High blood pressure means the pressure in your blood vessels is too high. According to the NHS, you are usually considered to have high blood pressure if your reading is 140/90 or higher when checked by a healthcare professional, or 135/85 or higher when checked at home. Most people with high blood pressure feel completely fine, so the only way to know is to get your BP checked.
In Pakistan, almost every family has someone who says "my BP is high" or "my BP has gone up". But many people are not sure what the two numbers on the machine actually mean, which readings are a problem, or why a doctor wants to check it more than once. This guide explains it in simple words, using only what the WHO and the NHS say.
What the two numbers in a blood pressure reading mean
Blood pressure is always written as two numbers, for example 130/80. The first number is always higher than the second.
According to the WHO hypertension fact sheet:
- The first number (systolic) is the pressure in your blood vessels when your heart contracts, or beats.
- The second number (diastolic) is the pressure in your blood vessels when your heart rests between beats.
The WHO writes readings in mmHg, which is why you may see a reading written as "140/90 mmHg". Hypertension is simply the medical name for high blood pressure.
Blood pressure reading ranges: what counts as high
The NHS guide to high blood pressure gives two different cut-offs, depending on where the reading was taken. Notice that the number used for home readings is a little lower.
| Situation | What the source says |
|---|---|
| Checked by a doctor, nurse or pharmacist | High if 140/90 or higher (NHS) |
| Checked at home with your own monitor | High if 135/85 or higher (NHS) |
| How hypertension is diagnosed | Systolic 140 or more and/or diastolic 90 or more, on two different days (WHO) |
| Very high blood pressure | Usually 180/120 or higher, and may cause symptoms (WHO) |
| Treatment goal for most people | Less than 140/90 (WHO) |
| Goal if you have heart disease, stroke, diabetes, kidney disease or high heart risk | Less than 130/80 (WHO) |
Two points are worth knowing:
- One high reading does not mean you have hypertension. The WHO says it is diagnosed when readings are high on two different days.
- Your personal target may be different. The WHO says your recommended blood pressure goal can depend on your other health conditions. Your doctor will tell you what number to aim for.
Why high blood pressure often has no symptoms
Many people believe that if they do not have a headache or feel dizzy, their BP must be fine. This is not true. The NHS says high blood pressure does not usually cause any symptoms, and many people have it without realising it. The WHO says most people with hypertension do not feel any symptoms.
The WHO estimates that 600 million adults with hypertension worldwide (44%) are unaware that they have the condition.
Rarely, high blood pressure can cause symptoms such as headaches, blurred vision or chest pain, according to the NHS. The WHO adds that very high blood pressure can cause headaches, blurred vision, chest pain and other symptoms.
Even without symptoms, high blood pressure that is not treated puts extra strain on your blood vessels, heart and other organs, such as your brain, kidneys and eyes. The NHS says it can increase your risk of:
- heart disease and heart attacks
- strokes
- heart failure
- kidney disease
- vascular dementia
The good news is that the NHS says lowering your blood pressure even a small amount can help reduce your risk of these problems.
How common is high blood pressure?
According to the WHO:
- An estimated 1.4 billion adults aged 30 to 79 had hypertension worldwide in 2024. That is 33% of people in this age range.
- Two-thirds of them live in low- and middle-income countries.
- Only about 320 million (23%) have their blood pressure under control.
- The WHO Eastern Mediterranean Region, which includes Pakistan, has the highest prevalence of hypertension at 38%.
The WHO calls hypertension a major cause of early death worldwide.
How blood pressure is measured, including home monitors
A blood pressure check is quick and painless. The NHS explains that a band (cuff) is inflated around your upper arm and the machine measures the pressure in your blood vessels.
If your first reading is high
If the test shows you might have high blood pressure, the NHS says you may be asked to:
- use a blood pressure monitor at home to check your BP regularly over the next few days
- come back a few days or weeks later to have it checked again
- wear a portable monitor that takes regular readings over 24 hours
These steps help confirm whether you really have high blood pressure.
Using a BP machine at home
Many families in Pakistan keep a digital BP machine at home. The WHO notes that people can measure their own blood pressure using automated devices, but an evaluation by a health professional is still important to assess your risk and any related conditions. So a home machine is useful for keeping track, but it does not replace a visit to your doctor. Remember that the home cut-off is 135/85, not 140/90. Write your readings down with the date and time and take them to your appointment.
Who should get checked
The NHS suggests getting your blood pressure checked if you think you might be at risk, or if you are 40 or over and have not had it checked for more than 5 years. In Pakistan, you can have it checked at your local clinic or hospital, and some pharmacies also offer BP checks.
Causes and risk factors for high blood pressure
The NHS and WHO list several things that make high blood pressure more likely. Some you cannot change, but many you can.
Things you cannot change
- Age: you are more likely to get high blood pressure as you get older. The WHO lists age over 65 years as a risk factor.
- Family history: having close relatives with high blood pressure.
- Ethnicity: the NHS says people with a South Asian, Black African or Black Caribbean background are at higher risk. This is very relevant for people in Pakistan.
- Other conditions: the WHO lists diabetes and kidney disease.
Things you can change
- an unhealthy diet, especially one high in salt
- a diet high in saturated fat and trans fats, and low in fruit and vegetables (WHO)
- being overweight or obese
- not being physically active
- smoking or using tobacco
- drinking too much alcohol
- feeling stressed over a long period (NHS)
The WHO also names air pollution as the most significant environmental risk factor for hypertension and related diseases.
