High blood pressure – medically called hypertension – occurs when the pressure of blood pushing through your arteries is consistently too high, much like a central heating system with excessive pressure that gradually damages pipes, joints, and the boiler itself. In your body, this damage affects arteries throughout the body, gradually increasing the risk of heart attacks, strokes, heart failure, and kidney problems.
Blood pressure readings have two numbers: the top number (systolic pressure) measures the force when your heart beats and pushes blood out, whilst the bottom number (diastolic pressure) measures the pressure when your heart relaxes between beats. A reading of 140/90 mmHg or higher typically indicates hypertension, though ideal targets vary based on your age and other health conditions. About one in three UK adults has high blood pressure, and many don’t know it because hypertension rarely causes symptoms until complications develop.
Dr Cassar’s approach to hypertension goes beyond simply treating the blood pressure number. As a consultant cardiologist with advanced cardiac imaging expertise, Dr Cassar assesses whether elevated blood pressure has already affected your heart structure and function—identifying heart muscle thickening, chamber enlargement, or early signs of strain that influence how aggressively blood pressure should be treated. This comprehensive assessment, combining blood pressure measurement with detailed cardiac imaging, ensures treatment is tailored to your individual cardiovascular risk rather than following a one-size-fits-all protocol.
Most people with high blood pressure feel absolutely fine. Unlike many health conditions, hypertension doesn’t usually cause noticeable symptoms until it’s been damaging blood vessels for years or reaches extremely high levels. This is precisely why blood pressure checks are so important—you cannot rely on how you feel.
When symptoms do occur, they’re often vague. Occasionally, people with very high blood pressure experience headaches (particularly at the back of the head), dizziness, or blurred vision. However, these symptoms are uncommon and shouldn’t be relied upon to detect high blood pressure. Some patients who’ve had high blood pressure for years report feeling more energetic and generally better once treatment brings their pressure down—they hadn’t realized they weren’t feeling their best until they experienced the difference.
Particularly severe headaches, often in the back of the head, especially upon waking
Feeling lightheaded or unsteady, especially when standing up quickly
Blurred vision or seeing spots, particularly with severely elevated blood pressure
Awareness of your heartbeat or irregular heart rhythms
Difficulty breathing, especially during physical activity or when lying down
Diagnosing high blood pressure isn’t as simple as taking one reading. Blood pressure naturally fluctuates throughout the day – it rises when you’re active and falls when you’re relaxed or sleeping. A single high reading doesn’t necessarily mean you have hypertension. Dr Cassar uses multiple measurements over time to confirm the diagnosis. When the picture is unclear, 24-hour blood pressure monitoring – where you wear a small device that automatically takes readings throughout the day and night – can provide clarity. This monitoring also identifies “white coat hypertension,” where blood pressure spikes in medical settings due to anxiety but remains normal at home. These readings can be misleading if we rely only on clinic measurements. Conversely, some people have normal clinic readings but elevated blood pressure the rest of the time (“masked hypertension”). Home monitoring and 24-hour recordings reveal these patterns.
Dr Cassar’s expertise in cardiac imaging becomes particularly valuable here. High blood pressure doesn’t just affect how you feel – it changes the heart’s structure over time. The heart muscle thickens (like any muscle working harder), the heart chambers may enlarge, and the blood vessels stiffen. These changes increase the risk of future heart problems and influence treatment decisions. Using advanced echocardiography (ultrasound of the heart), Dr Cassar can assess whether your heart has already been affected by high blood pressure. Has the heart muscle thickened? Are the chambers enlarged? Is the heart pumping efficiently? These findings help determine how aggressively blood pressure needs to be treated and whether additional therapies might be beneficial.
Beyond imaging, comprehensive evaluation includes blood tests to check kidney function (as kidneys both cause and are damaged by high blood pressure), blood sugar levels, cholesterol, and occasionally hormone levels if there is suspicion that another illness is driving high blood pressure. An electrocardiogram (ECG) checks the heart’s electrical activity and can reveal signs of longstanding high blood pressure. This thorough assessment serves two purposes: identifying any underlying causes of high blood pressure and evaluating your overall cardiovascular risk to guide how intensive treatment should be.
