
Thiazide-like Diuretics (e.g. Indapamide): Help the kidneys remove excess water and salt.
Note 1. Some patients need 2 or even 3 drugs to control BP. If 3 drugs are not controlling BP you need to see a hospital specialist. See below.
Do not be frightened of medication. The risks are low and there are few side-effects.
Note 2. Usually such medication is long-term. A few patients can wean themselves off it with continued lifestyle changes.
4. Fluid Management & Advanced Care
For patients with Heart Failure or advanced CKD, Loop Diuretics (such as Furosemide) may be used to manage fluid overload, which worsens BP.
These drugs are often used with a 1.5L fluid restiction. Do not do this unless asked to by your doctor.
In severe cases of CKD (Stage 4 or 5), uncontrolled hypertension can sometimes be a clinical indicator that dialysis is required.
5. Consistent Monitoring and Targets
The goal isn’t just to lower BP, but to hit a specific target to prevent stroke and heart attack.
General Target: 130/80 mmHg.
Diabetic Target: Closer to 120/70 mmHg, if tolerated.
Top Tip: Use nurse- or pharmacist-led clinics for U&E (Urea and Electrolytes) blood tests, at least every 6 months, to ensure your kidneys are handling your medication well.
If your blood pressure remains high despite being on three or more medications, you have Resistant Hypertension.
At this stage, a referral to a Cardiologist, Nephrologist, or Endocrinologist is necessary to find the underlying secondary cause, or use specialist stronger medication.
Lowering blood pressure is a marathon, not a sprint.
Through a combination of salt reduction, weight management, and the right medication, most people can reach a safe range and significantly lower their risk of life-altering complications.
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