High blood pressure (hypertension)
Also called: hypertension, high BP, raised blood pressure, HTN, essential hypertension
High blood pressure (hypertension) means the force of blood against your artery walls stays too high. It usually causes no symptoms, but over years it damages the heart, brain, kidneys and eyes. A simple blood pressure check finds it, and lifestyle changes plus medicines control it well.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Blood pressure is the force of blood pushing against the walls of your arteries (the tubes that carry blood from the heart). It is written as two numbers, for example 120/80. The first (systolic) number is the pressure when the heart beats. The second (diastolic) number is the pressure when the heart rests between beats. In most guidelines, hypertension means a reading of 140/90 or higher on more than one day. Some guidelines, including those used in the United States, call 130/80 or higher high. Readings between normal and these cut-offs are called elevated (raised) blood pressure, and the risk to health rises steadily as the numbers go up.
High blood pressure is very common. The World Health Organization estimates that about one in three adults aged 30 to 79 worldwide has it, and most of them live in low- and middle-income countries. Around four in ten do not know they have it, because it usually causes no symptoms. The only reliable way to find it is to measure it.
The good news is that hypertension can be controlled. Eating less salt, being active, keeping a healthy weight and not smoking all lower blood pressure. When these are not enough, safe and widely available medicines bring it down. Keeping blood pressure under control greatly reduces the chance of a heart attack, stroke or kidney failure later in life.
In Pakistan: what studies show
Surveys in Pakistan find high blood pressure in about half of adults: 53% in the 2013-2014 WHO STEPS survey and 46.2% in the 2016-2017 National Diabetes Survey. In a 2021 screening campaign, only 26.8% of people with high blood pressure had it under control.
- In the WHO STEPS household survey of adults in Pakistan (2013-2014), 53% had high blood pressure, counting people already taking blood pressure medicines.[1] (national survey, data 2013-2014)
- The second National Diabetes Survey of Pakistan (2016-2017, all four provinces) found high blood pressure in 46.2% of people tested, as reported in a 2023 review.[2] (national survey, data 2016-2017)
- At free blood pressure checks for volunteers across Pakistan in 2021, 58.2% of adults screened had high blood pressure, and 69.1% of them already knew about it.[3] (cross-sectional screening survey, data 2021)
- In the same 2021 screening, only 26.8% of people with high blood pressure had it under control.[3] (cross-sectional screening survey, data 2021)
- In the 2019 screening campaign, only 19.8% of people found to have high blood pressure had it under control.[4] (cross-sectional screening survey, data 2019)
- A 2018 review that combined 18 Pakistani studies (published 1990-2017) estimated that 26.34% of people aged 15 and over had high blood pressure.[5] (systematic review/meta-analysis, data studies from 1990-2017)
- The same review found high blood pressure was more common in towns and cities (26.61%) than in villages (21.03%).[5] (systematic review/meta-analysis, data studies from 1990-2017)
- One study of healthy adults in Islamabad, using 24-hour urine collection, estimated they ate about 8.64 grams of salt a day, which the authors describe as high.[6] (cross-sectional, data not stated)
Pakistan guidance: Management of Hypertension in Women. Pakistan Hypertension Clinical Practice Guidelines (Go Red for Women-Pakistan Task Force / Scientific Council Pakistan, with the Pakistan Cardiac Society (published in Pakistan Heart Journal), 2023)[7]; Pakistan Hypertension League treatment recommendations (cited in a 2023 review; original document not opened) (Pakistan Hypertension League, 2015 (as cited))[2]
What we do not know yet: Estimates disagree (26.34% pooled from older studies, 46.2% in NDSP, 53% in STEPS, 58.2% in volunteer screening) because of different age groups, definitions and sampling; there is no recent representative national survey of awareness and control, no province-by-province breakdown was found, and salt intake data come from one small Islamabad study. The WHO Global report country profile for Pakistan was not opened, and the NDSP hypertension figure was taken from a review rather than the original paper.