Dr Cassar develops personalized treatment plans based on your blood pressure levels, cardiovascular risk factors, and any existing organ damage. The goal is to reduce your blood pressure to a safe level and minimize your long-term cardiovascular risk.
Lifestyle changes can make a big difference in controling high blood pressure. Dr Cassar provides evidence-based guidance on reducing salt intake, maintaining a healthy weight, increasing physical activity, limiting alcohol consumption, managing stress, and stopping smoking. For some people with mild hypertension, lifestyle modifications are all that is required to bring the numbers under control. Even when medication is needed, healthy lifestyle choices enhance treatment effectiveness and may allow lower medication doses.
When lifestyle changes aren’t enough (and for most people they’re not, particularly as we age), medications are highly effective. The good news is that modern blood pressure tablets are generally well-tolerated, and serious side effects are uncommon. Several different types of medication work in different ways to lower blood pressure; Dr Cassar will work with you to find the right medications that control blood pressure without causing bothersome side effects.
About 1 in 10 people with high blood pressure has an identifiable underlying cause – called secondary hypertension. Clues include high blood pressure developing suddenly at a young age (under 40), very high blood pressure that’s difficult to control with multiple medications, or abnormal kidney function tests. Identifying these matters because treating the underlying condition can sometimes dramatically improve blood pressure control, occasionally eliminating the need for blood pressure tablets entirely. Dr Cassar performs targeted investigations when secondary hypertension is suspected and works with specialist colleagues (kidney doctors, endocrinologists, or sleep specialists) when appropriate. For example, treating sleep apnoea with a CPAP machine can substantially lower blood pressure in affected patients.
Once blood pressure is well controlled, ongoing monitoring ensures it stays that way and detects any developing complications early. Between appointments, home blood pressure monitoring provides valuable information—it’s now recommended that people with hypertension check their blood pressure periodically at home to ensure clinic readings reflect day-to-day control.
High blood pressure, also called hypertension, means the force of blood pushing against your artery walls is consistently too high. Think of it like water flowing through a garden hose—when the pressure is too high, it strains the hose over time. Your blood pressure is measured with two numbers: the top number (systolic) shows the pressure when your heart beats, and the bottom number (diastolic) shows the pressure when your heart rests between beats. A reading of 140/90 or higher generally means you have hypertension, though your target may be different depending on your individual circumstances. Dr Cassar will determine the right blood pressure goal for you based on your age, other health conditions, and overall cardiovascular risk.
For about 90% of people with hypertension, there’s no single identifiable cause—this develops gradually over many years due to a combination of factors including age (blood vessels naturally stiffen as we get older), genetics (it runs in families), being overweight, eating too much salt, lack of physical activity, drinking too much alcohol, chronic stress, and smoking. The remaining 10% have secondary hypertension caused by an underlying condition such as kidney disease, hormonal disorders (like an overactive thyroid or adrenal gland problems), sleep apnoea, or certain medications including some painkillers and contraceptive pills. If you develop high blood pressure before age 40 or it suddenly worsens despite treatment, doctors will investigate whether there’s an underlying cause that can be treated.
For most people, high blood pressure cannot be permanently cured, but it can be very effectively controlled. About 90% of people have what’s called primary hypertension, which develops gradually over time due to a combination of age, lifestyle, and genetics. This type requires ongoing management with lifestyle changes and often medication to keep blood pressure in a healthy range. However, about 10% of people have secondary hypertension, caused by another condition like kidney disease, hormonal problems, or certain medications. In these cases, successfully treating the underlying cause can sometimes cure the high blood pressure. Either way, with proper treatment most people can achieve good blood pressure control and significantly reduce their risk of complications like heart attack and stroke.
High blood pressure is called the silent killer because it typically causes no symptoms at all, even when it’s dangerously high and damaging your body. You can feel completely fine whilst your blood pressure is silently harming your heart, blood vessels, kidneys, brain, and eyes. Most people only discover they have high blood pressure during a routine check-up or when they develop a serious complication like a heart attack or stroke. This is why regular blood pressure checks are so important—you can’t feel high blood pressure, so the only way to know if you have it is to measure it. The good news is that once diagnosed, hypertension is highly treatable and most complications can be prevented with proper management.
