High Blood Pressure
High blood pressure is a cardiovascular condition characterized by persistently elevated blood pressure levels. If not properly diagnosed and treated, it can lead to serious cardiac and cerebrovascular complications.
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On this page
- What Is High Blood Pressure?
- What Are The Symptoms Of High Blood Pressure?
- How Do You Diagnose High Blood Pressure?
- How Do You Treat High Blood Pressure?
What Is High Blood Pressure?
Blood pressure is the force exerted by blood against the walls of the arteries, the blood vessels that carry oxygen-rich blood from the heart to all organs of the body.
Each blood pressure reading includes two values:
- Systolic pressure (the higher value): represents the pressure on artery walls during heart contraction.
- Diastolic pressure (the lower value): represents the pressure during the relaxation phase of the heart muscle, between beats.
According to the 2024 ESC/ESH Guidelines, blood pressure is classified as follows.
Normal Blood Pressure
Systolic pressure below 120 mmHg and diastolic pressure below 80 mmHg.
Elevated Blood Pressure
Systolic pressure between 120–139 mmHg and/or diastolic pressure between 70–89 mmHg.
In this category, blood pressure is still below the hypertension threshold but higher than optimal values. Without lifestyle changes, it may progress to hypertension over time.
Hypertension
Systolic pressure ≥140 mmHg and/or diastolic pressure ≥90 mmHg.
Hypertension is a condition in which blood pressure remains persistently elevated, forcing the heart to work harder to pump blood throughout the body.
Hypertensive Crisis
Systolic pressure >180 mmHg and/or diastolic pressure >120 mmHg.
Signs of a hypertensive crisis and possible organ damage include:
- Back or chest pain.
- Vision disturbances.
- Difficulty speaking.
- Numbness or muscle weakness.
- Shortness of breath.
A hypertensive crisis requires immediate medical attention.
What Are The Symptoms Of High Blood Pressure?
High blood pressure is often referred to as the “silent killer,” as most people do not experience noticeable symptoms even when blood pressure levels are high.
This makes it particularly dangerous: many individuals develop complications without being aware of the condition. According to the Italian National Institute of Health, 27% of people with high blood pressure in Italy are unaware of their condition.
When blood pressure is very high, nonspecific symptoms may occur:
- Dizziness or lightheadedness.
- Headache (often in the back of the head).
- Tachycardia (rapid heartbeat).
The onset of these symptoms requires prompt medical evaluation.
What Are The Risk Factors For High Blood Pressure?
The risk of developing high blood pressure increases with one or more predisposing factors:
Non-Modifiable Factors
- Advanced age.
- Genetic predisposition and family history.
- Male sex (higher prevalence in men until menopause in women).
Modifiable Lifestyle Factors
- Unbalanced diet high in sodium and low in potassium.
- Excessive alcohol consumption.
- Sedentary lifestyle and insufficient physical activity.
- Overweight and obesity.
- Smoking.
- Chronic unmanaged stress.
Medical Conditions That Increase Risk
- Diabetes mellitus.
- Kidney disease or renal failure.
- Sleep apnea.
- Certain cardiovascular conditions.
How Do You Diagnose High Blood Pressure?
The diagnosis of high blood pressure is based on a systematic clinical assessment that must exclude false readings (white coat hypertension) and confirm persistently elevated values over time.
Diagnostic Process
The first step is measuring blood pressure with a sphygmomanometer, performed by a healthcare professional under standardized conditions (after at least 5 minutes of rest, seated, with the arm at heart level).
For a correct diagnosis, blood pressure must be measured on multiple occasions, as a single elevated reading is not sufficient.
Supporting Tests
If high blood pressure is suspected, the physician may order additional tests to:
- Assess organ damage (cardiovascular and renal evaluation).
- Identify secondary causes of high blood pressure.
- Stratify overall cardiovascular risk.
Useful tests include:
- Blood tests – to assess metabolic profile, kidney function, and lipids.
- Urinalysis – to detect protein loss, indicating kidney involvement.
- Electrocardiogram (ECG) – to detect cardiac electrical abnormalities.
- Echocardiography – to evaluate heart structure and function.
