Hypertension

What is hypertension?

Blood pressure is the force exerted by circulating blood against the walls of the arteries. It is expressed as two numbers: systolic pressure (when the heart contracts) over diastolic pressure (when the heart relaxes), measured in millimetres of mercury (mmHg).

Hypertension is defined as a persistent resting blood pressure of 140/90 mmHg or above. It is classified by severity:

• Stage 1 hypertension is 140 to 159 / 90 to 99 mmHg. Lifestyle changes are the primary intervention.

• Stage 2 hypertension is 160/100 mmHg or above. Medication is typically required alongside lifestyle changes.

• Hypertensive urgency or emergency occurs when blood pressure rises to 180/120 mmHg or above, with or without signs of organ damage. This requires immediate medical attention.

There are two forms of hypertension. Primary (essential) hypertension has no single identifiable cause and accounts for approximately 90% of cases. Secondary hypertension icomes from an identifiable underlying condition such as kidney disease, thyroid dysfunction, or an adrenal tumour and is important to identify because it is often curable.

Symptoms of hypertension

Hypertension is known as the silent killer because it almost never causes symptoms until organ damage is well advanced. When symptoms do show up, they usually reflect complications rather than the elevated pressure itself:

• Headaches, particularly at the back of the head on waking

• Dizziness or lightheadedness

• Visual disturbances or floaters

• Nosebleeds

• Shortness of breath on exertion

• Chest pain or palpitations

• In hypertensive emergency: severe headache, confusion, blurred vision, chest pain, and breathlessness requiring immediate care

What causes hypertension?

Primary hypertension develops through a combination of lifestyle, metabolic, and genetic factors that progressively increase arterial pressure. Contributing causes include:

• Excess dietary salt increases fluid retention and arterial pressure. It is one of the most directly modifiable risk factors.

• Obesity and excess visceral fat activate the renin-angiotensin-aldosterone system and promote inflammation, both of which raise blood pressure.

• Physical inactivity reduces vascular elasticity and cardiovascular efficiency over time.

• Chronic stress elevates cortisol and catecholamines, sustaining elevated vascular tone.

• Alcohol excess raises blood pressure through multiple mechanisms including sympathetic nervous system activation.

• Smoking causes acute and chronic vascular damage that stiffens arteries and raises peripheral resistance.

• Genetic predisposition accounts for a significant proportion of primary hypertension risk, particularly in people with a strong family history.

• Age increases arterial stiffness progressively, raising systolic pressure over time.

Secondary hypertension causes include kidney disease, primary hyperaldosteronism, thyroid dysfunction, obstructive sleep apnoea, phaeochromocytoma, and renal artery stenosis. Identifying these is important because treating the underlying cause can normalise blood pressure without lifelong medication.

Blood pressure itself is measured with a sphygmomanometer, not a blood test. Elfcare's value in hypertension lies in identifying the metabolic conditions driving it, the organ damage it is causing, and the secondary causes that may be responsible.

Blood tests Elfcare's panel covers the key markers relevant to hypertension assessment:

• Creatinine, cystatin C, and eGFR: evaluate kidney health, as hypertension and kidney disease often trigger one another.

• Electrolytes: monitoring sodium and potassium helps detect hormonal imbalances that can cause high blood pressure.

• Thyroid profile (TSH, T3, T4): identifies thyroid dysfunction, which can directly cause blood pressure abnormalities.

• Cortisol: screens for excess stress hormones that may be driving secondary hypertension.

• HbA1c and glucose: assesses blood sugar, since diabetes and hypertension together accelerate organ damage.

• Total cholesterol, LDL, HDL, and triglycerides: evaluates total cardiovascular risk, which multiplies when high pressure and high fat levels coexist.

• CRP: measures vascular inflammation, a key driver of arterial stiffening.

• NT-proBNP: a marker of cardiac stress that shows if the heart is being overworked by sustained high pressure.

• Uric acid: linked to increased cardiovascular risk and metabolic conditions common in hypertension.

Full body MRI Elfcare's full body MRI provides a direct visual assessment of the damage hypertension causes over time. It can identify white matter changes or silent strokes in the brain, thickening of the heart muscle (hypertrophy) from overwork, and scarring or thinning of the kidneys. It also screens the aorta for dilatation or aneurysms, which are serious complications of long-standing high pressure.

Why early detection matters

Hypertension treated early, before significant organ damage has occurred, reduces the risk of heart attack, stroke, heart failure, and kidney disease by 30 to 50%. Every 20 mmHg rise in systolic pressure (or 10 mmHg in diastolic pressure) roughly doubles the risk of death from cardiovascular disease. The challenge is that most people do not know they have it. Identifying hypertension-related metabolic abnormalities, secondary causes, and early organ damage through blood testing and MRI gives a complete picture of cardiovascular risk at the earliest possible stage, when the widest range of interventions is available.

How Elfcare can help

Elfcare's blood panel covers the complete metabolic and organ function profile relevant to hypertension, including kidney function, electrolytes, thyroid function, lipids, HbA1c, CRP, and NT-proBNP. Together these identify the conditions most commonly driving hypertension, the secondary causes most likely to be curable, and the earliest signs of organ damage.

Our full body MRI provides direct structural assessment of the brain, heart, kidneys, and aorta, revealing the cumulative impact of elevated blood pressure on the body's most vital organs.

If our blood tests or MRI identify findings consistent with hypertension-related organ damage or a secondary cause, we take care of further diagnostics or refer you to the appropriate specialist.