Hypertension — high blood pressure — is one of the most dangerous conditions in the world precisely because it almost never causes symptoms. It silently damages your heart, brain, kidneys, and blood vessels for years before anything obvious happens. Over 1.3 billion people worldwide have hypertension. Most do not know it. In Ghana, studies estimate that over 30% of adults are hypertensive — and the majority are undiagnosed.

Understanding Blood Pressure

Every time your heart beats, it pumps blood into your arteries. Blood pressure is the force that blood exerts on the walls of those arteries as it flows through them.

Blood pressure is measured as two numbers:

  • Systolic pressure (the top number) — the pressure when your heart beats and pushes blood out. Normal is below 120 mmHg.
  • Diastolic pressure (the bottom number) — the pressure when your heart rests between beats. Normal is below 80 mmHg.

A reading is written as systolic/diastolic — for example, 120/80 mmHg, which is read as "120 over 80."

Blood Pressure Categories

  • Normal: below 120/80 mmHg
  • Elevated: 120–129 / below 80 mmHg — lifestyle changes recommended
  • Stage 1 Hypertension: 130–139 / 80–89 mmHg — lifestyle changes; medication if risk is high
  • Stage 2 Hypertension: 140/90 mmHg or higher — lifestyle changes and medication
  • Hypertensive Crisis: above 180/120 mmHg — seek emergency care immediately

What High Blood Pressure Does to the Body

Imagine your arteries as rubber hoses. Under normal pressure, they are flexible, smooth, and elastic. Under persistently high pressure, the walls of the arteries undergo constant stress.

Over time, this causes:

  • The artery walls thicken and stiffen — a process called arteriosclerosis
  • The inner lining of arteries becomes damaged, making them more prone to plaque build-up — atherosclerosis
  • Narrowed arteries reduce blood flow to vital organs
  • The heart has to pump harder against this resistance, causing it to enlarge and eventually weaken

This is happening silently — no pain, no obvious symptoms — for years.

Complications — What Happens if Hypertension is Not Treated

Heart Attack

High blood pressure accelerates the build-up of fatty plaques (atherosclerosis) inside coronary arteries — the vessels that supply blood to the heart muscle. When a plaque ruptures, a blood clot forms and completely blocks the artery. The heart muscle is starved of oxygen. This is a heart attack (myocardial infarction). Hypertension doubles the risk.

Stroke

High pressure damages brain blood vessels in two ways. It accelerates atherosclerosis, leading to blockages (ischaemic stroke). Or it weakens vessel walls until they burst, causing bleeding in or around the brain (haemorrhagic stroke). Hypertension is the single most important preventable cause of stroke.

Kidney Failure

The kidneys contain thousands of tiny, fragile blood vessels that filter waste from the blood. High pressure damages these vessels, reducing the kidneys' ability to filter effectively. Over time, kidneys fail entirely — requiring dialysis or transplant. Hypertension is the second leading cause of kidney failure worldwide after diabetes.

Heart Failure

The heart muscle enlarges as it works harder to pump against high pressure. Eventually, the enlarged heart becomes weak and unable to pump effectively — a condition called heart failure. Fluid backs up into the lungs and legs. Breathlessness, leg swelling, and fatigue result.

Vision Loss

High pressure damages the tiny blood vessels in the retina (the back of the eye) — a condition called hypertensive retinopathy. In severe cases it causes bleeding and vision loss. It is also a risk factor for glaucoma and other eye conditions.

What Causes Hypertension?

Primary (Essential) Hypertension — 90% of Cases

No single identifiable cause. Develops gradually over years through a combination of:

  • Genetics — strong family history significantly increases risk
  • Age — arteries stiffen naturally with age; blood pressure tends to rise over time
  • High sodium (salt) intake — sodium causes the body to retain water, increasing blood volume and pressure
  • Excess weight — more body mass requires more blood supply; the heart works harder
  • Physical inactivity — inactive people have higher resting heart rates
  • Alcohol — heavy drinking raises blood pressure significantly
  • Smoking — nicotine raises blood pressure immediately and damages artery walls long-term
  • Chronic stress — stress hormones constrict blood vessels and raise heart rate
  • Poor sleep — sleep apnoea in particular is strongly linked to hypertension

Secondary Hypertension — 10% of Cases

Caused by an identifiable underlying condition. Important to identify because treating the cause can resolve the hypertension:

  • Kidney disease (most common cause of secondary hypertension)
  • Hormonal disorders — overactive adrenal glands, thyroid disorders
  • Obstructive sleep apnoea
  • Certain medications — contraceptive pills, NSAIDs, decongestants, stimulants
  • Narrowing of the aorta (coarctation)

Diagnosis and Monitoring

How Blood Pressure is Measured

A blood pressure cuff (sphygmomanometer) is placed around the upper arm. The cuff inflates to temporarily stop blood flow, then slowly deflates while the device detects pressure. The process takes about a minute and is completely painless.

For an accurate reading:

  • Sit quietly for 5 minutes before measuring
  • Feet flat on the floor, arm at heart level
  • Do not smoke, drink caffeine, or exercise in the 30 minutes before
  • Take at least two readings, one minute apart, and average them
  • Measure at the same time of day for consistency

A single high reading does not confirm hypertension — blood pressure naturally fluctuates. Hypertension is diagnosed after multiple elevated readings on separate occasions.

Treatment

Lifestyle Changes — Always First Line

  • Reduce salt — aim for less than 5g per day (about 1 teaspoon). Read labels — processed foods are the biggest source of hidden salt
  • DASH diet — Dietary Approaches to Stop Hypertension: rich in fruits, vegetables, whole grains, low-fat dairy, and lean protein; low in red meat, saturated fat, and sugar
  • Exercise — 150 minutes of moderate aerobic activity per week (brisk walking, cycling, swimming). Consistent exercise can lower systolic blood pressure by 5 to 8 mmHg
  • Weight loss — losing even 5kg can reduce blood pressure meaningfully
  • Limit alcohol — no more than 1 to 2 standard drinks per day
  • Stop smoking — blood pressure improves measurably within weeks of quitting
  • Manage stress — mindfulness, adequate sleep, and regular relaxation all help

Medications — When Lifestyle is Not Enough

Most people with Stage 2 hypertension need medication alongside lifestyle changes. Common drug classes include:

  • ACE inhibitors (e.g., lisinopril, enalapril) — relax blood vessels by blocking a hormone that causes constriction. Also protect the kidneys — first choice for people with diabetes or kidney disease
  • ARBs (e.g., losartan, valsartan) — similar to ACE inhibitors; used when ACE inhibitors cause a dry cough
  • Calcium channel blockers (e.g., amlodipine) — relax artery walls and reduce heart rate
  • Thiazide diuretics (e.g., hydrochlorothiazide) — help kidneys remove excess sodium and water, reducing blood volume
  • Beta-blockers (e.g., atenolol) — reduce heart rate and force of contraction

Many people need two or more medications to reach target blood pressure. This is normal — not a sign that treatment is failing.

Never Stop Medication Without Advice

A common and dangerous mistake: stopping blood pressure medication because you "feel fine." Blood pressure may be normal because the medication is working — not because the problem has resolved. Stopping suddenly can cause a dangerous rebound rise in pressure. Always consult your doctor before making any changes to your medication.

Hypertension is called the silent killer for a reason — it does its damage long before you feel it. But it is also one of the most preventable and treatable conditions in medicine. Check your blood pressure at least once a year if you are over 30. Know your numbers. 120 over 80 is the goal. Your heart, brain, and kidneys will thank you.