Chronic Hypertension

What chronic hypertension means

Blood pressure is the force of blood against artery walls, written as systolic (when the heart beats) over diastolic (between beats). US guidelines classify adult readings as:

"Chronic" separates long-term hypertension from short-lived rises due to pain, stress or illness, and in pregnancy from gestational hypertension, which starts after 20 weeks. Our general hypertension page covers basic information on high blood pressure.

Causes and risk factors

Primary (essential) hypertension accounts for about 90% of cases. It develops gradually from a mix of:

• age and family history
• excess weight
• high salt and low potassium intake
• physical inactivity
• alcohol
• poor sleep and obstructive sleep apnea
• chronic stress

Secondary hypertension has an identifiable cause, suspected with onset under 30, sudden worsening or resistance to three medicines:

• chronic kidney disease and renal artery stenosis
• primary aldosteronism (excess aldosterone), a common and under-recognized cause
• thyroid disease, Cushing syndrome, pheochromocytoma
• medicines: NSAIDs, decongestants, birth control pills with estrogen, some antidepressants, stimulants

Symptoms

Most people feel completely well, which is why high blood pressure is called a "silent killer." Very high blood pressure can cause headaches, nosebleeds, breathlessness, chest pain, vision changes and confusion. Do not rely on symptoms. Measure.

Diagnosis

• Repeated measurements on at least two occasions.
• Home or ambulatory blood pressure monitoring confirms the diagnosis and detects white-coat hypertension (high only in the clinic) and masked hypertension (normal in the clinic, high at home).
• Initial tests: blood sugar, cholesterol, kidney function and electrolytes, urine for protein, thyroid function, and an ECG.
• Screening for primary aldosteronism is now recommended more widely, especially with resistant hypertension or low potassium.

Treatment

Lifestyle

Each measure lowers systolic pressure by several points, and together they can match one medicine:

• reduce sodium to under 1,500 to 2,300 mg a day
• follow a DASH-style diet rich in fruit, vegetables, whole grains and low-fat dairy
• increase potassium from food, unless you have kidney disease
• lose weight if overweight
• exercise about 150 minutes a week
• limit alcohol
• stop smoking

Medicines

First-line choices include thiazide diuretics, ACE inhibitors, angiotensin receptor blockers (ARBs) and calcium channel blockers. Many people need two or more, often combined in a single pill. Most adults are treated to a target below 130/80.

Chronic hypertension in pregnancy

Chronic hypertension affects a growing number of pregnancies. It raises the risk of preeclampsia (about 1 in 4 to 1 in 3 will develop it), placental abruption, poor fetal growth, preterm birth and stillbirth.

• Before pregnancy: see your doctor to plan. ACE inhibitors, ARBs and some other drugs must be stopped because they can harm the developing baby. Switch before conception or as soon as pregnancy is confirmed.
• Treatment: the ACOG guideline supports treating to below 140/90, based on the CHAP trial. Preferred medicines include labetalol, extended-release nifedipine and methyldopa.
• Low-dose aspirin from 12 to 28 weeks (ideally before 16 weeks) is recommended to reduce preeclampsia risk, as advised by your clinician.
• Monitoring: regular blood pressure checks, urine protein, blood tests, and ultrasound scans of fetal growth.
• Delivery: usually planned between 37 and 39 weeks depending on control and complications.
• After birth: blood pressure often peaks 3 to 6 days postpartum. Keep checking it at home and continue follow-up. Many medicines are safe while breastfeeding.

Complications

Uncontrolled chronic hypertension damages blood vessels and organs over years:

• heart attack and hypertensive heart disease, including heart failure
• stroke and vascular dementia
• kidney damage
• hypertensive retinopathy and vision loss
• peripheral artery disease and aortic aneurysm
• atrial fibrillation

Outlook

Chronic hypertension is usually lifelong but highly controllable. Lowering systolic pressure by 10 mm Hg cuts the risk of heart attack, stroke and heart failure by about 20 to 40%. Regular home monitoring and medication adherence are key.

Frequently asked questions

What is chronic hypertension?

Chronic hypertension is blood pressure that stays high over time, 130/80 mm Hg or higher by US guidelines. In pregnancy, it means high blood pressure (140/90 or higher) that started before pregnancy or was found before 20 weeks.

Is chronic hypertension dangerous in pregnancy?

It increases the risk of preeclampsia, placental problems, poor fetal growth and preterm birth. With planning, safe medicines, low-dose aspirin and close monitoring, most people with chronic hypertension have healthy pregnancies.

Can chronic hypertension be cured?

Primary hypertension usually cannot be cured, but it can be controlled. Some people can reduce or stop medicine after major weight loss and lifestyle changes. Secondary hypertension may be cured by treating the cause, such as an adrenal tumor.

What is the difference between chronic and gestational hypertension?

Chronic hypertension is present before pregnancy or diagnosed before 20 weeks. Gestational hypertension begins after 20 weeks in someone with previously normal blood pressure and usually resolves within 12 weeks after delivery.

Does chronic hypertension cause symptoms?

Usually not. Most people feel well even with high readings, which is why regular checks matter. Very high blood pressure can cause headaches, chest pain, breathlessness or vision changes, which need urgent care.