Pakistan studies cited
- Rafique I, Saqib MAN, Munir MA, et al. Prevalence of risk factors for noncommunicable diseases in adults: key findings from the Pakistan STEPS survey. Eastern Mediterranean Health Journal 2018;24(1):33-41. doi:10.26719/2018.24.1.33. Open source
- Elahi A, Ali AA, Khan AH, et al. Challenges of managing hypertension in Pakistan - a review. Clinical Hypertension 2023;29:17. doi:10.1186/s40885-023-00245-6. Open source
- Memon FS, Beaney T, Bai K, et al. May Measurement Month 2021: an analysis of blood pressure screening results from Pakistan. European Heart Journal Supplements 2024;26(Suppl 3):iii68-iii70. doi:10.1093/eurheartjsupp/suae052. Open source
- Memon F, Beaney T, Clarke J, et al. May Measurement Month 2019: an analysis of blood pressure screening results from Pakistan-South Asia. European Heart Journal Supplements 2021;23(Suppl B):B117 (from the page's article link). Open source
- Shah N, Shah Q, Shah AJ The burden and high prevalence of hypertension in Pakistani adolescents: a meta-analysis of the published studies. Archives of Public Health 2018. doi:10.1186/s13690-018-0265-5. Open source
- Saqib MAN, Rafique I, Ansar M, et al. High Salt Intake Implications as Risk Factor for Hypertension and Comparison of Three Salt Estimation Methods: Findings from Islamabad, Pakistan. Pakistan Heart Journal 2021 (issue; published online January 2022);54(4):309-314. doi:10.47144/phj.v54i4.2156. Open source
- Nasim S, Sirichand P, Imran N, et al. Management of Hypertension in Women. Pakistan Hypertension Clinical Practice Guidelines. Pakistan Heart Journal 2023;56(Suppl 1):S1-S22. doi:10.47144/phj.v56iSupplement_1.2455. Open source
Symptoms
- Usually no symptoms at all, even when the pressure is high; most people find out at a routine check
- Headache, usually only when the pressure is very high
- Dizziness or light-headedness
- Blurred or changed vision
- Nosebleeds that happen with very high readings
- Chest pain or an irregular heartbeat with very high readings
- Shortness of breath
- Feeling sick (nausea) or vomiting with very high readings
- Buzzing in the ears, anxiety or confusion when the pressure is dangerously high
Causes and risk factors
Causes
- Primary (essential) hypertension: no single cause is found. It develops slowly over years from a mix of genes, ageing and lifestyle. This is by far the most common type.
- Stiffening of the arteries with age, which raises the pressure inside them
- Too much salt and too little potassium in the diet, which makes the body hold on to water
- Secondary hypertension: a separate illness raises the pressure, such as chronic kidney disease, narrowing of the kidney artery, hormone (gland) problems of the adrenal or parathyroid glands, or obstructive sleep apnoea (breathing stops briefly during sleep)
- Some medicines, including birth control pills, steroids, some cold and migraine remedies, diet pills and some mental health medicines
- Pregnancy, including pre-eclampsia (high blood pressure with protein in the urine after the middle of pregnancy)
What makes it more likely
- Getting older, especially over 65
- A parent, brother or sister with high blood pressure
- Being overweight or obese
- A diet high in salt, saturated fat and processed food, and low in fruit and vegetables
- Not being physically active
- Smoking or using other tobacco products
- Drinking too much alcohol
- Diabetes or chronic kidney disease (about six in ten people with diabetes also have high blood pressure)
- Long-term stress, anxiety or depression, and exposure to polluted air
Complications
High blood pressure quietly damages blood vessels all over the body. In the heart it can cause angina (chest pain from poor blood flow), heart attack, heart failure (a weak heart that cannot pump well), irregular heart rhythms and valve disease. In the brain it can burst or block an artery and cause a stroke, and high pressure in middle age is linked to memory problems and dementia later on. In the kidneys it leads to chronic kidney disease and, in time, kidney failure. It can also harm the small blood vessels of the eye and reduce sight, reduce blood supply to the legs, and weaken the main artery (aorta) so that it bleeds. Heart disease and stroke are among the leading causes of death, and uncontrolled hypertension is one of their biggest drivers.
