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High Blood Pressure

Topic Overview

The cardiovascular system

What is high blood pressure?

Blood pressure is a measure of how hard the blood pushes against the walls of your arteries as it moves through your body. It's normal for blood pressure to go up and down throughout the day, but if it stays up, you have high blood pressure. Another name for high blood pressure is hypertension.

When blood pressure is high, it starts to damage the blood vessels, heart, and kidneys. This can lead to heart attack, stroke, and other problems. High blood pressure is called a "silent killer,'' because it doesn't usually cause symptoms while it is causing this damage.

Your blood pressure consists of two numbers: systolic and diastolic. Someone with a systolic pressure of 120 and a diastolic pressure of 80 has a blood pressure of 120/80, or "120 over 80." Blood pressure is measured in millimeters of mercury (mm Hg).

  • The systolic number shows how hard the blood pushes when the heart is pumping.
  • The diastolic number shows how hard the blood pushes between heartbeats, when the heart is relaxed and filling with blood.

High blood pressure is 140/90 or higher. Adults should have a blood pressure of less than 120/80. Many people fall into the category in between, called prehypertension. People with prehypertension need to make lifestyle changes to bring the blood pressure down and help prevent or delay high blood pressure.1

About 1 out of 3 adults in the United States has high blood pressure.

What causes high blood pressure?

In most cases, doctors can't point to the exact cause. But several things are known to raise blood pressure, including being very overweight, drinking too much alcohol, having a family history of high blood pressure, eating too much salt, and getting older.

Your blood pressure may also rise if you are not very active, you don't eat enough potassium and calcium, or you have a condition called insulin resistance.

What are the symptoms?

High blood pressure doesn't usually cause symptoms. Most people don't know they have it until they go to the doctor for some other reason.

Very high blood pressure can cause headaches, vision problems, nausea, and vomiting. These symptoms can also be caused by dangerously high blood pressure called malignant high blood pressure. It may also be called a hypertensive crisis or hypertensive emergency. Malignant high blood pressure is a medical emergency.

How is high blood pressure diagnosed?

Most people find out that they have high blood pressure during a routine doctor visit. For your doctor to confirm that you have high blood pressure, your blood pressure must be at least 140/90 on three or more separate occasions. It is usually measured 1 to 2 weeks apart.

You may have to check your blood pressure at home if there is reason to think the readings in the doctor's office aren't accurate. You may have what is called white-coat hypertension, which is blood pressure that goes up just because you're at the doctor's office.

How is it treated?

Treatment depends on how high your blood pressure is, whether you have other health problems such as diabetes, and whether any organs have already been damaged. Your doctor will also consider how likely you are to develop other diseases, especially heart disease.

You can help lower your blood pressure by making healthy changes in your lifestyle. If those lifestyle changes don't work well enough, you may also need to take pills. Either way, you will need to control your high blood pressure throughout your life.

Most people take more than one pill for high blood pressure. Work with your doctor to find the right pill or combination of pills that will cause the fewest side effects.

What can you do to prevent high blood pressure?

Making lifestyle changes can help you to prevent high blood pressure. You can:

  • Stay at a healthy weight or lose extra weight.
  • Eat heart-healthy foods.
  • Eat less salt and salty foods.
  • Exercise regularly.
  • Cut back on drinking. Limit alcohol to 2 drinks a day for men and 1 drink a day for women.

Cause

Experts know that many things are linked to high blood pressure. But experts still don't fully understand the exact cause. Things that are linked to high blood pressure include:

  • Aging.
  • Drinking more than 2 alcoholic drinks a day for men or more than 1 alcoholic drink a day for women.
  • Eating a lot of sodium (salt).
  • Being overweight or obese.
  • Not exercising.
  • Being under a lot of stress.
  • Eating a diet low in potassium, magnesium, and calcium.
  • Being insulin-resistant.

Primary, or essential, high blood pressure is the most common type of high blood pressure. Most people who have high blood pressure have primary high blood pressure.

