The 10 warning signs of high blood pressure – and what to do about it

Hypertension often shows no signs until it’s an emergency. Photo / 123RF

Chest pain, blurry vision, confusion and a shortness of breath, the symptoms of a hypertensive crisis cannot be missed. But hypertension itself – otherwise known as high blood pressure, where the force of blood cells pushing up against your arteries is consistently too high – sneaks up on the one in four of us that it affects.

It also does little to announce itself until it becomes an emergency. Hypertension is “a silent killer”, says Dr Semiya Aziz, an NHS GP and founder of Say GP. The condition can cause everything from “increased risk of heart attacks and strokes to vascular dementia and renal problems”.

“You would never know whether you had hypertension unless you had your blood pressure measured by a healthcare professional in a relaxed environment, where you haven’t been rushing around, so it can be really hard to detect,” Aziz says.

For this reason, everyone over 40 is advised by the NHS that they should get their blood pressure checked at least once every five years. But with factors such as rapid weight gain or stress raising the risk of hypertension, it’s important to know the warning signs between check-ups.

We asked Aziz to break down the telltale signs of hypertension, and reveal what you can do to lower your risk.

1. You’re overweight

Obesity has been shown to cause somewhere between 65 and 78% of all cases of primary hypertension – where blood pressure is dangerously high with no clear reason why, rather than being directly caused by another health condition such as sleep apnoea or a thyroid problem.

“Even being overweight for a short period of time after gaining a lot of weight quickly can raise your blood pressure to dangerous levels,” Aziz says.

Although there’s no specific weight range that would mark a cause for concern, the NHS’s BMI calculator suggests that anyone with a score over 25 weighs too much for their height.

Fortunately, “the risk of high blood pressure caused by being overweight disappears after someone loses enough weight to bring them back into a healthy range”, Aziz says. Losing just half a stone (3kg) is more than enough to lower your blood pressure, and having been overweight in the past puts you at no greater risk.

Losing just 3kg can significantly reduce high blood pressure. Photo / 123RF

2. You smoke (or used to)

Aside from causing an immediate temporary increase in blood pressure and heart rate, smoking also causes your risk of hypertension to go up, as it makes your arteries narrow and harden.

“We know that the nicotine in cigarettes raises blood pressure and can damage the walls of your blood vessels, which in conjunction with hypertension can increase the risk of heart attacks and strokes,” Aziz says.

People who still smoke have the highest risk of developing hypertension, research has found, while those who used to smoke are still at a higher risk than those who have never smoked at all.

“Quitting smoking is still an effective way to reduce your risk of hypertension overall,” Aziz says.

Smokers have a significantly higher risk of hypertension, even after quitting. Photo / 123RF

3. You’re aged above 60

The arteries in your body naturally stiffen with age, causing blood pressure to rise, even in those who have always lived very healthy lifestyles.

“Most commonly we see hypertension increase in people aged over 60,” Aziz says, “though risk also rises from the age of 40 so we recommend that people start receiving regular blood pressure tests then”.

As many as 60% of people aged over 60 have hypertension, a figure that rises to 65% of men and 75% of women aged over 70.

While there is little that you can do to counter your age, of course, it is key that you get your blood pressure checked regularly. “It’s common to feel fit and healthy and yet still have dangerously high blood pressure, and the only way you can know it is if you have your blood pressure read,” Aziz warns.

Blood pressure naturally rises with age, making regular check-ups vital. Photo / 123RF

4. You have a diet heavy in processed foods

Whether you’re slim or overweight, “if you’re eating the wrong foods, you increase your inflammatory markers, which causes low grade inflammation affecting your whole metabolic system – including your blood pressure”, Aziz says.

Multiple studies have linked a diet heavy in ultra-processed foods to high blood pressure. One piece of research involving 10,000 Australian women found that those who ate the most UPFs were almost 40 times more likely to develop high blood pressure.

To remedy this, Aziz recommends that you eat a diet “with lots of lean protein and healthy fats, as well as fruit and vegetables, and preferably low sodium”, as a high-salt diet can also increase hypertension risk in the long term.