Diagnosing hypertension requires multiple blood pressure readings taken over time, as blood pressure naturally varies throughout the day and can be affected by stress, activity, and even just being in a medical setting. Your doctor will measure your blood pressure during clinic appointments using an inflatable cuff around your upper arm. If readings are consistently high, they may recommend 24-hour ambulatory blood pressure monitoring, where you wear a device that automatically takes readings throughout the day and night. This gives a comprehensive picture of your blood pressure patterns and helps distinguish true hypertension from “white coat hypertension,” where readings are only high in medical settings due to nervousness. Once hypertension is confirmed, doctors perform additional tests including blood tests, an ECG, and sometimes heart scans to check whether high blood pressure has already affected your heart or other organs.
Yes, high blood pressure does run in families. If one parent has hypertension, you have about a 25% chance of developing it. If both parents have it, your risk increases to about 50%. However, genetics isn’t destiny—lifestyle factors play a huge role too. Even with a strong family history, maintaining a healthy weight, eating a balanced diet low in salt, staying physically active, limiting alcohol, and not smoking can significantly reduce your risk or delay the onset of hypertension. If you have a family history of high blood pressure, it’s especially important to have regular blood pressure checks from your 20s onwards and to discuss prevention strategies with your doctor. Early intervention and healthy lifestyle choices can make a real difference, even when you’re genetically predisposed.
Stress can temporarily raise your blood pressure—your body releases hormones that make your heart beat faster and your blood vessels tighten. However, whilst stress causes short-term spikes in blood pressure, the relationship between chronic stress and long-term hypertension is more complex. Chronic stress may contribute to high blood pressure indirectly by leading to unhealthy coping behaviors like overeating, drinking too much alcohol, smoking, or being less physically active. Managing stress through techniques like regular exercise, adequate sleep, relaxation exercises, meditation, or talking to someone can be an important part of blood pressure control. If you’re under significant ongoing stress, discuss this with your doctor as part of your overall cardiovascular risk management, as stress reduction can complement other treatment strategies.
For some people with borderline or mildly elevated blood pressure, lifestyle changes alone can bring readings back to normal. The most effective changes are losing excess weight (even 5-10% of body weight makes a significant difference), reducing salt intake to less than 6g daily, exercising regularly (at least 150 minutes of moderate activity like brisk walking weekly), limiting alcohol to recommended limits, stopping smoking, and managing stress. However, if blood pressure is significantly elevated or you have other cardiovascular risk factors like diabetes or previous heart problems, medication is usually needed alongside lifestyle changes. Even when medication is required, lifestyle improvements enhance effectiveness, may allow lower doses, and benefit your overall health. Most doctors recommend trying lifestyle changes first for mild hypertension, then adding medication if blood pressure remains high after 3-6 months.
Yes, salt (sodium) has a significant effect on blood pressure for most people, though sensitivity varies between individuals. When you eat too much salt, your body retains more water to dilute the sodium concentration in your blood. This extra fluid increases the volume of blood your heart must pump, raising pressure against artery walls. Most UK adults consume about 8-9 grams of salt per day when the recommended limit is 6 grams (about a teaspoon). Most dietary salt comes from processed and restaurant foods, not the salt shaker. Reducing salt intake can lower blood pressure quite substantially—typically by 5-6 mmHg systolic, though some people are particularly salt-sensitive and see bigger reductions. Practical steps include avoiding adding salt at the table, choosing fresh foods over processed ones, checking food labels for sodium content, and using herbs and spices for flavor instead of salt.
Whilst salt substitutes can help, they should be the last priority in reducing your salt intake. According to Action on Salt, approximately 61% of salt in the UK diet comes from processed and restaurant foods, 21% occurs naturally in foods, and only 18% comes from salt we add ourselves at the table or during cooking. This means that even if you completely stopped adding salt, you’d only address less than one-fifth of your total salt intake. The most important steps are: first, drastically reduce processed and packaged foods (bread, breakfast cereals, ready meals, processed meats, soups, sauces, and cheese are major contributors); second, cook from scratch using fresh ingredients where you control salt content; third, check food labels and choose lower-salt options; and finally, for the small amount of salt you do add, consider using a salt substitute. A 2024 study in the Journal of the American College of Cardiology found that people using salt substitutes (containing about 60-75% regular salt and 25-30% potassium chloride) were 40% less likely to develop hypertension than those using regular salt, though this research was conducted in rural China where dietary patterns and lifestyle differ from the UK. Salt substitutes are available in UK supermarkets but check with your doctor first if you have kidney disease or take certain medications, as the extra potassium could be harmful.