High blood pressure often goes together with other heart risks such as raised cholesterol. If your doctor has also checked your fats, our guide to cholesterol test results explains what those numbers mean.
Treatment: lifestyle changes and medicines
Lifestyle changes that help
Both the NHS and WHO say healthy lifestyle changes can help lower blood pressure. These changes help everyone with hypertension, even people who also need medicine.
Do:
- Eat a healthy, balanced diet with more vegetables and fruit.
- Be active. Both sources say aim for at least 150 minutes of exercise a week. The WHO says this can be 150 minutes of moderate activity or 75 minutes of vigorous activity, plus strength-building exercise on 2 or more days a week.
- Sit less. Walking, swimming, dancing and other everyday activities all count, according to the WHO.
- Lose weight if you are overweight.
- Take any medicines exactly as prescribed and keep your appointments (WHO).
Don't:
- Eat too much salt. The NHS says avoid salty food and adding salt to your meals. In a Pakistani kitchen, this can mean adding less salt at the table and cutting back on very salty snacks and achaar.
- Drink too much caffeine. The NHS lists coffee, tea and cola as drinks high in caffeine, which is worth thinking about if you drink many cups of chai a day.
- Smoke or use tobacco.
- Drink too much alcohol. The NHS says avoid regularly drinking more than 14 units a week.
- Eat lots of foods high in saturated or trans fats (WHO).
The WHO also suggests reducing and managing stress, checking your blood pressure regularly and managing other medical conditions.
Medicines are a decision for your doctor
Lifestyle changes are important, but the WHO says some people will still need medicine, and many who make these changes will still need to take it. That is not a failure.
The NHS says a doctor will usually prescribe medicine if your blood pressure is very high, if you are at higher risk of problems such as a heart attack or stroke, or if your BP stays high after lifestyle changes. The WHO describes several common types, including ACE inhibitors, angiotensin-2 receptor blockers (ARBs), calcium channel blockers and diuretics.
Which medicine is right depends on things like how high your blood pressure is, your age and your ethnicity, according to the NHS. Some people need more than one. Only your doctor can decide this, so please do not start, stop or share BP tablets on your own or on someone else's advice. The WHO specifically warns against missing or sharing medication.
When to see a doctor
Book a visit with your doctor if:
- you have never had your blood pressure checked, or you are 40 or over and have not had it checked for more than 5 years
- your home readings are 135/85 or higher, or a clinic reading is 140/90 or higher
- you often get headaches or blurred vision
- you have chest pain that comes and goes
- you have other symptoms you are worried could be caused by high blood pressure
Urgent warning signs: call 1122
The WHO says people with very high blood pressure (usually 180/120 or higher) can have symptoms such as severe headaches, chest pain, dizziness, difficulty breathing, nausea, vomiting, blurred vision, confusion, anxiety, buzzing in the ears, nosebleeds or an abnormal heart rhythm. If you have any of these with high blood pressure, seek care immediately.
Call 1122 or go to the nearest emergency department straight away if:
- you have sudden pain or discomfort in your chest that does not go away. It can feel like squeezing, pressure, burning or indigestion.
- the pain spreads to your arm, neck, jaw, stomach or back
- you have chest pain and feel sweaty, sick, light-headed or short of breath
The NHS says these can be signs of a heart attack and you need immediate treatment in hospital. Do not drive yourself.
You can find PMDC-verified doctors by city and specialty and book a visit on SehatDoc Booking.
Sources
Medical note: This guide is for general information and is not a substitute for advice from a doctor who can examine you.
Frequently asked questions
- What blood pressure reading is considered high?
- According to the NHS, you are usually considered to have high blood pressure if your reading is 140/90 or higher when checked by a healthcare professional. If you check it at home, the cut-off is 135/85 or higher. The WHO says hypertension is diagnosed when readings are high on two different days, so one high reading alone is not a diagnosis.
- What do the top and bottom numbers in blood pressure mean?
- The top (first) number is the systolic pressure, which is the pressure in your blood vessels when your heart beats. The bottom (second) number is the diastolic pressure, which is the pressure when your heart rests between beats. Both numbers matter, and a reading counts as high if either one is at or above the cut-off.
- Can you have high blood pressure without any symptoms?
- Yes. The NHS says high blood pressure does not usually cause symptoms and many people have it without realising. The WHO estimates that 44% of adults with hypertension worldwide do not know they have it. The only way to find out is to get your blood pressure checked.
- Can I check my blood pressure at home with a BP machine?
- Yes. The WHO says people can measure their own blood pressure with automated devices, and the NHS may ask you to use a home monitor for a few days to confirm a high reading. At home, a reading of 135/85 or higher is usually considered high. A health professional should still assess you, because a home machine cannot check your overall risk.
- What blood pressure level is dangerously high?
- The WHO says very high blood pressure is usually 180/120 or higher and can cause symptoms such as severe headache, chest pain, dizziness, difficulty breathing, blurred vision or confusion. If you have these symptoms with a high reading, seek care immediately. In Pakistan, call 1122 or go to the nearest emergency department.
- Can high blood pressure be controlled without medicine?
- Healthy lifestyle changes such as eating less salt, being active, losing weight if needed, not smoking and limiting alcohol can help lower blood pressure, according to the NHS and WHO. However, the WHO says many people who make these changes will still need medicine. Whether you need medicine, and which one, is a decision for your doctor.
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