Secondary high blood pressure, which is caused by another disease or medicine, is less common.

Elevated blood pressure readings may not always mean that you have high blood pressure. For some people, just being in a medical setting causes their blood pressure to rise. This is called white-coat hypertension.

Symptoms

People who have high blood pressure usually don't have any symptoms. Most people who have high blood pressure feel fine. It's during a routine exam or a doctor visit for another problem that they find out that they have high blood pressure.

Very severe high blood pressure (such as 180 over 110 or higher) may lead to malignant high blood pressure. This is also called hypertensive emergency or hypertensive crisis. Very severe high blood pressure is a medical emergency. Symptoms of very severe high blood pressure include:

  • Severe headache.
  • Blurry vision.
  • Nausea or vomiting.

What Happens

Healthy arteries have smooth inner walls. Your blood flows through them without a problem. The blood vessels stay strong and flexible.

But when you have high blood pressure, blood flows through your arteries with too much force, even though you can't feel it. Over time, this pressure damages the walls of your arteries. They aren't smooth anymore. They get rough spots on them where fat and calcium start to build up. This buildup is called plaque (say "plak").

Plaque is part of atherosclerosis, sometimes called "hardening of the arteries." Over time, the plaque narrows the artery and blocks blood flow through it.

Atherosclerosis makes your arteries narrower. It also makes them stiffer. Blood can't flow through them as easily. This lack of good blood flow starts to damage some of the organs in your body.

This damage doesn't happen all at once. It happens slowly over time. But you can't tell that it's happening, because you don't feel anything. It can lead to:

What Increases Your Risk

Things that increase your risk (risk factors) for high blood pressure include:

  • A family history of high blood pressure.
  • Aging.
  • Eating a lot of sodium (salt).
  • Drinking more than 2 alcoholic drinks a day for men or more than 1 alcoholic drink a day for women.
  • Being overweight or obese.
  • Lack of exercise or physical activity.
  • Race. African Americans are more likely to get high blood pressure, often have more severe high blood pressure, and are more likely to get the condition at an earlier age than others. Why they are at greater risk is not known.

Other possible risk factors include:

  • Low intake of potassium, magnesium, and calcium.
  • Sleep apnea and sleep-disordered breathing.
  • Long-term use of pain medicines like NSAIDs—for example, naproxen (such as Aleve) or ibuprofen (such as Motrin or Advil)—or COX-2 inhibitors, such as celecoxib (Celebrex). Aspirin does not increase your risk for getting high blood pressure.

When to Call a Doctor

Call your doctor now or seek immediate care if:

  • Your blood pressure is much higher than normal (such as 180/110 or higher).
  • You think high blood pressure is causing symptoms, such as:
    • Severe headache.
    • Blurry vision.
    • Nausea or vomiting.

These are symptoms of malignant high blood pressure or hypertensive crisis.

Call a doctor if:

  • Your blood pressure is 140/90 or higher on two or more occasions.
  • You think you may be having side effects from your blood pressure medicine.
  • Your blood pressure is usually normal and well controlled, but it goes above the normal range on more than one occasion.

Adults are encouraged to have their blood pressure checked regularly.

Who to see

Your blood pressure can be checked:

  • At a clinic where you work or go to school.
  • At pharmacies, health fairs, fitness centers, community centers, fire stations, and ambulance stations.
  • By a nurse practitioner or physician assistant.
  • By a primary care doctor.

For diagnosis and management of high blood pressure, see:

  • A primary care doctor.
  • An internist.
  • A cardiologist (heart specialist). In general, a cardiologist is needed only in cases of extremely high blood pressure or when the person has other serious heart problems.
  • A nephrologist (kidney specialist), in extreme cases.
  • A nurse practitioner.
  • A physician assistant.

