High blood pressure (hypertension) is the single biggest preventable cause of cardiovascular disease and one of the most under-diagnosed conditions in the UK. It rarely causes symptoms until significant damage has been done. Proper assessment includes a single clinic reading, but ideally also home or ambulatory monitoring to confirm the true picture.
Educational information — not a substitute for clinical assessment
This page describes blood pressure and hypertension in general terms to help you decide whether assessment may be helpful. It is not a diagnostic tool. If you recognise yourself in what follows, please book a consultation.
Blood pressure is the force exerted by blood against the walls of arteries as the heart pumps. It’s measured as two numbers:
Blood pressure varies normally throughout the day, with activity, stress, sleep, and many other factors. A single high reading doesn’t equal hypertension. What matters is the consistent average level over time.
UK adults have hypertension. Half of them don’t know it. Treating high blood pressure reduces risk of stroke, heart attack, and kidney disease substantially.
Less than 120/80 mmHg is generally optimal for adults.
Important: clinic thresholds are higher than home thresholds because clinic readings tend to be elevated by the situation. ABPM (ambulatory blood pressure monitoring — wearing a device for 24 hours that takes readings automatically) gives the most accurate average.
Untreated hypertension significantly increases the risk of:
Hypertension causes essentially no symptoms in most people until damage has been done. Headaches are commonly blamed on blood pressure but the connection is weak. Most hypertension is “silent.” This is exactly why screening and proactive checking matter.
Very high blood pressure (180/120 or higher) plus any of these symptoms warrants same-day medical assessment, often in A&E:
• Chest pain or pressure
• Shortness of breath
• Severe headache with confusion
• Visual changes
• Weakness, numbness, or speech difficulty
• Severe back pain (possible aortic involvement)
• Bleeding
Around 20% of people have higher BP in clinical settings than at home. This is “white-coat hypertension.” If clinic readings suggest hypertension but home and ambulatory readings are normal, the diagnosis is white-coat, not true hypertension — though regular monitoring is still important because risk of future hypertension is higher.
The opposite: normal BP in clinic but elevated at home. Also affects around 10–15% of patients. This is genuine hypertension despite normal clinic readings, and carries similar cardiovascular risk to sustained hypertension.
Diagnosis based on a single clinic reading misses about a third of people who actually have hypertension or doesn’t have it. Proper diagnosis uses multiple measurements, ideally including home or ambulatory monitoring. NICE NG136 reflects this — recommending ABPM as the gold standard for confirming a clinic diagnosis of hypertension.
Previous BP readings, family history, lifestyle factors, current medications (some raise BP), symptoms, previous cardiovascular events, other conditions that influence treatment choice.
For a clinic BP that suggests hypertension, NICE NG136 recommends confirmation with:
Blood pressure decisions aren’t made on BP alone. We assess overall cardiovascular risk:
Treatment plan tailored to BP level, cardiovascular risk, age, comorbidities, and your preferences. Some people start medication; some focus on lifestyle first; many do both.
Lifestyle changes can lower BP significantly — sometimes enough to avoid medication, often a useful adjunct to it.
NICE NG136 recommends starting medication for:
Several classes of BP-lowering medication are widely used, each with different side-effect profiles and indications. The choice depends on age, ethnicity, comorbidities, and other factors. NICE NG136 provides specific guidance on first-line, second-line, and third-line choices. UK law prevents naming specific prescription medications on this website — we discuss specific options in clinic.
For most patients, target BP is:
Consider booking if:
Current prices are on our Fees page. ABPM is usually quoted separately from the consultation. Repeat reviews are typically shorter and cheaper than initial consultations.
Most UK PMI policies cover hypertension assessment and management. Some cover ABPM specifically. We provide procedure codes.
A cuff on the upper arm connected to a small device clipped to a belt. Takes readings automatically — you don’t do anything. Mildly inconvenient but most people tolerate it well for 24 hours. The cuff inflates briefly every 20–30 minutes during the day, hourly at night.
Use a validated upper-arm monitor — not a wrist monitor. The British and Irish Hypertension Society maintains a list of validated devices. Avoid the cheapest models. We can advise on specific models in consultation.
For most established hypertension, yes — but with lifestyle changes some patients can reduce or stop medication. We review periodically.
Some medications have specific side effects. Most are well tolerated. If one isn’t suiting you, we can try a different class. The benefits of treating hypertension well outweigh medication risks for most patients.
Stress contributes but is rarely the whole story. Persistent BP elevation despite reducing acute stress usually indicates underlying hypertension. ABPM helps clarify.
Some have modest BP effects (garlic, hibiscus, coenzyme Q10) but none replace evidence-based treatment. Some interact with prescribed medications. Discuss with us before adding any.
Masked hypertension — affects around 10–15% of people. Genuine hypertension that doesn’t show in clinic. Worth confirming with ABPM and treating appropriately.
Care at MHW Clinic is delivered by a small clinical team, with Dr Haydar Bolat as Clinical Director. The specific clinicians involved in your care depend on the plan agreed with you at consultation.
UK-registered GP and Clinical Director at MHW. Provides comprehensive blood pressure and hypertension assessment including clinic readings, ambulatory monitoring (ABPM), cardiovascular risk evaluation, lifestyle advice and medication initiation/review.
View profileLanguages spoken across the team: English, Turkish, Bulgarian, Bengali, Hindi, Albanian, Azerbaijani, German, Romanian. We can also arrange professional telephone interpreters in most other languages at no extra cost. More on languages and interpreters →
This page was reviewed by Dr Haydar Bolat, Clinical Director at MHW Clinic. Content is based on NICE Guideline NG136 (Hypertension in adults), British and Irish Hypertension Society guidance, and current UK clinical practice and current UK clinical practice. It is updated when guidance changes. Educational information only — not a substitute for clinical assessment.
Book a proper blood pressure assessment. Treating hypertension early is one of the single most impactful things in medicine.