High blood pressure (hypertension)
What the numbers mean, how the diagnosis should actually be made, which medicines are used and why, and what happens if blood pressure is left untreated — written for patients seen at Uttarbanga Clinic, Cooch Behar.
রক্তচাপের সংখ্যাগুলির মানে কী, সঠিকভাবে রোগ নির্ণয় কীভাবে হয়, কোন ওষুধ কেন দেওয়া হয় এবং চিকিৎসা না করলে কী হয় — কোচবিহারের উত্তরবঙ্গ ক্লিনিকের রোগীদের জন্য লেখা।
Hypertension means blood pressure that stays at or above 140/90 mmHg on repeated office measurement. It usually causes no symptoms at all, while quietly damaging the heart, brain, kidneys and eyes — which is why it is called the silent killer. Diagnosis needs repeated readings, ideally supported by home measurement, and treatment combines salt reduction, weight loss and activity with medicines. Dr Soumya Ghosh, MD (General Medicine), manages hypertension, including blood pressure that stays high on two or three medicines, at Uttarbanga Clinic on Sunity Road, Cooch Behar.
Key facts
- Diagnosed at ≥ 140/90 mmHg on office measurement (the ACC/AHA threshold is ≥ 130/80).
- Usually completely symptomless — which is exactly why regular checking matters.
- Home and 24-hour ambulatory readings confirm the diagnosis and expose white-coat and masked hypertension.
- Main drug classes: ARBs and ACE inhibitors, calcium-channel blockers, and thiazide-like diuretics.
- Most people eventually need two or more drugs, often as a single combination pill.
What counts as high blood pressure?
Blood pressure is classified by the higher of the two numbers. Under the 2023 European Society of Hypertension guidelines, readings below 120/80 mmHg are optimal, 140–159 over 90–99 is grade 1 hypertension, and 160/100 or above is grade 2 or 3.[1] American guidelines set the threshold lower, at 130/80. The disagreement matters less than it appears: both agree that risk rises continuously with pressure, and that the decision to treat depends on total cardiovascular risk, not on the reading alone.
| Category | Systolic (mmHg) | Diastolic (mmHg) |
|---|---|---|
| Optimal | < 120 | and < 80 |
| Normal | 120 – 129 | and/or 80 – 84 |
| High-normal | 130 – 139 | and/or 85 – 89 |
| Grade 1 hypertension | 140 – 159 | and/or 90 – 99 |
| Grade 2 – 3 hypertension | ≥ 160 | and/or ≥ 100 |
How should blood pressure actually be measured?
A great many people are treated for hypertension they do not have, and a great many are missed, because of how the reading is taken. A valid measurement requires the patient seated and rested for five minutes, back supported, feet flat, arm at heart level, an appropriately sized cuff on a bare arm, and no talking during the reading. Two readings are taken a minute apart and averaged. A single high reading in a clinic never establishes the diagnosis.
- White-coat hypertension
- Blood pressure that is high in the clinic but normal at home. It affects a meaningful minority of patients and leads to unnecessary treatment if it is not identified. Home or ambulatory monitoring is the way to find it.
- Masked hypertension
- The reverse — normal in the clinic, high at home. It carries the same cardiovascular risk as sustained hypertension and is entirely missed without home readings.
- Resistant hypertension
- Blood pressure that stays above target despite three medicines including a diuretic, all at appropriate doses. Before accepting the label, adherence, measurement technique, salt intake, alcohol, NSAIDs and secondary causes all need checking.
How is high blood pressure treated?
Treatment starts with the things that lower pressure without a prescription: reducing salt, losing weight where there is excess, regular activity, and limiting alcohol. Salt is the largest single lever in a typical Bengali diet, and most of it comes from added salt, pickles, papad, processed snacks and packaged food rather than from cooking alone. Medicine is added when lifestyle change is insufficient or when pressure is high enough that waiting is unsafe.
Most patients ultimately need more than one drug, and current guidelines recommend starting with a combination of two agents at low dose rather than pushing a single drug to its maximum — better control, fewer dose-related side effects, and better adherence when it comes as one pill. Angiotensin receptor blockers such as telmisartan are widely used because they lower pressure smoothly across twenty-four hours and protect the kidney and heart. Dr Ghosh served on the expert panel of the TELIENDURE consensus on telmisartan across the cardiometabolic continuum, presented at the 35th European Meeting on Hypertension and Cardiovascular Protection in Gdańsk in May 2026.
| Class | Examples | Common side effects |
|---|---|---|
| ARB | Telmisartan, losartan | Generally well tolerated; raised potassium |
| ACE inhibitor | Ramipril, enalapril | Dry cough in a minority; raised potassium |
| Calcium-channel blocker | Amlodipine, cilnidipine | Ankle swelling, flushing |
| Thiazide-like diuretic | Indapamide, chlorthalidone | Low sodium or potassium; raised uric acid |
| Beta blocker | Metoprolol, bisoprolol | Fatigue, slow pulse; used where there is a specific indication |
Why does silent high blood pressure still need treating?
