What is blood pressure?

Blood pressure (BP) — is an important indicator of the cardiovascular system. It reflects the force with which blood presses against the walls of the arteries as it flows through them.

Blood pressure consists of two components:

1. Systolic BP — the pressure during heart contraction, when blood is pushed into the aorta.
2. Diastolic BP — the pressure during heart relaxation between contractions.

🔹 Normal for a healthy adult: ≤120/80 mmHg
At the same time:

• the upper value = systolic,
• the lower value = Diastolic BP.

📌 Advice for readers: regular home blood pressure monitoring helps detect abnormalities even before symptoms appear.

Why does blood pressure change throughout the day?

BP is not a constant value — it fluctuates under the influence of different factors.

Main reasons for temporary changes:

• Physical activity — during physical activity, the heart works harder, and blood pressure rises.
• Emotions and stress — the hormones adrenaline and cortisol increase blood pressure.
• Age — with age, blood vessels become stiffer, which naturally leads to an increase in blood pressure.
• Bad habits:
  • smoking,
  • alcohol consumption,
  • caffeine within 30 minutes before measurement.

Measurement errors:

• crossed legs,
• arms hanging down instead of being at chest level,
• talking during the measurement.

⚠️ All of this can lead to falsely elevated readings.

When is blood pressure considered high?

🏥 International and national societies

ACC/AHA (American College of Cardiology / American Heart Association, USA)

• Two leading cardiology organizations in the United States.
• In 2017, they lowered the threshold for diagnosing hypertension to 130/80 mmHg., which sparked a lot of debate.
• Their classification is considered more “strict” and is aimed at early prevention.

ESC/ESH (European Society of Cardiology / European Society of Hypertension)

• The European Society of Cardiology and the European Society of Hypertension.
• Their 2018 guidelines are more “lenient” compared to the American ones.
• Their classification includes a category “high normal blood pressure” (130–139 / 85–89), which is important for prevention.

JNC (Joint National Committee, USA)

• The Joint National Committee on Hypertension.
• In 2003, it released JNC 7 Report, which for a long time was considered the “gold standard.”
• It is still used in some countries today.
• It introduced the term “prehypertension”.

RSC (Russian Society of Cardiology, Russia)

The classification is close to the European one (ESC/ESH).

The main scientific cardiology organization in Russia.

In 2020, it released updated clinical guidelines.

Why is high blood pressure dangerous?

Hypertension is often called the “silent killer”, because it often develops without symptoms. Yet it has a destructive impact on the entire body.

Possible complications:

• Heart: coronary artery disease, myocardial infarction, heart failure.
• Brain: stroke, transient ischemic attacks, dementia.
• Kidneys: chronic kidney disease, nephrosclerosis.
• Eyes: retinopathy, vision loss.
• Reproductive system: erectile dysfunction in men, decreased libido in women.

👉 The higher the blood pressure, the greater the risk of complications.

Types of hypertension

Primary (essential) hypertension

• The most common form (up to 90–95% of cases).
• The causes do not have a single specific basis.
• Associated with:
  • age-related vascular changes,
  • lifestyle,
  • heredity.

Secondary hypertension

• It occurs as a consequence of other diseases:
  • kidney diseases,
  • endocrine disorders,
  • use of medications (NSAIDs, hormones, antidepressants).
• Requires mandatory identification of the cause.

Risk factors for developing hypertension

Genetics and family history

If parents or close relatives had hypertension, the risk of developing the disease is significantly higher.

Medical conditions

• diabetes mellitus,
• kidney diseases,
• endocrine disorders (Cushing's syndrome, adrenal tumors).

Medications

Some medications can increase blood pressure:

• NSAIDs (nonsteroidal anti-inflammatory drugs),
• corticosteroids,
• oral contraceptives,
• psychostimulants (amphetamine, methamphetamine).

Lifestyle and nutrition

• excessive consumption of salt and fats,
• lack of potassium and fiber,
• smoking and alcohol,
• low physical activity.

Age, sex, and ethnicity

• Men are more often affected by hypertension before the age of 55.
• In women, the risk increases after menopause.
• Higher predisposition in people of African and Caribbean descent.

Psycho-emotional factors

• chronic stress,
• lack of sleep,
• type A personality (increased anxiety).

Current data: COVID-19

Studies show that coronavirus infection can increase blood pressure due to disruption of the renin–angiotensin–aldosterone system.

Diagnosis of hypertension

Main methods

• Blood pressure measurement using a sphygmomanometer (manual or electronic).
• Ambulatory blood pressure monitoring (ABPM) — helps detect blood pressure fluctuations throughout the day.

Symptoms (not always present)

• headaches,
• dizziness,
• shortness of breath on exertion,
• weakness and fatigue.

❗️But more often, hypertension does not cause any symptoms.

How to lower blood pressure: lifestyle changes

Physical activity

• Minimum 150 minutes of aerobic exercise per week.
• Beneficial activities include walking, swimming, and cycling.
• You can start with 10–15 minutes a day, gradually increasing the load.

Diet

• To use the DASH diet (rich in vegetables, fruits, and whole grains).
• Limit salt intake: less than 1,500 mg of sodium per day.
• Avoid fatty meats, fast food, and salty snacks.

Alcohol and smoking

• Men: no more than 2 servings of alcohol per day.
• Women: no more than 1 serving.
• Complete smoking cessation is a mandatory requirement.

Weight and stress management

• Weight normalization reduces blood pressure by 5–10 mmHg.
• Relaxation practices (such as yoga and breathing exercises) help reduce stress.

Medication treatment of hypertension

If lifestyle changes do not help, the doctor prescribes medication.

Main groups:

1. ACE inhibitors (enalapril, captopril).
2. Angiotensin II receptor blockers (ARBs) (losartan, valsartan).
3. Calcium channel blockers (CCBs) (amlodipine, nifedipine).
4. Diuretics (indapamide, chlorothiazide).

📌 The choice of medication depends on the patient's age, comorbidities, and tolerance.

❗️Important: self-medication for hypertension is unacceptable.

📚 Literature and sources

1. American College of Cardiology / American Heart Association (ACC/AHA).
   2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.
   https://www.ahajournals.org/doi/10.1161/HYP.0000000000000065
2. World Health Organization (WHO).
   Hypertension fact sheet, 2023.
   https://www.who.int/news-room/fact-sheets/detail/hypertension
3. European Society of Cardiology (ESC) / European Society of Hypertension (ESH).
   2018 ESC/ESH Guidelines for the management of arterial hypertension.
   https://academic.oup.com/eurheartj/article/39/33/3021/5079119
4. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7).
   https://www.ncbi.nlm.nih.gov/books/NBK9630/
5. Russian Society of Cardiology.
   Clinical guidelines “Arterial Hypertension in Adults” (2020).
   https://scardio.ru/content/Guidelines/klinicheskie-rekomendacii-arterialnaya-gipertenziya-2020.pdf
6. Whelton PK, Carey RM, Aronow WS, et al.
   High Blood Pressure in Adults: Report from the ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline Writing Committee. Hypertension. 2018;71(6):e13–e115.
   https://pubmed.ncbi.nlm.nih.gov/29133356/
7. Zhou B, Perel P, Mensah GA, Ezzati M.
   Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nature Reviews Cardiology. 2021;18(11):785–802.
   https://www.nature.com/articles/s41569-021-00559-8