Untreated high blood pressure can lead to serious, life-threatening complications. The constant excess pressure damages and narrows your arteries, making your heart work much harder. Over time, this can cause heart attacks (when blood flow to heart muscle is blocked), strokes (when blood flow to the brain is disrupted), heart failure (when the heart becomes too weak or stiff to pump effectively), kidney disease or kidney failure (high blood pressure damages the tiny blood vessels in kidneys), vision loss (damage to blood vessels in the eyes), peripheral artery disease (narrowing of leg arteries causing pain when walking), and sexual dysfunction. These complications develop gradually over years, which is why hypertension is so dangerous—you feel fine whilst damage accumulates silently. The excellent news is that these complications are largely preventable with proper blood pressure control. Even if you feel perfectly well, treating high blood pressure significantly reduces your risk of these serious problems.
You should consider seeing a cardiologist like Dr Cassar if your blood pressure remains high despite taking multiple medications, if you develop symptoms like chest pain or severe breathlessness, if blood tests show your kidneys or heart have been affected, if you’re younger than 40 with high blood pressure (suggesting a possible underlying cause), or if you have other heart conditions alongside hypertension. Many patients are referred by their GP when blood pressure proves difficult to control or when specialist assessment is needed. Dr Cassar’s expertise in advanced cardiac imaging allows thorough evaluation of whether high blood pressure has affected your heart, and his detailed approach helps identify any underlying causes that may have been missed. At his clinics in Basingstoke and Winchester, Dr Cassar can usually see patients within 1-2 weeks for urgent cases, or within 2-4 weeks for routine assessments.
Whilst GPs manage most hypertension cases very effectively, a cardiologist like Dr Cassar offers specialist expertise that can be crucial for complex cases. Dr Cassar uses his expert cardiac imaging skills to assess in detail how high blood pressure has affected your heart structure and function. He can identify subtle heart damage early, investigate potential underlying causes through comprehensive testing, access the full range of blood pressure medications including specialist combinations, and coordinate care with other specialists when needed. For patients with resistant hypertension (high blood pressure despite three or more medications), unexplained blood pressure spikes, or concurrent heart conditions, specialist cardiology input often makes the difference between struggling with poor control and achieving optimal blood pressure management. Dr Cassar’s private clinics in Hampshire also offer more time for detailed discussion and faster access to advanced investigations.
Dr Cassar typically offers appointments within 1-2 weeks, providing prompt access for both urgent assessments and routine specialist consultations. For established patients needing follow-up, appointments are usually available within a similar timeframe. The private clinic setting at Candover Clinic in Basingstoke ensures you’ll have Dr Cassar’s full attention during your consultation, with appointments typically lasting 30-45 minutes—allowing time for thorough discussion of your condition, detailed examination, and often same-day investigations. This comprehensive approach means most patients leave their first appointment with a clear diagnosis, treatment plan, and understanding of their condition.
Most people with hypertension need long-term medication to keep blood pressure controlled, though “for life” depends on individual circumstances. If you have borderline high blood pressure and make significant lifestyle changes—losing weight, exercising regularly, reducing salt, cutting back alcohol—you might eventually reduce medication under careful supervision. However, medication should never be stopped without consulting your doctor first, as blood pressure can rise dangerously when treatment is discontinued abruptly. For most people, blood pressure medication is a long-term commitment, but this isn’t a failure—it’s preventing heart attacks, strokes, and kidney damage. Modern medications are highly effective and well-tolerated. Your doctor will review your treatment regularly, adjust doses as needed, and work with you to find the most effective combination with fewest side effects. The goal is optimal blood pressure control with medications you’re comfortable taking long-term.