Because hypertension rarely produces symptoms, patients often stop treatment once readings normalise, reasoning that the problem has resolved. This is the single most common and most dangerous mistake in the management of blood pressure. The reading is normal because of the medicine; stopping it allows pressure to rise again, silently, and the damage resumes. Sustained control is what prevents stroke, heart attack, heart failure, chronic kidney disease and loss of vision. Blood pressure is managed for life, and the aim is a steadily normal number rather than an occasional one.
When should a younger patient be investigated further?
Most hypertension has no single identifiable cause. But secondary hypertension — high blood pressure caused by an underlying condition that may be correctable — should be actively looked for in specific situations: onset before about age 40, blood pressure that is very high at presentation, pressure that stays high on three appropriate drugs, a sudden deterioration in previously controlled pressure, low potassium without a diuretic, or clinical clues such as episodic sweating and palpitations. The relevant causes include kidney disease, renal artery narrowing, primary aldosteronism, thyroid disease, obstructive sleep apnoea and, uncommonly, phaeochromocytoma.
সংক্ষেপে (বাংলায়)
উচ্চ রক্তচাপকে ‘নীরব ঘাতক’ বলা হয়, কারণ উপসর্গ ছাড়াই এটি হার্ট, কিডনি, মস্তিষ্ক ও চোখের ক্ষতি করে। ‘ভালো লাগছে’ বলে ওষুধ বন্ধ করে দেওয়া সবচেয়ে বড় ও সবচেয়ে বিপজ্জনক ভুল — রক্তচাপ স্বাভাবিক থাকে ওষুধের জন্যই। কম লবণ, ওজন নিয়ন্ত্রণ, হাঁটাচলা ও নিয়মিত ওষুধে রক্তচাপ নিয়ন্ত্রণে রাখলে স্ট্রোক ও হার্ট অ্যাটাকের ঝুঁকি অনেক কমে। কোচবিহারের উত্তরবঙ্গ ক্লিনিকে ডাঃ সৌম্য ঘোষ রক্তচাপের চিকিৎসা করেন, বিশেষত দুই-তিনটি ওষুধেও যাঁদের রক্তচাপ কমছে না।
Written and medically reviewed by Dr Soumya Ghosh, MBBS, MD (General Medicine)
Consultant Physician (Internal Medicine), Uttarbanga Clinic, Cooch Behar · Assistant Professor, Dept. of General Medicine, MJN Medical College & Hospital, Cooch Behar
West Bengal Medical Council Reg. No. 67751 — verify on the Indian Medical Register · ORCID 0009-0004-1686-5540 · Last reviewed
Frequently asked questions
Can I stop my blood pressure medicine once the reading is normal?
No. The reading is normal because of the medicine. Stopping allows pressure to rise again silently and the damage to the heart, kidneys and brain resumes. Any change in dose should be made only by your doctor, and there are situations — substantial weight loss, for example — where a reduction is genuinely appropriate.
Is home blood pressure monitoring reliable?
Yes, and it is often more informative than a single clinic reading. Use a validated upper-arm monitor, not a wrist device. Sit rested for five minutes, take two readings a minute apart, morning and evening, and record them for a week before your appointment.
Does high blood pressure cause symptoms?
Usually none, until it is very high or has already caused damage. Headache, nosebleeds and dizziness are commonly attributed to blood pressure but are unreliable indicators. This is precisely why periodic checking matters.
Which is the best blood pressure medicine?
There is no single best drug. The right choice depends on age, kidney function, whether there is diabetes or heart disease, whether pregnancy is possible, and how the individual responds. Most people end up on a combination, which is expected rather than a sign of failure.
How much salt should I be having?
The World Health Organization recommends under 5 g of salt a day — roughly one level teaspoon in total, including what is already in food. In practice, the changes with the biggest effect are cutting added salt at the table, reducing pickles and papad, and limiting packaged snacks.
Blood pressure review with Dr Soumya Ghosh
Uttarbanga Clinic, Sunity Road, near Police Line Chowpathi, Ward 20, Cooch Behar 736101. Monday to Saturday, 10:00–20:00. Walk-in or book ahead.
References and guidelines
- Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension. J Hypertens 2023. eshonline.org/guidelines
- Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension Global Practice Guidelines. Hypertension 2020;75:1334–57. ish-world.com
- Association of Physicians of India — hypertension guidance. japi.org · apiindia.org.
- World Health Organization. Hypertension fact sheet. who.int
- TELIENDURE expert consensus on telmisartan across the cardiometabolic continuum. Presented at the 35th European Meeting on Hypertension and Cardiovascular Protection (ESH 2026), Gdańsk, 28–31 May 2026. Poster (PDF)
This page is general health information written and reviewed by a registered medical practitioner. It is not medical advice, does not create a doctor–patient relationship, and is not a substitute for consultation with a doctor who has examined you. Diagnosis and treatment are individualised after clinical assessment. Medicines mentioned here are prescription-only and must be taken under medical supervision. See the editorial and medical review policy. Last reviewed .