High blood pressure: understanding, screening and treatment in 2026

1. What is high blood pressure?

High blood pressure (hypertension) means the pressure of blood in the arteries is too high. Measured in millimetres of mercury (mmHg), it is expressed by two numbers: the systolic (peak pressure during heart contraction) and the diastolic (minimum pressure between beats). The 2024 European ESC/ESH guidelines define hypertension from 140/90 mmHg in the office or 135/85 mmHg at home.

In Belgium, nearly one adult in three is hypertensive, and prevalence exceeds 50 % after age 65. It is the leading preventable risk factor for stroke, myocardial infarction, chronic kidney disease and vascular dementia. Recent trials (SPRINT, STEP) confirm that tighter control reduces mortality, even in older patients.

2. Warning signs to watch for

Hypertension is nicknamed "the silent killer" because it causes no symptoms in most cases. When present, signs are non-specific:

• morning headaches, mainly at the back of the head
• dizziness, feeling unsteady
• tinnitus (ringing in the ears)
• palpitations, breathlessness on exertion
• recurrent nosebleeds
• visual disturbances (floaters, blurred vision)

A hypertensive crisis (>180/120 mmHg) with chest pain, severe shortness of breath or neurological deficit is an emergency: call 112.

3. How to screen for it?

Screening relies on regular blood pressure measurement. The 2024 ESC/ESH guidelines recommend a check every 3 to 5 years from age 18, then yearly after 40 or in the presence of risk factors (overweight, diabetes, family history, smoking, African origin).

To confirm the diagnosis, home self-measurement has become the reference: 2 readings morning and evening for 7 days, seated after 5 minutes of rest. ABPM (24-hour ambulatory monitoring) remains useful when white-coat or masked hypertension is suspected. Initial work-up includes: blood test (creatinine, potassium, glucose, lipids), urine dipstick and ECG. At Maison Médicale Parc Astrid, all of this is covered by the INAMI flat-rate.

4. What are the treatments?

Management rests on two inseparable pillars: lifestyle measures and, if needed, medication.

Non-pharmacological measures, validated by 2024 meta-analyses, include: salt reduction to less than 5 g/day, weight loss (each kilogram lost lowers pressure by about 1 mmHg), 150 minutes of moderate physical activity per week, alcohol limitation, smoking cessation, stress management and a DASH or Mediterranean diet rich in potassium (vegetables, fruits, nuts).

For medication, the 2024 ESC/ESH guidelines now favour upfront dual therapy at low dose, most often an ACE inhibitor (or ARB) combined with a calcium channel blocker or a thiazide diuretic. This approach improves adherence and speeds up control. Beta-blockers remain indicated when coronary artery disease or heart failure is associated.

5. Follow-up at Maison Médicale Parc Astrid

Once treatment is started, your GP organises structured follow-up. A 4-week consultation assesses tolerance and efficacy, then every 3 to 6 months once blood pressure is stable. An annual blood test and an ECG every 2 to 3 years complete the monitoring.

Our multidisciplinary team supports you daily: loan of a validated blood pressure monitor for home measurement, therapeutic education with the nurse, personalised nutritional advice and coordination with the cardiologist or nephrologist when needed. For patients registered in the flat-rate, all these consultations are free, with no upfront payment — a major advantage for a lifelong condition.