When to see a doctor
- A reading of 180/120 or higher together with any of the symptoms below: get emergency care now
- Severe headache with confusion, blurred vision or a nosebleed that will not stop
- Chest pain, pressure or tightness, or an irregular or racing heartbeat
- Sudden shortness of breath or difficulty breathing
- Nausea and vomiting with a very high reading
- High blood pressure found during pregnancy, especially with headache, swelling or vision changes
- Home readings that stay high even though you are taking your medicines: see your doctor promptly, not urgently
Diagnosis
Blood pressure is measured with a cuff on the upper arm. Because it changes through the day, one high reading is not enough. The diagnosis is made when readings are high on at least two different days. Doctors now prefer to confirm the diagnosis with readings taken outside the clinic, either with a home monitor or a small device worn for 24 hours (ambulatory monitoring). This picks up white-coat hypertension (pressure that is only high at the clinic) and masked hypertension (pressure that is normal at the clinic but high at home). If you have an irregular heartbeat (atrial fibrillation), the doctor should measure by hand rather than with an automatic machine.
Once high blood pressure is confirmed, the doctor checks for damage it may already have caused and for other heart risks. This usually means a blood test for kidney function, blood sugar and cholesterol, a urine test, an ECG (heart tracing), and an eye examination. An echocardiogram (ultrasound of the heart) or a kidney ultrasound may be added. People diagnosed before the age of 40 should be checked for a secondary cause such as kidney, gland or sleep problems.
Treatment
- Start with lifestyle changes for everyone: cut salt, eat more fruit and vegetables, lose weight if needed, move more, stop smoking and limit alcohol. For mildly raised pressure with no other risks, these alone may be tried for about three months.
- Start medicine when pressure is high and lifestyle changes are not enough, or straight away if the pressure is very high or you already have diabetes, kidney disease, heart disease or signs of organ damage. Your doctor decides which medicine and the dose.
- The first medicine is usually one of four main classes: an ACE inhibitor, an angiotensin receptor blocker (ARB), a calcium channel blocker, or a thiazide-type diuretic (water tablet).
- If one medicine is not enough, a second and then a third from a different class is added. Most people end up needing two or more. Combination tablets that hold two medicines in one pill make this easier.
- Aim for the target your doctor sets. Below 140/90 is the usual goal; below 130/80 is advised for people with heart disease, diabetes, kidney disease or high heart risk, and the 2024 European guideline aims for a systolic (top) number of 120 to 129 when this is tolerated. Older or frail people may have a gentler target.
- Keep taking the medicines every day, even when you feel well, and attend follow-up visits. If a side effect troubles you, tell your doctor so the medicine can be changed rather than stopped.
- If pressure stays high on several medicines, your doctor will check that the tablets are being taken, look for a secondary cause, and may refer you to a heart or kidney specialist.
