What is… Hypertension?

Hypertension - more commonly known as high blood pressure - is one of the most prevalent medical conditions worldwide. Often referred to as a “silent killer,” it can quietly damage the body for years before symptoms appear, increasing the risk of heart disease, stroke, kidney failure, and other serious conditions.

In both clinical practice and medico-legal contexts, hypertension is a recurring issue. From missed diagnoses to poor management, it frequently features in negligence claims. This blog will break down what hypertension is, how it develops, why it matters, and where it intersects with the law.

Understanding Blood Pressure

Blood pressure is the force of circulating blood against the walls of the arteries. It is expressed as two numbers:

• Systolic pressure (the top number): the pressure when the heart contracts.

• Diastolic pressure (the bottom number): the pressure when the heart relaxes between beats.

A typical healthy reading is around 120/80 mmHg. Hypertension is usually defined as readings consistently at or above 140/90 mmHg in clinic, or 135/85 mmHg on home monitoring.

Types of Hypertension

There are several forms of hypertension, each with different causes and implications:

1. Primary (essential) hypertension: the most common type (around 90–95% of cases), there is no single cause, but linked to genetics, lifestyle, and ageing.

   
   

2. Secondary hypertension: caused by an underlying condition (e.g., kidney disease, hormonal disorders, sleep apnoea), it is often more severe and requires treating the root cause.

   
   

3. White-coat hypertension: elevated readings in clinical settings but normal at home.

   
   

4. Resistant hypertension: blood pressure remains high despite the use of three or more medications.

Risk Factors

Hypertension does not arise in isolation. Risk factors include:

• Age (risk increases as people get older).

• Family history of hypertension or cardiovascular disease.

• High salt intake.

• Obesity and physical inactivity.

• Smoking and excessive alcohol consumption.

• Stress.

• Conditions such as diabetes and chronic kidney disease.

These factors are important not just medically but also when considering standards of care in negligence cases.

Why Hypertension Matters

High blood pressure puts extra strain on the heart and arteries. Over time, this can lead to:

• Heart attacks and heart failure.

• Stroke and transient ischaemic attacks.

• Kidney disease.

• Aneurysms.

• Cognitive decline and dementia.

Because symptoms are often absent, many people only discover they have hypertension after significant damage has occurred.

Diagnosing Hypertension

Diagnosis usually involves blood pressure monitoring across multiple occasions, ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM), blood and urine tests to check for organ damage and ECGs to assess the heart. Failure to carry out proper monitoring is a common source of medico-legal dispute.

Treating Hypertension

Treatment depends on severity and risk profile. Treatment typically comes down to two options: lifestyle changes and medications. Reducing salt intake and increasing regular physical activity are examples of lifestyle change, and beta-blockers and diuretics are examples of medication.

Effective treatment significantly reduces long-term risks.

Hypertension and Clinical Negligence

Hypertension cases feature frequently in negligence claims, often where:

• A patient’s raised blood pressure was repeatedly recorded but not investigated.

• Hypertension was diagnosed but not appropriately managed.

• Complications (stroke, heart attack, kidney failure) occurred due to inadequate treatment.

• Risks were not explained, affecting patient decisions about lifestyle or medication (raising informed consent issues under Montgomery).

The Role of Expert Witnesses

Expert witnesses - often general practitioners, cardiologists, nephrologists, or stroke specialists, play a key role in hypertension-related claims. Their role may involve:

• Reviewing medical records to check whether elevated readings were acted upon.

• Assessing whether investigations or referrals were appropriate.

• Determining whether earlier intervention could have prevented complications.

• Providing condition and prognosis reports for claimants with long-term consequences.

Hypertension and Prevention

The good news is that hypertension is highly preventable and manageable. Public health initiatives focus on:

• Screening programmes.

• Lifestyle education.

• Accessible monitoring services in pharmacies and community clinics.

From a medico-legal perspective, prevention also reduces litigation risk: fewer missed diagnoses, fewer complications, and fewer claims.

Final Thoughts

Hypertension may be common, but its consequences are anything but ordinary. As a silent, progressive condition, it can devastate lives if left unchecked. For clinicians, vigilance in diagnosis and management is essential. For solicitors and expert witnesses, hypertension cases highlight the importance of record-keeping, guideline adherence, and early intervention.

Ultimately, hypertension is a condition where careful management changes outcomes, clinically and legally.

At Apex Experts, our panel of

medical experts includes GPs, cardiologists, nephrologists, and stroke specialists who can provide independent, CPR-compliant opinions in hypertension-related claims.