Hypertension (high blood pressure) treatment

The American College of Cardiology and the American Heart Association define normal blood pressure as a reading below 120/80 mmHg.

A systolic blood pressure reading between 120 and 129 mmHg and a diastolic blood pressure not above 80 mmHg is categorised as elevated blood pressure. This may mean you have an increased risk of developing hypertension in the future and should take preventative measures such as losing weight, eating a healthy diet and taking regular exercise. 

Stage 1 hypertension is diagnosed when your systolic blood pressure is between 130 and 139 mmHg, or your diastolic blood pressure is between 80 and 89 mmHg.

Stage 2 hypertension is defined as a systolic blood pressure of 140 mm Hg or higher, or a diastolic blood pressure of 90 mmHg or above.

Hypertensive crisis

A hypertensive crisis is a medical emergency that is defined as a blood pressure higher than 180/120 mmHg. 

Seek urgent medical attention if you experience symptoms of a hypertensive crisis such as sudden chest pain, shortness of breath, nausea, drowsiness and light-headedness.

Many people with high blood pressure don't experience any symptoms and may be unaware that they have it. This is why it’s important to get your blood pressure checked regularly. 

If your blood pressure is very high, you may experience symptoms including: 

• Chest pain 
• Severe headache
• Shortness of breath or difficulty breathing 
• Feeling dizzy, faint or lightheaded 
• Nausea
• Vomiting
• Changes to your vision including blurred vision 
• Anxiety
• Confusion
• Buzzing in your ears
• Frequent nosebleeds
• Abnormal heart rhythm (arrhythmias)

There are two types of hypertension, each with a different cause.

Essential (primary hypertension)

Essential, or primary hypertension is the most common type of hypertension and develops gradually over time. While there is no single cause for essential hypertension, certain factors can increase your risk of high blood pressure including:

• Age: Essential hypertension is more common in people over 65 years of age
• Family history of hypertension
• Race and ethnic background: Hypertension is more common in people of black African, black Caribbean and South Asian descent
• Drinking excessive amounts of alcohol
• A sedentary lifestyle
• Being overweight or obese
• Smoking
• Chronic stress
• Having diabetes or pre-diabetes (metabolic syndrome)
• A diet high in salt, sugar and some types of fats

Secondary hypertension

Secondary hypertension is high blood pressure that occurs due to another issue such as a health condition or medication. It often starts suddenly and can be more severe than essential hypertension. 

Some causes of secondary hypertension include:

• Kidney disease
• Complications of diabetes 
• Obstructive sleep apnoea
• Pregnancy
• Obesity
• Congenital heart problems (heart problems present at birth)
• Thyroid problems
• Adrenal gland problems
• Some medications including non-steroidal anti-inflammatory drugs (NSAIDs), decongestants, and hormonal contraceptives

As it often has no symptoms until it is severe, hypertension often goes undiagnosed and therefore untreated for many years. 

Untreated hypertension can cause serious damage to your heart, brain, kidneys, eyes and arteries, and can contribute to other conditions, such as erectile dysfunction. 

Some complications of untreated hypertension include problems with your:

• Heart: Such as angina, heart failure, cardiac arrhythmias and heart attack
• Brain: Including stroke, transient ischaemic attack (mini-stroke), and dementia
• Kidneys: High blood pressure can damage the blood vessels in the kidneys leading to kidney failure
• Eyes: Hypertension can damage the blood vessels in the eyes and lead to damage to the retina (retinopathy) and nerves
• Arteries: High blood pressure over time can lead to narrowing and hardening of the arteries and a weakening of the artery wall (aneurysm)

At your first consultation, you will be seen by a consultant cardiologist, a doctor specialising in conditions affecting the heart. 

Your consultant will ask you about your symptoms, general health, medical and family history, and any medications you take regularly. They will also ask you some questions about your lifestyle including your diet, alcohol intake, stress level, whether you smoke and how much exercise you take. Your consultant will perform a physical examination, including listening to your heart with a stethoscope and measuring your blood pressure.

Will I need any tests or scans?

Blood pressure varies from moment to moment due to physical exertion, stress levels, eating habits and time of day. To gain a clearer picture of your blood pressure levels over time, your consultant may ask you to measure your blood pressure yourself at home and return to the clinic with the results. 

Alternatively, your consultant may arrange for you to have a procedure called ambulatory blood pressure monitoring. This involves wearing a blood pressure cuff and a monitor which records your blood pressure at regular intervals over 24 hours. 

Your consultant may also order other tests including blood and urine tests to check your general health and an electrocardiogram (ECG) to measure the electrical activity in your heart.

How is hypertension diagnosed?

Hypertension is diagnosed if your systolic blood pressure is consistently 140 mmHg and your diastolic blood pressure 90 mmHg or higher.

Why is this first consultation so important?

Your first appointment is important as it’s where you’ll meet your consultant, the doctor responsible for your care. Your consultant will take time to get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have. 

At Circle Health Group, we want you to be as well-informed and comfortable as possible during your hypertension treatment, so please discuss any questions or concerns with your consultant during your appointment. 