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| ACE inhibitors | a first-choice medicine; protects the kidneys and heart, commonly used when there is diabetes or kidney disease | Enalapril (37 brands), Lisinopril (21 brands), Ramipril (7 brands) |
| Angiotensin receptor blockers (ARBs) | a first-choice medicine that works in a similar way to ACE inhibitors and is often used when an ACE inhibitor causes a dry cough | Losartan (129 brands), Valsartan (9 brands), Telmisartan (25 brands), Irbesartan (3 brands), Candesartan Cilexetil (4 brands) |
| Calcium channel blockers | a first-choice medicine that relaxes the artery walls; widely used alone or in combination | Amlodipine (175 brands), Nifedipine (17 brands), Verapamil (14 brands) |
| Thiazide-type diuretics (water tablets) | a first-choice medicine that helps the kidneys remove extra salt and water; often the second or third medicine added | Hydrochlorothiazide (10 brands), Indapamide (3 brands) |
| Combination tablets (two medicines in one pill) | used when one medicine is not enough; fewer pills a day makes it easier to keep taking treatment | Amlodipine + Valsartan (37 brands), Amlodipine + Perindopril (1 brand), Losartan + Hydrochlorothiazide (37 brands), Telmisartan + Amlodipine (184 brands), Valsartan + Hydrochlorothiazide (8 brands), Lisinopril + Hydrochlorothiazide (27 brands) |
Also used (not yet in our price list): chlorthalidone, felodipine
Self-care and prevention
Self-care
- Use less salt: avoid adding salt at the table, and cut down on pickles, papad, chips, processed meat and packaged snacks, which carry most of the hidden salt
- Eat more fruit, vegetables, lentils and whole grains, and less fried food and saturated fat
- Be active for at least 150 minutes a week, for example a brisk 30-minute walk on five days, and sit less
- Lose weight if you are overweight; even a small loss helps lower pressure
- Stop smoking and all tobacco products, including naswar and sheesha, and avoid alcohol or keep it very low
- Check your blood pressure at home with a validated upper-arm monitor: sit quietly for five minutes first, and bring the monitor to appointments so its readings can be checked
- Take your medicines every day at the same time, do not skip doses or share tablets, and do not stop them without asking your doctor
- Manage stress with sleep, prayer or meditation, walking and time with family, and keep other conditions such as diabetes under control
Prevention
- Keep your weight in a healthy range
- Eat a low-salt diet rich in fruit and vegetables
- Be physically active most days
- Do not smoke or use tobacco, and avoid alcohol
- Have your blood pressure checked at least once a year after the age of 40, and earlier if it runs in your family or you have diabetes
- Control blood sugar and cholesterol if they are raised
Common questions
What blood pressure reading is normal?
A reading below 120/80 is normal. Readings from 120/80 up to the hypertension cut-off are called elevated and are a warning to improve your lifestyle. Most guidelines call 140/90 or higher high blood pressure; some use 130/80. Your doctor will tell you which target applies to you.
Can high blood pressure be cured?
Primary hypertension cannot usually be cured, but it can be controlled for life. Lifestyle changes lower it, and medicines keep it in the safe range. If a secondary cause such as a kidney or gland problem is found and treated, the pressure may return to normal.
Do I have to take blood pressure tablets for the rest of my life?
Most people do. The medicines work only while you take them, and the pressure goes back up when they stop. Some people who lose a lot of weight and change their diet can reduce their tablets, but only with the doctor's agreement and regular checks. Never stop on your own.
I feel fine. Do I really have high blood pressure?
Yes, feeling fine does not mean the pressure is normal. Hypertension almost never causes symptoms until it has already damaged the heart, brain or kidneys. That is why it is called a silent condition. Trust the readings, not how you feel.
Is home blood pressure monitoring useful?
Yes. Home readings often show your true pressure better than clinic readings, and guidelines now recommend them to confirm the diagnosis and to follow treatment. Use an automatic upper-arm monitor with the right cuff size, rest for five minutes before measuring, and write the readings down for your doctor.
Sources
- WHO. Hypertension (2025).
- NICE. Hypertension in adults: diagnosis and management (NG136) - Overview (2019).
- NICE. Hypertension in adults: diagnosis and management - [C] Evidence review for initiating treatment (2019).
- ESC. 2024 ESC Guidelines for the Management of Elevated Blood Pressure and Hypertension (2024).
- ACC. 2024 ESC Guidelines for Management of Elevated BP and Hypertension: Key Points - American College of Cardiology (2024).
- CDC. About High Blood Pressure | High Blood Pressure | CDC (2026).
- MedlinePlus. High blood pressure in adults - hypertension: MedlinePlus Medical Encyclopedia (2025).
- JPMA. Assessment of the risk factors of hypertension among adult & elderly group in twin cities of Pakistan (2017).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
StrokeCoronary artery disease (angina)Heart failureType 2 diabetes mellitusHigh cholesterol (dyslipidaemia)