Side effects vary depending on which medication you’re taking. Common ones include feeling tired or dizzy (especially when standing up quickly), headaches, ankle swelling, a persistent dry cough (particularly with ACE inhibitors), or needing to pass urine more frequently (with diuretics or “water tablets”). Many people have no side effects at all, and most side effects improve after a few weeks as your body adjusts. Never stop taking your medication because of side effects without speaking to your doctor first—there are many different blood pressure medications available, and if one doesn’t suit you, another usually will. Your doctor will carefully select medications based on your individual circumstances and can adjust your treatment if you experience troublesome side effects. Sometimes taking medication at a different time of day or adjusting the dose can resolve side effects without changing the drug.
Many people need two or more blood pressure medications to achieve good control—this is completely normal and not a sign that treatment isn’t working. Different medications work in different ways (some relax blood vessels, others reduce fluid volume, others relax the heart), and using two or more medications at lower doses often works better than using a high dose of a single medication. Combination therapy also tends to cause fewer side effects than high doses of individual drugs. About half of people with hypertension need at least two medications, and some people need three or four to achieve optimal control. What matters most isn’t how many medications you’re taking, but whether your blood pressure is well controlled and you’re not experiencing troublesome side effects. Your doctor will carefully select the best combination of medications for your individual situation.
Yes, home blood pressure monitoring is strongly recommended for anyone with hypertension or at risk of developing it. Monitoring at home provides multiple readings in your normal environment, helps track response to treatment, can detect patterns (like morning surges or evening spikes), empowers you to take an active role in managing your condition, and identifies white coat hypertension (where readings are only high in medical settings). Choose an automatic upper-arm monitor that’s been properly validated—your doctor can recommend specific models. Avoid wrist monitors as they’re less accurate. Take readings at the same times each day, ideally morning and evening, after sitting quietly for five minutes. Keep a record to share at appointments—many modern monitors can store readings or connect to smartphone apps. Home monitoring doesn’t replace clinic appointments but provides valuable additional information that helps optimize your treatment.
Yes, regular exercise is one of the best things you can do for high blood pressure. Physical activity helps lower blood pressure, strengthens your heart, helps with weight control, and reduces stress. Aim for at least 150 minutes of moderate-intensity activity per week—this could be brisk walking, swimming, cycling, or dancing. You don’t need to do it all at once; even 10-15 minute bursts of activity throughout the day add up. If your blood pressure is very high (over 180/110) or you have heart disease or other complications, talk to your doctor before starting a new exercise program. Most people with well-controlled hypertension can exercise safely and should do so. Start gradually if you’re not used to exercising, and avoid very intense activities or heavy weightlifting until your blood pressure is under good control. Regular moderate exercise can lower blood pressure by 5-8 mmHg.
Following the DASH (Dietary Approaches to Stop Hypertension) diet can significantly lower blood pressure. Focus on eating plenty of fruits and vegetables (aim for at least 5 portions daily), whole grains (brown rice, wholemeal bread, oats), lean proteins (chicken, fish, beans, lentils), and low-fat dairy products. Foods particularly beneficial for blood pressure include leafy green vegetables, berries, beetroot, oats, bananas, fatty fish like salmon and mackerel, seeds and nuts (unsalted), and garlic. Reduce your intake of processed and packaged foods (which are high in hidden salt), red and processed meats, foods high in saturated fat, sugary foods and drinks, and obviously, added salt. The Mediterranean diet is also excellent for heart health and blood pressure. Making gradual changes to your eating habits is more sustainable than dramatic overhauls—even small improvements can make a meaningful difference to your blood pressure.
Yes, drinking too much alcohol can raise blood pressure both immediately and over time. Whilst one drink may temporarily lower blood pressure slightly, regular heavy drinking increases blood pressure and makes hypertension harder to control. Alcohol also contains calories that can contribute to weight gain, another risk factor for high blood pressure. Current UK guidance recommends no more than 14 units per week (roughly 6 pints of average-strength beer or 10 small glasses of wine), spread over at least 3 days with several alcohol-free days each week. If you have high blood pressure, cutting back on alcohol can help lower it—some people see significant improvement within a few weeks of reducing their intake. Binge drinking (consuming lots of alcohol in a short period) is particularly harmful for blood pressure and should be avoided completely.
There are excellent resources to support you in managing high blood pressure:
