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What is the difference between these two sentences:

I have high blood pressure.

and

I have a high blood pressure.

I can only guess that the first one mean that I have high blood pressure all the time. Meanwhile, the second one mean that I measured blood pressure a couple of times and one of those times the blood pressure was high. Is that correct?

2

I have high blood pressure

Is correct.

I have a high blood pressure

Is not correct.

We do not use the phrase “a pressure“, unless (1) you are talking about a specific pressure at a specific location,

I feel a strange pressure in my belly.

The air pressure gauge shows a pressure of 30 psi.

Or (2) you are using the article “a“ to introduce something.

I feel a pressure to conform.

I feel a growing pressure to conform.

(Compare:)

I feel pressured to succeed.

You can say:

I have a high blood pressure level.

This is all right, because you’re saying “a level”, not “a pressure.” This is like saying:

I have a high level of blood pressure.

If you mean to say you have a specific reading which is unusual, you can say:

I have a high level of blood pressure right now.

Or

My blood pressure is high (right now).

My blood pressure is higher than usual.

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