A diet heavy in processed foods can increase the risk of hypertension by up to 40 times. Photo / 123RF

5. You drink alcohol three times a week

Heavy alcohol consumption “is a well-known cause of hypertension”, says Aziz. Drinking alcohol daily increases your risk of hypertension, even if it’s only one or two drinks.

“For men, that means drinking 14 units a week, or for four days in a row, while women are considered to be drinking too heavily if they have 7 units a week or drink for three days in a row,” she explains.

Fortunately, hypertension caused by drinking can be reversed when someone cuts down on their alcohol intake. Even people who drink very heavily, regularly having six drinks a day or more, can see their blood pressure significantly reduced by halving the alcohol they consume.

Drinking alcohol three days a week can increase your risk of high blood pressure. Photo / 123RF

6. You feel faint and dizzy

“Some individuals who have high blood pressure might complain of feeling light-headed and dizzy,” Aziz says. While this can be easy to pass off as normal, a sudden faint feeling “could indicate a spike in your blood pressure”.

In some cases, the narrow blood vessels in your ears can become damaged by high blood pressure, causing reduced blood flow through those areas and then poor balance.

However, sudden dizziness can also be a sign of a heart attack or stroke. If the dizziness is sudden or comes with chest pain, difficulty breathing and feeling of anxiety or doom, it’s important to phone for an ambulance straight away.

Persistent headaches at the base of the skull may indicate extremely high blood pressure. Photo / 123RF

7. Your chest hurts

Chest pain is another symptom of hypertension that can overlap with the symptoms of a heart attack or stroke.

“Persistent tightness, pressure or a feeling of strain in your chest can indicate hypertension as these are symptoms of angina, where there’s a temporary reduction in blood flow to the heart, which causes pain in the chest,” Aziz explains.

Angina can later lead to changes in your heart rhythm, which is another sign of hypertension. Both are “classic instances” where hypertension might be diagnosed.

Severe and sudden chest pain, however, can indicate a heart attack which needs emergency attention.

Chest pain is another symptom of hypertension. Photo / 123RF

8. You have a persistent headache

It’s easy to write off a headache as a minor ailment, but some kinds of persistent headache can indicate that your blood pressure is too high.

“Recurrent headaches with throbbing persistent pain beginning at the bottom of the skull” can indicate hypertension, Aziz says, “though this is more common when blood pressure is extremely high, such as in a hypertensive crisis”.

This sort of pain in your head can feel totally different to other headaches or migraines you might have experienced. Normal headaches are not thought to be directly caused by high blood pressure.

9. Your ears are buzzing

Tinnitus or a ringing in your ears has been associated with hypertension, especially in older patients. Some research suggests that around 44% of all those who have tinnitus also have hypertension.

Tinnitus that’s new or that has a pulsing sound, like your heartbeat, “can be associated with very high blood pressure levels”, Aziz says.

10. Your vision is blurry

Visual disturbances or “what we call retinopathy”, such as blurred or double vision, “can be caused by damage to the blood vessels in the eye from high blood pressure”, Aziz says.

Other vision changes caused by high blood pressure could include eye “floaters”, small specks that drift across a person’s vision, and in some cases vision loss, which can be sudden.

Sudden changes in vision are another sign that your symptoms have reached the level of an emergency and need to be treated at hospital.

Hypertension can damage the blood vessels in the eyes, leading to blurred vision or floaters. Photo / 123RF

How to treat and manage hypertension

In some cases, a person’s blood pressure can only be brought down to a safe level through medication. However, there are adjustments you can make to your lifestyle that lower your risk of developing hypertension or bring your blood pressure to a lower level.

• Eat a balanced diet that is low in salt and sodium (no more than 6g of salt per day)
• Exercise regularly, for at least two and a half hours every week
• Consider losing weight if you are overweight
• Limit your caffeine intake to no more than 4 cups of tea or coffee per day
• Take measures to lower your stress levels, such as practising breathing exercises or taking up a restorative exercise such as yoga or tai chi
• Get at least 7 hours of sleep every night