Hypertension (high blood pressure)

Blood pressure is the force of blood pushing against the walls of your arteries. Hypertension, or high blood pressure, means that force stays higher than it should over time, which makes the heart work harder and slowly damages blood vessels in the heart, brain, kidneys and eyes. Most people feel nothing at all, which is why readings are taken at routine visits rather than only when something feels wrong.

What high blood pressure is, and what it is not

High blood pressure is not a state of being tense or stressed, and it is not something you can judge by how you feel. It is a measurement, taken over time, of how hard blood is pushing through your arteries. Because it usually causes no symptoms, it is often called a silent condition, and the damage it does builds quietly over years rather than announcing itself.

It is also not diagnosed from a single reading. One high number at a walk-in clinic on a stressful day is not hypertension. Canadian practice looks at several readings, taken properly, and usually confirms them away from the clinic. Nosebleeds and headaches are often assumed to be signs of high blood pressure, but they are not reliable indicators, and waiting for a symptom is not how the condition gets found.

Signs and symptoms

• Usually no symptoms at all, even when readings are quite high
• Headaches in some people, particularly with very high readings
• Dizziness or feeling lightheaded
• Blurred or changed vision
• Shortness of breath
• Nosebleeds, which are uncommon and not a reliable sign
• Chest discomfort, or a pounding feeling in the chest, neck or ears

Because symptoms are unreliable, two people with the same readings can feel completely different, and feeling well is not evidence that your numbers are where your care team wants them.

What raises the risk

Some risk factors cannot be changed:

• Getting older
• A family history of high blood pressure
• Ancestry, since Black and South Asian communities in Canada are diagnosed more often
• Living with chronic kidney disease or diabetes

Others can often be worked on, usually with support from a health care team:

• Eating patterns high in salt and low in vegetables and fruit
• Low physical activity, and living with obesity
• Regular or heavy alcohol use
• Smoking, ongoing stress, and poor sleep, including untreated sleep apnea

How high blood pressure is diagnosed in Canada

Diagnosis rests on repeated readings rather than a single one. The 2025 Hypertension Canada guideline asks that office readings be taken with a validated automated device after a rest period, with several readings averaged, and that the diagnosis then be confirmed away from the clinic, using either ambulatory blood pressure monitoring worn for a day or home readings taken twice daily for about a week. Blood and urine tests, and often an electrocardiogram, are usually added to look for causes and to check the effect on your kidneys and heart.

Treatment and day-to-day management

Clinical research for Hypertension (high blood pressure) is enrolling. See the current studies ↓

Care combines medicines with the parts of daily life that move blood pressure, and it is usually adjusted over months rather than settled in one visit. Depending on your readings and what else you live with, a health care team may discuss:

• ACE inhibitors and angiotensin receptor blockers
• Thiazide and thiazide-like diuretics
• Long acting dihydropyridine calcium channel blockers
• Single pill combinations of two or more of these classes, and mineralocorticoid receptor antagonists such as spironolactone when blood pressure stays high on several medicines
• Non-drug care, including counselling on dietary sodium, physical activity programs, support to reduce alcohol, assessment for sleep apnea, and home blood pressure monitoring

Which combination suits you depends on your readings, your other conditions and how you tolerate each medicine. Those are decisions for you and your own clinician, and nothing here is a recommendation about any of them.

When to talk to a doctor

• Call 911 for chest pain, a sudden severe headache, sudden weakness or numbness on one side, trouble speaking, or sudden vision loss. These can be signs of a heart attack or a stroke.
• Seek urgent care for a very high reading together with symptoms such as severe headache, confusion, chest pain, breathlessness or vomiting.
• Book with your family doctor or nurse practitioner if your home readings stay above the level your care team set with you, or if you are having side effects from your medicines. Do not stop a blood pressure medicine on your own.

Why clinical research matters for high blood pressure

Blood pressure stays above target for a large share of people in Canada even when they are on treatment, and how low to aim, and how to help people stay on therapy for years, are both still debated. Studies now recruiting include aldosterone synthase inhibitors, dual endothelin receptor antagonists, and long acting agents given by injection every few months, such as small interfering RNA and antibody based therapies aimed at angiotensinogen. Device based approaches such as renal denervation are also under study, alongside pharmacist-led and team-based care models and remote home monitoring programs.

All of those are tested in clinical studies before they reach general practice. Taking part is voluntary, informed consent comes first, and you can withdraw at any point without affecting the care you get from your own doctor. Joining a study does not mean stopping your current treatment, and no one can say in advance whether a study will help you personally.

Learn more from Canadian sources

• Hypertension Canada, including its list of validated home devices
• Public Health Agency of Canada: high blood pressure
• Heart & Stroke
• Canadian Cardiovascular Society