High blood pressure: what it is and how to keep it under control

High blood pressure (also called hypertension) is when the force of blood pushing against your artery walls is too high. It rarely causes any symptoms until it has already damaged your heart, kidneys, or brain. That is why every adult should have their blood pressure measured at least once a year.

The good news: hypertension is one of the most treatable long-term conditions. Simple changes plus (sometimes) one tablet a day can add many healthy years to your life.

On this page

• What blood pressure numbers mean
• Why it matters — what happens if it is not treated
• Who is at higher risk?
• How to lower it — lifestyle
• When medicine is needed
• Living with hypertension

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What blood pressure numbers mean

Blood pressure is measured in two numbers. The top number (systolic) is the pressure when your heart beats. The bottom number (diastolic) is when your heart rests.

Reading	What it means
Below 120/80	Normal
120-139 / 80-89	Elevated — small changes now stop it becoming high
140/90 or higher	High blood pressure (hypertension)
180/110 or higher	Very high — see a health worker today

One high reading does not mean you have hypertension. You need at least 2 high readings on different days for the diagnosis. Blood pressure goes up when you are stressed, in pain, or have just walked fast — measurements should be taken after 5 minutes of sitting calmly.

Why it matters — what happens if it is not treated

Long-term high blood pressure damages your blood vessels. That leads to:

• Stroke (bleeding or a clot in the brain)
• Heart attack and heart failure
• Kidney failure (needing dialysis)
• Eye damage (blurred vision, blindness)
• Poor blood flow to legs

Most of these problems come with no warning. That is why “silent” pressure is dangerous.

Who is at higher risk?

• Adults over 40
• Family history of high blood pressure
• Overweight, especially around the waist
• Very salty diet
• Little physical activity
• Heavy alcohol drinking
• Long-term stress
• Diabetes or kidney disease
• Pregnancy (see antenatal danger signs)

Blood pressure tends to run in families. If your parent had a stroke or heart attack young (before 55), you should be checked yearly starting at age 30.

How to lower it — lifestyle

For elevated blood pressure (120-139 / 80-89), lifestyle changes alone are often enough. For diagnosed hypertension, they make the medicine work better.

::: doList

Do

• Eat less salt — no more than one small teaspoon of added salt a day. Avoid bouillon cubes, packet soups, and processed meats
• Eat more vegetables and fruit — 5 handfuls a day
• Walk 30 minutes most days — brisk enough that you can still talk but not sing
• Lose extra weight if you carry weight around the waist
• Sleep 7-8 hours most nights
• Manage stress — prayer, walking, talking to someone, breathing exercises
• Have your blood pressure checked every 3-6 months if it has been high once :::

::: dontList

Don’t

• Do not add extra salt at the table
• Do not drink more than 2 alcoholic drinks a day for men, 1 for women — less is better
• Do not smoke (chat also raises blood pressure and heart rate)
• Do not stop taking medicine because you “feel fine” — that is exactly when it is working
• Do not try herbal remedies as a replacement for medicine
• Do not skip check-ups :::

::: factBox

The single biggest change: salt

Ethiopian food can be salty — spice mixes, cheese, cured meats, and restaurant food all add up. Cutting salt by half can drop the top number by 5-10 mm Hg on its own. Taste your food before adding more salt at the table. :::

When medicine is needed

If your blood pressure stays high after 3 months of lifestyle changes, or if it is very high to start with (160/100+), a health worker will prescribe a tablet.

The most common first-line medicines in Ethiopia are:

• Amlodipine (a calcium channel blocker) — one tablet daily
• Hydrochlorothiazide (a mild diuretic) — one tablet daily
• Enalapril or lisinopril (ACE inhibitors) — one tablet daily

Sometimes two of these are combined into a single tablet. All are available free or cheap at government health centres.

Rules:

• Take the tablet every day at the same time, even if you feel completely fine
• Do not skip doses — even one week off lets the pressure creep up
• Tell the health worker about any side effects (dry cough, swollen ankles, dizziness on standing)
• Come back in 4-6 weeks to check the pressure and adjust the dose if needed

Most people need medicine for the rest of their life. This is not a failure — it is simply how the body works after 40. A tablet a day is a small price for avoiding a stroke.

::: urgentAdvice severity=“urgent”

Urgent advice: go to a health facility today if:

• A single reading of 180/110 or higher (get it checked twice, 5 minutes apart)
• Severe headache that will not go away
• Blurred vision or seeing spots
• Chest pain or heaviness
• Difficulty breathing
• Weakness in one arm, leg, or side of face — possible stroke, do not wait
• Slurred speech — possible stroke, do not wait :::

Living with hypertension

• Buy a home blood pressure monitor if you can — check once a week and note the number
• Take your medicine with a daily routine (with breakfast, before bed)
• Bring your card and a list of medicines to every clinic visit
• Tell your family — they can support your diet and remind you
• Attend every follow-up — most Ethiopian health centres now offer free NCD clinic days
• Vaccinations still matter — flu vaccine yearly if available, pneumococcal vaccine after 60

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Reviewed by Dr. Hanna Alemayehu, MD, MPH — Family medicine, Addis Ababa Last reviewed: 5 September 2026 · Next review due: 5 September 2028

Sources:

1. World Health Organization. Hypertension fact sheet. March 2023.
2. Federal Ministry of Health, Ethiopia. National Non-Communicable Disease Strategic Plan. 2021.
3. World Health Organization. HEARTS technical package for cardiovascular disease management. 2022.

Content adapted from WHO hypertension guidance and Ethiopian MoH NCD strategic plan. Reviewed for Ethiopian context by Dr. Hanna Alemayehu.

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Draft notes (delete before publish)

• Word count: ~960
• Grade 7
• isTimeCritical: false; urgentAdvice for hypertensive crisis + stroke signs
• Uses doList, dontList, factBox (salt as the single biggest change)
• First-line meds match Ethiopian NCD formulary (amlodipine, HCTZ, enalapril/lisinopril)
• Chat (khat) mentioned as risk factor — regionally important
• Dr. Hanna Alemayehu is placeholder — B2B-22