- Renal ultrasound – to rule out renal artery stenosis or other kidney diseases.
- Ambulatory blood pressure monitoring (ABPM) – 24-hour monitoring during daily activities.
Importance Of Early Diagnosis
Early diagnosis makes it possible to:
- Start treatment before complications develop.
- Stratify cardiovascular risk using validated algorithms (SCORE2).
- Implement targeted prevention strategies.
Complications Of High Blood Pressure
If left undiagnosed and untreated, high blood pressure can cause significant damage to the heart, brain, kidneys, and other organs.
Heart-Related Complications
- Myocardial infarction.
- Angina pectoris.
- Heart failure.
- Ischemic heart disease.
Vascular Complications
- Atherosclerosis (arterial stiffening and narrowing).
- Peripheral artery disease.
- Aortic aneurysm.
Brain Complications
- Ischemic or hemorrhagic stroke.
Kidney Complications
- Chronic kidney disease.
- Renal failure.
Other Complications
- Vision loss due to hypertensive retinopathy.
- Sexual dysfunction (in both men and women).
Early prevention and treatment significantly reduce these risks.
How Do You Treat High Blood Pressure?
The treatment of high blood pressure is personalized and based on a comprehensive assessment of an individual’s cardiovascular risk, blood pressure levels, and the presence of other medical conditions. The therapeutic approach combines lifestyle measures and, when necessary, pharmacological therapy.
Lifestyle Changes
Lifestyle changes remain the cornerstone of high blood pressure management and should always be implemented, regardless of whether medications are used.
Interventions with proven effectiveness include:
Diet
- Follow a balanced diet rich in fruits and vegetables, low in sodium (salt), and high in potassium.
- Reduce the intake of saturated fats.
- Limit or avoid alcohol consumption.
Physical Activity
- Engage in regular physical activity (at least 150 minutes of moderate aerobic exercise per week).
- Include muscle-strengthening exercises.
Weight Management
- Maintain a healthy body weight (BMI between 18.5 and 24.9).
- Weight loss (even modest) is associated with significant reductions in blood pressure.
Stress Reduction
- Implement stress management techniques (meditation, yoga, mindful breathing).
- Ensure adequate nighttime rest.
Smoking Cessation
- Quitting smoking is an absolute priority due to its immediate cardiovascular benefits.
Pharmacological Therapy
When lifestyle modifications are not sufficient or cardiovascular risk is high, the physician prescribes pharmacological treatment. Antihypertensive medications act through different mechanisms to lower blood pressure.
The main classes of drugs include:
- ACE inhibitors and Angiotensin II Receptor Blockers (ARBs) – lower blood pressure by interfering with the renin-angiotensin-aldosterone system.
- Beta-blockers – slow the heart rate and reduce the force of cardiac contraction.
- Calcium channel blockers – relax blood vessels, facilitating blood flow.
- Diuretics – reduce circulating blood volume by eliminating sodium and water.
- Centrally acting agents – act on the central nervous system.
The choice of medication depends on the patient’s clinical history, tolerability, the presence of comorbidities, and potential drug interactions. According to the latest guidelines, combination therapy (two or more active agents) is often required to achieve blood pressure targets.
A crucial element of treatment is regular blood pressure monitoring and evaluation of therapeutic effectiveness. Patients should learn how to measure their blood pressure correctly (at home or in healthcare settings) and report any symptoms or unexpected changes to their physician.
How Can High Blood Pressure Be Prevented?
The best way to prevent high blood pressure is regular monitoring starting from the age of 18.
According to the 2024 ESC/ESH Guidelines, the recommended frequency of measurement is:
- Every 3–5 years between ages 18 and 39, in the absence of risk factors.
- At least once a year from age 40 onward or in the presence of risk factors.
In addition, adopting a healthy lifestyle from a young age is essential:
- Balanced diet.
- Regular physical activity.
- Maintaining a healthy weight.
- Avoiding smoking and excessive alcohol consumption.
- Effective stress management.
Prevention is often more effective than late treatment in reducing the overall burden of cardiovascular disease.
Reviewed May 2026.