Prognosis for High Blood Pressure

Very high blood pressure and hypertensive emergencies. A marked increase in blood pressure can occur for a variety of reasons, including stopping prescribed treatment, excessive salt intake, the use of certain medicines such as anti-inflammatory drugs, corticosteroids or nasal decongestants, the use of recreational drugs or other harmful substances, experiencing pain or stress, or having certain medical conditions. 

If blood pressure readings are very high and remain elevated despite repeated measurements taken correctly, medical advice should be sought. It is not recommended to self-medicate or attempt to lower blood pressure abruptly without appropriate medical supervision. 

A hypertensive emergency occurs when a severe rise in blood pressure is accompanied by acute damage to target organs, such as the brain, heart, kidneys, retina or major arteries. In these situations, immediate medical attention is required. 

Seek urgent medical help if any of the following symptoms occur: chest pain, shortness of breath, sudden weakness or loss of sensation on one side of the body, speech difficulties, confusion, sudden loss of vision, a severe headache of sudden onset, loss of consciousness, a significant reduction in urine output. 

Stroke. High blood pressure is one of the main risk factors for stroke. A stroke occurs when not enough blood reaches a given part of the brain, either because a blood vessel becomes blocked or ruptures. 

Symptoms may include sudden weakness or numbness in the face, arm, or leg (especially on one side of the body), difficulty speaking or understanding, loss of vision, impaired balance, a severe sudden headache, or altered consciousness. If these symptoms occur, patients should call emergency services immediately. 

Heart attack and angina. Poor control over high blood pressure increases the risk of coronary artery disease, angina (ischaemic heart disease) and heart attack. Symptoms may include chest pain or pressure, which may spread to the arm, neck, jaw, back or stomach, and may be accompanied by sweating, nausea, shortness of breath or a feeling of severe distress. 

If a heart attack or angina is suspected, patients should seek urgent medical attention. 

Cardiac complications. Hypertension increases the workload of the heart and, over time, may lead to structural changes such as thickening of the wall of the left ventricle, (known as left ventricular hypertrophy) and enlargement of the left atrium. These changes increase the risk of abnormal heart rhythms, such as atrial fibrillation and heart failure.

Cerebral complications. High blood pressure increases the risk of stroke, cognitive decline and cerebrovascular disease. An effective blood pressure control reduces this risk.

Renal complications. High blood pressure can cause damage to the renal blood vessels and contribute to the development or progression of chronic kidney disease. An early sign of kidney damage is the presence of albumin in the urine (albuminuria).  

People with high blood pressure and diabetes present a greater risk of developing chronic kidney disease and therefore require close monitoring of blood pressure, kidney function and albuminuria.

Vascular complications. High blood pressure causes damage to the walls of the arteries, promotes arterial stiffness and accelerate the process of atherosclerosis. As a result, the risk of peripheral arterial disease and other cardiovascular complications increases.

Ocular complications. Persistent high blood pressure can damage the blood vessels in the retina, leading to hypertensive retinopathy. In advanced stages, this may cause visual changes, although such complications are now less common due to earlier diagnosis and improved management.