Hypertension

The silent enemy of the heart and arteries

What is hypertension?

Blood pressure is the force exerted by blood against artery walls.

When this pressure remains too high over time, it is called arterial hypertension. Blood pressure-related cardiovascular risk increases progressively as readings rise: there is more to it than a strict distinction between “normal blood pressure” and “high blood pressure”.

Hypertension is extremely common and is one of the most important modifiable cardiovascular risk factors.

An estimated 10 million people in Italy currently have hypertension, but only a small proportion are aware of their condition. On average, only 50 out of every 100 people with hypertension know they have it. Of those 50, only half receive treatment and, more concerning still, fewer than half of those receiving treatment follow it correctly. As a result, no more than 10 out of every 100 people with hypertension are treated as they should be.

Why is hypertension called the silent killer?

Because in most cases, hypertension causes no obvious symptoms.

You can feel perfectly well while having high blood pressure for years.

Headaches, dizziness, fatigue or other problems may be early symptoms of hypertension, especially if they have never occurred before.

When we think of hypertension, we tend to picture middle-aged people or those approaching older age.

We rarely think of young people, much less children. Yet it has been known for some years that hypertension is not limited to adulthood: it occurs at all ages, including in school-age children.

Approximately 8% of adolescents in New York and Bologna have blood pressure above the normal range, and more than 1% of these adolescents have definite hypertension. More than half of young people with high blood pressure have one or both parents with hypertension, and 55% have obesity.

The only way to know your blood pressure is to measure it.

What happens if blood pressure stays high?

Think of your arteries as an extremely delicate network of pipes.
Excessive pressure constantly applied to their walls, year after year, can promote vascular damage and atherosclerosis and make the heart work harder.

Over time, several organs can be affected.

Heart

Increased risk of coronary artery disease, heart attack, cardiac hypertrophy, heart failure and arrhythmias.

Brain

Increased risk of stroke and cognitive decline.

Kidneys

Hypertension can progressively damage kidney function.

Arteries

It promotes vascular damage and complications of atherosclerosis.

Eyes

It can damage the small blood vessels in the retina and lead to progressive blindness.

The 2025 AHA/ACC guidelines identify hypertension as the most common modifiable risk factor for coronary artery disease, heart failure, atrial fibrillation, stroke, chronic kidney disease, dementia and mortality.

Hypertension: which numbers should you know?

Blood pressure
Systolic and diastolic

Systolic pressure - the upper number

Diastolic pressure - the lower number

Pressure in the arteries when the heart contracts.

Pressure between heartbeats, when the heart relaxes.

According to the 2024 European Society of Cardiology (ESC) guidelines:

Office blood pressure

<120/70 mmHg

120–139 and/or 70–89 mmHg

≥140 and/or ≥90 mmHg

A single high reading does not necessarily mean you have hypertension. Diagnosis requires an appropriate assessment and, when indicated, repeated measurements, particularly at home, or 24-hour ambulatory blood pressure monitoring.

Do you really know your blood pressure?

When did you last check it?

Blood pressure should be measured correctly: at rest, while seated, using a validated device and an appropriately sized cuff. Make sure your arm rests on a support. Do not hold your arm up unsupported, and make sure a rolled-up shirt sleeve does not constrict it. Always take at least two or three readings each time and calculate their average. Record both numbers and the time of day on your blood pressure log, and remember to bring the log to every medical appointment.

Home blood pressure monitoring can be extremely useful for both diagnosis and ongoing management. The latest international guidelines also place great importance on home measurements, while advising caution with cuffless devices such as smartwatches, because sufficiently accurate performance has not been demonstrated in large scientific studies.

Today's automatic measuring devices are often accurate, but they should use an upper-arm cuff and be scientifically validated. European guidelines state that devices must be clinically validated and that cuffless technologies worn on the wrist or finger are not currently recommended for routine clinical use.
If you use a traditional, nonautomatic sphygmomanometer, take your time and deflate the cuff very slowly. Place the stethoscope diaphragm on the inside of the arm, just above the elbow. The reading at the first loud sound you hear while slowly deflating the cuff is the systolic pressure; the reading at the last audible sound is the diastolic pressure.

