If there is one medical term guaranteed to trigger anxiety, it’s high blood pressure.

A familiar scenario plays out every day. A patient visits their GP for something entirely unrelated. The blood pressure cuff comes out. The reading is a little high. The doctor frowns, suggests a repeat reading next week, and mentions tablets “if it’s still raised.”

And just like that, anxiety takes over.

The patient goes home, consults Dr Google, and is bombarded with terrifying headlines about strokes, heart attacks, and kidney failure. When they return for the follow-up appointment, they’re already tense — unsurprisingly, their blood pressure is even higher. The spiral continues, and suddenly they’re facing the prospect of lifelong medication.

This blog is for that patient.

My aim is to demystify blood pressure and explain how to think about it more calmly and more intelligently — by asking three simple but crucial questions before worrying about medication.

 

Why the Blood Pressure Number Causes So Much Confusion

Blood pressure is often treated as a single, definitive number. In the UK, for example, we’re told that anything above 140/90 means you have “high blood pressure.”

But this never really made sense to me.

We are all different — different genetics, different lifestyles, different stress responses. Why should one number define everyone?

The more important question isn’t:

“Is my blood pressure high?”

But rather:

“Is my blood pressure high for me?”

To answer that properly, you need to ask your doctor three things.

 

Question 1: What Is My True Blood Pressure?

Blood pressure fluctuates constantly throughout the day and night. It rises with stress, activity, anxiety, caffeine, and lack of sleep — and falls when we relax or sleep.

That’s why a single reading in a doctor’s surgery is often the least accurate way to assess blood pressure. Clinics are artificial environments, and many people experience “white coat hypertension,” where anxiety alone drives the numbers up.

A far better approach is:

  • Home blood pressure readings over several days, or
  • A 24-hour ambulatory blood pressure monitor

The 24-hour monitor automatically measures your blood pressure multiple times during the day and night and calculates an average. That average is far more meaningful than any isolated reading.

In fact, many people are surprised to discover that their true average blood pressure is significantly lower than the clinic values that caused all the worry in the first place.

Before discussing tablets, always ask:

“What is my average blood pressure over 24 hours?”

 

Question 2: Is My Blood Pressure a Symptom of Something Else?

In many cases, raised blood pressure isn’t a disease — it’s a signal.

Common contributors include:

  • Excess weight
  • Smoking
  • Sedentary lifestyle
  • High alcohol intake
  • Chronic stress
  • Poor sleep (including sleep apnoea)

If blood pressure is reflecting an unhealthy lifestyle, then simply prescribing tablets to “make the number look better” misses the point.

Lowering the number without addressing the cause doesn’t meaningfully reduce long-term risk. The risk comes from the lifestyle itself — not just the blood pressure reading.

Lifestyle changes improve overall health and blood pressure simultaneously. Medication may still have a role, but it should never replace addressing the underlying drivers.

 

Question 3: Is My Blood Pressure Actually Causing Harm?

This is the most important — and most misunderstood — question.

People worry about strokes, heart attacks, and kidney failure, but these complications occur after years of sustained damage, not overnight.

For major events to happen, there must first be low-level, silent damage occurring inside the body.

And crucially — we can look for that damage.

 

Where Do We Look?

  1. The Eyes (Retina)

The tiniest blood vessels in the body are found at the back of the eye. High blood pressure can cause tiny haemorrhages that are visible during a simple eye examination.

  1. The Kidneys

Early blood vessel damage in the kidneys causes leakage of protein into the urine — detectable long before kidney blood tests become abnormal.

  1. The Heart

If the heart is pumping against higher pressure over time, the muscle thickens. This can be easily seen on an echocardiogram (ultrasound of the heart).

 

Why This Changes Everything

Research consistently shows that people with evidence of low-level organ damage are the ones most likely to suffer harm from high blood pressure.

That’s why context matters more than the number alone.

  • Someone with 130/80 and evidence of organ damage may need aggressive treatment.
  • Someone with 150/90 without any damage may not need medication immediately.

In both cases, lifestyle optimisation is essential — but medication decisions should be individualised, not automatic.Putting It All Together

 

Before panicking about blood pressure, make sure you can answer these three questions:

  1. What is my true average blood pressure?
  2. Is my blood pressure a sign of lifestyle factors I can improve?
  3. Is my blood pressure actually causing harm to my organs?

When you approach blood pressure this way, it becomes far less frightening — and far more logical.

 

Final Thoughts

Blood pressure is complex. It deserves nuance, not fear.

I hope this explanation helps you feel more in control, better informed, and less anxious about a single number on a machine.

If you found this helpful, I’d genuinely love to hear your thoughts. I took a short break recently due to burnout, but I’m feeling refreshed and excited to create more content again.

 

Here is a video I have done on this subject:

https://youtu.be/XjF5QgFARVc?si=9ZrOqQ3zEyhYZlAH

Keywords: high blood pressure; hypertension; anxiety; heart disease; heart failure