The screening process to identify and treat high blood pressure should begin in childhood and be carried out throughout adulthood as part of the routine physical examination. In some patients, high blood pressure may be affected by peripheral arterial disease, i.e., cholesterol blockages, causing the blood pressure to register as much as one hundred points higher in one arm than the other. The higher measurement is the one that reflects the actual blood pressure in the heart and should be closely monitored.

Hypertension remains asymptomatic in most patients until an organ becomes affected by the increased pressure—a process that usually takes many years to occur. For example, high blood pressure can ultimately lead to stroke, swelling of the brain, kidney failure, or heart failure. Patients may grow additional heart muscle, called hypertrophy, in order to compensate for the increased pressure. While this added muscle may initially enable the heart to continue supporting the normal output of blood, the increasing thickness will ultimately also create decreased muscular elasticity—what we call compliance. Approximately half of the patients who present with heart failure due to hypertension have symptoms of shortness of breath, swollen ankles, and fluid in the lungs due to poor diastolic function. Yet these same patients may maintain good pump action and systolic function. This variation in ability is important for physicians to recognize and treat.

We also see patients with what is called labile, or "white coat" hypertension, whose blood pressure varies greatly depending on anxiety and other factors. In some patients, this occasional elevation in blood pressure may represent the beginning phase of persistent high blood pressure. Studies have shown that patients who demonstrate labile blood pressure move on to develop high blood pressure more often than the general population.

Physicians typically treat hypertension using medical therapies. For the vast majority of patients, no surgical treatment exists for hypertension. (Surgical therapies are available for those few patients whose high blood pressure stems from an obstruction in their aorta or renal arteries, or from an abnormality in the function of their adrenal gland.) In conjunction with medical therapies, physicians often prescribe a diet and exercise regimen to help treat essential hypertension, or hypertension that has no definable cause. Ultimately, physicians hope to achieve enough benefit to the patient through lifestyle modifications that the medical therapy can eventually be decreased or even eliminated.

Patients whose hypertension remains unresponsive to medication and leads to heart failure may ultimately have to be considered for heart transplantation. Uncontrolled hypertension can also result in kidney failure, the need for dialysis, and a possible kidney transplant—particularly among those patients with diabetes.