Dr Hisham Al-Janabi is a consultant in cardiology, interventional cardiology and internal medicine. His clinic at Al-Kasasbeh Center in Aqaba provides cardiolog…

Hypertension is a sustained rise in the force of blood against the artery wall, and it is called the silent killer because it usually produces no symptom at all. Many people believe headache, dizziness or a flushed face signal high blood pressure, when in reality most affected people feel nothing until organs are damaged. Measurement is the diagnosis: you cannot know your blood pressure from how you feel, and the diagnosis is never made on a single reading but on repeated readings at different times, sometimes supported by home recording or a 24-hour ambulatory monitor. The danger of uncontrolled blood pressure is that it works silently for years: it thickens and weakens the heart muscle, accelerates hardening of the arteries, raises the risk of stroke and heart attack, and damages the kidneys and the retina. For that reason the doctor does not simply measure the pressure but examines the heart and pulses and requests kidney function, electrolytes, glucose, lipids, urinalysis and often an electrocardiogram, while looking for secondary causes in younger patients or when treatment is resistant, such as obstructive sleep apnoea, renal artery narrowing, hormonal disorders, and certain medicines and painkillers. Treatment has two tracks, not one. Lifestyle comes first: less salt, fewer processed foods and pickles, weight reduction, regular activity, more vegetables and fruit, better sleep, stopping smoking, and cutting alcohol and stimulants. Medication is added when needed. A patient may require more than one medicine because each works through a different pathway, and this is not proof that the condition is worse; it means the plan has been fitted to the individual. A general page gives no brand names, no doses and no target numbers, because the value appropriate for each person is set by their own doctor according to age, kidney function, diabetes, pregnancy and other conditions. The single most important message here is this: **do not stop your blood pressure medicine or reduce its dose yourself when the reading improves, because the reading improved as a result of the medicine.** Stopping it lets the pressure climb again silently and can cause an acute surge. The limits of treatment also deserve plain words: medication controls blood pressure rather than curing it permanently in most cases, controlling blood pressure does not remove the need to control glucose, lipids and weight, no herb or drink replaces treatment, and feeling well is not evidence that your pressure is controlled. Which medicine suits you and when to start it are decided by clinical examination and direct assessment, not by reading a page.
Procedure steps
- 1
Reliable repeated measurement
Blood pressure is measured after five minutes of rest, with a cuff matched to arm size placed on bare skin, the back supported, feet on the floor, the arm supported at heart level and no talking. Two or more readings are taken a minute apart, and in both arms at the first visit. Hypertension is never diagnosed from one reading, and home recording or a 24-hour ambulatory monitor may be requested to confirm it.
- 2
Assessing organs and risk factors
The doctor examines the heart and limb pulses, listens over the arteries, and requests kidney function, electrolytes, glucose, lipids and urinalysis, usually with an electrocardiogram, and sometimes retinal examination or cardiac imaging. The purpose is to establish whether the pressure has already affected an organ, since that changes how intensively and how quickly treatment begins.
- 3
Searching for a secondary cause
When hypertension appears at a young age, is very severe, or fails to respond to appropriate treatment, a treatable cause is sought: obstructive sleep apnoea, renal artery narrowing, kidney disease, adrenal or thyroid hormone disorders, and certain medicines such as anti-inflammatory painkillers, contraceptive pills, nasal decongestants and stimulants.
- 4
Lifestyle plan
A practical plan is built: reducing salt, processed foods, pickles, tinned products and fast food; increasing vegetables, fruit, legumes and low-fat dairy; a realistic target for weight and waist reduction; regular activity matched to capacity; treating sleep problems; stopping smoking; and cutting alcohol. This plan reduces the need for medication and makes what is prescribed work better.
- 5
Medication and structured follow-up
The doctor selects the medicine or combination according to age, kidney function, diabetes, pregnancy and other conditions, and explains how it is taken and when readings should be recorded. The effect of any change is judged after some weeks using reliable home readings and blood tests where needed. Any adjustment or discontinuation follows a medical decision after review, and patients are reminded not to miss doses and to renew the prescription before it runs out.
Before the procedure
Before a blood pressure assessment visit, record your home readings over several days with the date, time and the name of your device, and bring the device itself so the reading and cuff size can be checked against your arm. Write a full list of your medicines and supplements, and do not omit anti-inflammatory painkillers, contraceptive pills, nasal decongestants, energy drinks and herbal products, since several of these genuinely raise blood pressure. Avoid coffee, tea, smoking and exertion for at least half an hour before measurement, and empty your bladder first. Tell the doctor about your family history, about snoring or witnessed pauses in breathing during sleep, about any dizziness on standing, and about pregnancy or plans for it. Bring previous blood tests and any electrocardiogram you have.
After the procedure
Take your medicine at the same time every day and tie it to a fixed daily habit so it is not forgotten, renew the prescription before it runs out, and do not interrupt it while travelling or busy. Keep structured home readings and bring them to review rather than relying on memory. Continue reducing salt, staying active and losing excess weight even after the readings settle. **Do not stop the medicine or reduce the dose yourself because the reading has become good; it became good because of the medicine.** If a side effect such as dizziness, cough or ankle swelling troubles you, see your doctor to adjust the plan instead of stopping quietly. **Call emergency services immediately for a very high reading accompanied by severe headache, chest pain, breathlessness, change in vision, weakness or numbness on one side of the body, slurred speech, confusion, or a nosebleed that will not stop.**
Expected duration
A blood pressure assessment and planning visit usually takes 20 to 40 minutes, while the measurement itself takes minutes after five minutes of rest. Confirming the diagnosis may require readings over one to four weeks, or an ambulatory monitor worn for 24 hours. The effect of a medication change is judged after two to four weeks, and review then settles to every 3 to 6 months once stable.
Finding Hypertension Treatment services in Jordan
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