Normal blood pressure is not constant throughout the day. The highest readings occur in the morning, just after waking. During the afternoon, pressure gradually falls, continuing through the night, when the lowest readings occur. In people with hypertension, the highest readings are found between 10 a.m. and noon and the lowest between 2 a.m. and 5 a.m. A sharp rise is consistently observed on waking.

Which tests are used to assess hypertension?

There is currently a tendency to order numerous tests for people with hypertension, many of them as expensive as they are unnecessary. In the great majority of cases, the useful tests are few, simple and free of risk. Everyone with hypertension should instead undergo the following assessments:

Examination of the back of the eye to assess the retinal arteries, the only arteries that can be observed directly. Periodic fundus examinations can also show the progression of hypertension and the effects of treatment.

Assessment of kidney function is also essential. In most cases, this can be limited to blood urea, serum creatinine and plasma electrolytes, particularly when taking diuretics.

An electrocardiogram should be performed in everyone with hypertension to identify left ventricular strain and ischemia, among the early consequences of hypertension.

An echocardiogram can detect early changes in cardiac function, such as diastolic dysfunction and ventricular hypertrophy.

Can hypertension be prevented?

In many cases, there is a great deal we can do.

Diet, body weight, physical activity, salt and alcohol intake, and other aspects of lifestyle influence blood pressure.

To help prevent and manage it, it is important to:

Maintain an appropriate weight

Be physically active regularly

Eat a balanced diet

Limit excess salt

Avoid smoking

Moderate alcohol intake

Manage other cardiovascular risk factors

Scorri la tabella

Hypertension stage	Other risk factors, hypertension-mediated organ damage (HMOD), or disease	Hypertension grade (mmHg)
		High-normal systolic 130–139 diastolic 85–89	Grade 1 systolic 140–159 diastolic 90–99	Grade 2 systolic 160–179 diastolic 100–109	Grade 3 systolic ≥180 diastolic ≥110
Stage 1 (uncomplicated)	No risk factors	Low risk	Low risk	Moderate risk	High risk
	1 or 2 risk factors	Low risk	Moderate risk	Moderate to high risk	High risk
	≥3 risk factors	Low to moderate risk	Moderate to high risk	High risk	High risk
Stage 2 (asymptomatic disease)	HMOD, stage 3 CKD, or diabetes mellitus without organ damage	Moderate to high risk	High risk	High risk	High to very high risk
Stage 3 (established disease)	Symptomatic cardiovascular disease, stage ≥4 CKD, or diabetes mellitus with organ damage	Very high risk	Very high risk	Very high risk	Very high risk

Managing blood pressure means gaining health

The goal of prevention is more than lowering a number on a monitor.

It is to reduce the risk of heart attack and stroke, protect the heart, brain, kidneys and arteries, and increase the number of years spent in good health.

A close and consistent relationship between morbidity, mortality and hypertension severity has been clearly demonstrated: the higher the blood pressure, the earlier and more frequent the complications. At any blood pressure level, the likelihood of cardiovascular events decreases as readings fall.

Physicians agree that almost all cases of hypertension can now be controlled, but inadequate monitoring and poor adherence to treatment are unfortunately often overlooked.

The latest guidelines support this message as well, shifting the focus from simply lowering blood pressure to reducing cardiovascular events and the individual's overall risk.

Know

your numbers

Monitor

your blood pressure and cardiovascular risk regularly

Prevent

problems by addressing modifiable factors early

Blood pressure is only one of the factors that shape our future health.

Knowing and managing it, alongside other risk factors and lifestyle habits, means investing in healthy longevity.

Scientific sources

European Society of Cardiology. 2024 ESC Guidelines for the Management of Elevated Blood Pressure and Hypertension. European Heart Journal, Volume 45, Issue 38, October 7, 2024, Pages 3912–4018.

American Heart Association / American College of Cardiology. 2025 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.

American Heart Association. Home Blood Pressure Monitoring (2025 update).