Hypertension

For a lay person:

Hypertension, or high blood pressure, is when the force of blood pushing against the walls of your arteries stays too high over time. Think of it like the pressure in a garden hose that’s turned up too strong — it can damage the pipes (your blood vessels), heart, brain, kidneys, and other organs if left untreated. Most people feel no symptoms, which is why it’s called the “silent killer.” It’s very common and often linked to aging, family history, being overweight, eating too much salt, lack of exercise, or stress. The good news is it’s easy to check with a simple arm cuff and can usually be managed well with lifestyle changes and/or medication, greatly lowering the risk of heart attack, stroke, and other problems.

For a trained medical person:

Hypertension is a chronic condition defined by persistently elevated blood pressure (BP) levels that increase cardiovascular, cerebrovascular, renal, and other disease risk. Per the 2025 AHA/ACC and related guidelines (reaffirming the 2017 framework):

BP Categories (average of ≥2 careful readings on ≥2 occasions):

• Normal: <120 mm Hg systolic and <80 mm Hg diastolic
• Elevated: 120–129 mm Hg systolic and <80 mm Hg diastolic
• Stage 1 Hypertension: 130–139 mm Hg systolic or 80–89 mm Hg diastolic
• Stage 2 Hypertension: ≥140 mm Hg systolic or ≥90 mm Hg diastolic
• Hypertensive Crisis: >180 mm Hg systolic and/or >120 mm Hg diastolic (requires immediate evaluation; emergency if target-organ damage present)

Diagnosis requires confirmation with proper technique, including out-of-office measurements (home BP monitoring or ambulatory BP monitoring) to rule out white-coat or masked hypertension. Thresholds for out-of-office: awake mean ≥130/80 mm Hg or 24-hour mean ≥125/75 mm Hg generally correspond to office hypertension.

Classification:

• Primary (essential) hypertension (~90–95%): multifactorial (genetic, environmental, lifestyle).
• Secondary hypertension: identifiable cause (e.g., renal artery stenosis, primary aldosteronism, OSA, CKD, Cushing’s, pheochromocytoma, coarctation, drugs).

Pathophysiology: Increased peripheral vascular resistance and/or cardiac output, endothelial dysfunction, vascular remodeling, sympathetic overactivity, renin-angiotensin-aldosterone system activation, and inflammation.

Management goals: Target <130/80 mm Hg for most adults (universal goal in 2025 guidelines). First-line therapies include lifestyle modification (DASH diet, sodium <2,300 mg/day ideally <1,500 mg, weight loss, exercise, limited alcohol, smoking cessation) plus pharmacotherapy (thiazide/thiazide-like diuretics, ACEI/ARB, CCB, or combinations). Risk stratification uses tools such as the PREVENT equation. Screen for and treat secondary causes when indicated. Monitor for complications: hypertensive heart disease, HF, CAD, stroke, CKD, retinopathy, cognitive decline.

Hypertension remains the leading modifiable risk factor for global cardiovascular mortality.