Exams and Tests

The main test for high blood pressure is simple, fast, and painless. These are the usual steps:

  1. You sit quietly for 5 minutes before the test, with both feet flat on the floor.
  2. You sit down with your arm resting on the arm of the chair so that your arm is level with your heart.
  3. An inflatable sleeve, called a cuff, is wrapped around your upper arm. It's attached to a dial that will show your blood pressure numbers.
  4. The nurse (or other health professional) seals the cuff and pumps it up. You feel tight pressure as the cuff cuts off the blood flow in your arm.
  5. Next, the nurse slowly loosens the cuff while using a stethoscope to listen to the heartbeat in your inner elbow. When the cuff is just loose enough that blood starts to flow again and the nurse can hear it, that is your systolic blood pressure.
  6. The cuff is slowly loosened some more. When it's loose enough that your heartbeat can no longer be heard through the stethoscope, that is your diastolic blood pressure.

If this test shows that your blood pressure is high, your doctor will likely have you come in two more times to be tested. This will confirm that you have high blood pressure.

Some people only have high blood pressure when they're at the doctor's office. This is called white-coat hypertension. If your doctor thinks this is getting in the way of measuring your true blood pressure, you may need to take your blood pressure at home.

Regular blood pressure checks

All adults should have their blood pressure checked regularly. Experts recommend:2

  • At least every 1 to 2 years if your blood pressure is normal (119/79 or lower).
  • At least every year—or as often as your doctor recommends—if you have prehypertension. This means your systolic pressure (the first number) is 120 to 139 and your diastolic pressure (the second number) is 80 to 89.
  • More often if you have other risk factors for heart disease or evidence of disease caused by high blood pressure.

The automated devices you find in grocery stores or drugstores may not be accurate. Having your blood pressure checked at the doctor's office is best.

A home blood pressure monitor makes it easy to keep track of your blood pressure. It's a good idea to bring your home monitor to the doctor's office to check its accuracy.

Click here to view an Actionset.High Blood Pressure: Checking Your Blood Pressure at Home

Other tests

Besides taking your blood pressure, your doctor will do a physical exam and medical history. Your doctor may also have you get other tests to find out whether high blood pressure has damaged any organs or caused other problems. These tests may include:

Your doctor may also check your risk of coronary artery disease.

Sometimes doctors automatically schedule routine tests because they think that's what patients expect. But experts say that routine heart tests can be a waste of time and money. For more information, see Heart Tests: When Do You Need Them?

Treatment Overview

Untreated high blood pressure can lead to heart attacks or strokes. The higher your blood pressure, the greater your risk. Lowering blood pressure lowers the risk of damaging blood vessels and getting atherosclerosis.

High blood pressure usually can't be cured. But it can be controlled. The two types of treatment for high blood pressure are:

  • Lifestyle changes.
  • Daily medicines.

For most people, the goal of treatment is to get the blood pressure below 140/90. But a person's goal may be lower. Your doctor will give you a blood pressure goal that is based on your health. For example, your goal may be lower if you have other conditions such as diabetes, heart failure, coronary artery disease, or chronic kidney disease.

Treating high blood pressure usually is a lifelong effort.

Treatment for high blood pressure

Blood pressure

Treatment

Blood pressure of 120–139 over 80–89 (prehypertension)

Lifestyle changes

High blood pressure of 140–159 over 90–99

Lifestyle changes, possibly medicines

High blood pressure of 160 over 100 or higher

Medicines plus lifestyle changes

High blood pressure plus organ damage or other risk factors for heart disease

Medicines plus serious lifestyle changes and treatment for the other health problems

Secondary high blood pressure

Medicines, treatment of the condition causing your high blood pressure, or both

Treating high blood pressure with lifestyle changes

Your doctor may suggest that you make one or more of the following changes:

  • Lose weight. If you're overweight, losing extra pounds may bring your blood pressure down.
  • Get more active. Regular aerobic exercise can help lower blood pressure.
  • Stop smoking. Nicotine temporarily increases blood pressure and heart rate with each use.
  • Cut back on drinking. Limit alcohol to 2 drinks a day for men, 1 drink a day for women.
  • Eat less sodium. To help lower blood pressure, try to eat less than 1,500 mg a day.3
  • Follow the DASH diet. The DASH (Dietary Approaches to Stop Hypertension) eating plan can help you lower your blood pressure.