At the end of your appointment, your consultant will explain the results of any tests to you and provide a diagnosis. They will create a personalised treatment plan tailored to your individual needs and explain all that this entails including how to measure your blood pressure yourself, any potential side effects of your medication and when you need to return for a follow-up appointment.

Hypertension is usually treated with a combination of lifestyle changes, and medication. In some cases, a minimally invasive procedure called renal artery denervation may be recommended.

Lifestyle changes

Adopting a healthy lifestyle is vital in reducing your risk of developing high blood pressure and managing the condition after you are diagnosed.

Lifestyle changes such as eating a healthy diet, stopping smoking and losing weight reduce factors that can increase blood pressure, lower your risk of complications such as a heart attack or stroke, and improve your overall health and quality of life.

Your consultant can advise you on what lifestyle changes you need to make. They may also refer you to other health professionals such as physiotherapists, dietitians,  counsellors and consultants specialising in other areas of medicine.

Some lifestyle changes to help manage hypertension include:

• Take regular exercise: The NHS recommends at least 150 minutes of moderate-intensity activity per week. This may include brisk walking, cycling, water aerobics, swimming or hiking
• Eat a healthy balanced diet: Reduce salt, sugar and processed foods and eat more fruits, vegetables, lean protein and whole grains. 
• Lose weight if needed or maintain a healthy weight: Our team of expert dieticians can offer advice and support on losing weight safely
• Stop smoking: Your consultant can advise you on this or refer you for further support if needed
• Manage stress: Yoga, meditation, breathing exercises and other relaxation techniques can help you reduce your stress levelsGet the right amount of sleep: Most people need between seven and nine hours of sleep per night

Medication

If your blood pressure is very high, has not improved with lifestyle changes or you have an increased risk of complications, such as a stroke or heart attack, your consultant may prescribe medication to help lower your blood pressure.

There are several types of medications used to treat hypertension. Your consultant will decide on the most appropriate medication or medications for you depending on factors such as how high your blood pressure is, your age, ethnicity, lifestyle, general health, and any other medical conditions you have.

Some medications to treat hypertension include:

ACE inhibitors

ACE inhibitors such as ramipril, captopril and lisinopril reduce the effect of angiotensin-converting enzyme (ACE), an enzyme that controls blood pressure hormones. Inhibiting this enzyme causes your blood vessels to relax and dilate (widen), lowering your blood pressure.

Angiotensin-2 receptor blockers (ARBs)

ARBs work in a similar way to ACE inhibitors and lower your blood pressure by inhibiting blood pressure hormones. Your consultant may prescribe ARBs if you experience side effects after taking ACE inhibitors. Examples of ARBs include candesartan, losartan, and valsartan.

Diuretics

Commonly known as ‘water pills’, diuretics work by increasing urine production in your kidneys and removing excess salt and fluid from your body. This reduces your blood volume and slows blood flow, which in turn, lowers your blood pressure. Thiazide diuretics such as indapamide, hydrochlorothiazide, and bendroflumethiazide are normally the first type of diuretics prescribed for hypertension.

Calcium channel blockers

Calcium channel blockers like amlodipine, felodipine and nifedipine prevent calcium from entering the cells of your arteries and heart. This causes your artery walls to relax and dilate, increasing blood flow and lowering your blood pressure.

Renal artery denervation (renal ablation)

If your hypertension has not improved with lifestyle changes and medication, a new, minimally invasive procedure called renal artery denervation may be recommended.

This procedure involves inserting a thin, flexible tube called a catheter into your renal arteries through an artery in your groin. An electric current is then used to destroy the nerves, reducing the nerve stimulation and other mechanisms that can cause hypertension.

Like all medications, drugs used to treat hypertension can cause side effects in some people. Most side effects are mild and improve on their own over time. 

Tell your consultant about any other medications you’re taking, including over-the-counter medicines and supplements, before you start your blood pressure medication. Some other medications can interact with the way your blood pressure medication works, making it less effective or increasing the risk of side effects.

Your consultant will explain all the potential side effects before you start your medication. 

If you experience unpleasant side effects, or if your side effects are getting worse, or not getting better, speak to your consultant. It’s often possible to alter your dose, try another medication, or take a combination of medications that is more suitable for you. Never stop taking your blood pressure medication or change your prescribed dose without first checking with your consultant. 

The possible side effects of blood pressure medications vary depending on the type of medication, but some common side effects include:

• Cough
• Feeling dizzy or lightheaded
• Headache
• Nausea
• Vomiting
• Diarrhoea
• Constipation
• Erectile dysfunction
• Anxiety
• Palpitations, irregular or rapid heart rate
• Drowsiness or weakness
• Fatigue
• Leg cramps
• Skin rash
• Difficulty sleeping
• Unintended weight changes

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about hypertension treatment, book your appointment online today or call a member of our team directly on 0808 189 5499.

Content reviewed by Circle in-house team in November 2024. Next review due November 2026.

High blood pressure NHS 

High blood pressure British Heart Foundation  

How should I diagnose hypertension? National Institute for Health and Care Excellence (NICE)  

Medications for high blood pressure Blood Pressure UK