For tips on how to do these things, see the Living With High Blood Pressure section of this topic.

A woman

One Woman's Story:

Izzy, 60

"I could never have imagined I could get (my blood pressure) down so low by losing weight. I feel sure it was the WAY I lost weight, with DASH."—Izzy

Read more about Izzy and how she uses the DASH eating plan.

Treating high blood pressure with medicines

If lifestyle changes don't lower your blood pressure to your goal, you may need to take daily medicines as well.

Medicines control—but usually don't cure—high blood pressure. So you will probably need to take them for the rest of your life. Most people need to take two or more medicines.

Click here to view a Decision Point.High Blood Pressure: Should I Take Medicine?

Some people find it hard to take their medicines properly. They may feel it's too much trouble—especially when they don't feel sick. Or they're worried about side effects. Some people find it hard to keep track of when and how to take their medicines.

If you have trouble taking high blood pressure medicines for any reason, talk to your doctor.

Click here to view an Actionset.High Blood Pressure: Taking Medicines Properly
A man

One Man's Story:

Tyrell, 35

"I learned that it doesn't matter how healthy you feel—if you have high blood pressure, you're sick and you'd better do something about it."—Tyrell

Read more about Tyrell and why he started taking his medicines properly.

Prevention

A heart-healthy lifestyle can help you prevent high blood pressure. These changes are especially important for people who have risk factors for high blood pressure that cannot be changed, including family history, race, or age.

Here are some things you can do:

  • Don't smoke.
  • Stay at a healthy weight.
  • Eat heart-healthy foods.
  • Eat less salt.
  • Get regular exercise.
  • Cut back on drinking.

For help with all of these, see the Living With High Blood Pressure section of this topic.

Living With High Blood Pressure

Lifestyle changes are important to help control high blood pressure, especially if you have other risk factors for coronary artery disease and stroke.

Even if your doctor has prescribed medicine for you, you can still take many steps at home to lower your blood pressure and reduce your risk. Some people can even take less medicine after making these changes.

What changes do you need to make?

Make these lifestyle changes to help lower your blood pressure:

How do you make lifestyle changes?

Making any kind of change in the way you live your daily life is like being on a path. The path leads to success. Here are the first steps on that path:

  1. Have your own reason for making a change. If you do it because someone else wants you to, you're less likely to have success. When you have high blood pressure, the reason for making lifestyle changes is clear: to lower your blood pressure. If you don't feel ready now, learn more about high blood pressure and the damage it can do. When you truly want to make changes, you're ready for the next step.
  2. Set goals. Include long-term goals as well as short-term goals that you can measure easily. Your doctor can help you figure out what your long-term goals should be for your blood pressure. Short-term goals are the small steps you take, week by week, to improve your health.
  3. Measure improvements to your health. Before you make lifestyle changes, ask your doctor to check your blood pressure. Then, as you start to make changes, have your blood pressure checked often, and keep track of the numbers. You can buy a home blood pressure monitor that is easy to use.
  4. Think about what might get in your way, and prepare for slip-ups. By thinking about these barriers now, you can plan ahead for how to deal with them if they happen. Use a personal action planpersonal action plan(What is a PDF document?) to write down your barriers and backup plans.
  5. Get support from your family, your doctor, and your friends. Tell them about your long-term and short-term goals and how they can help.

For help making lifestyle changes, see the topic Change a Habit by Setting Goals.

A woman

One Woman's Story:

Izzy, 60

"A big lesson I learned is that everything we do routinely is a habit. And habits can be changed. I'm living proof."—Izzy

Read more about Izzy and how she changed her eating habits.

A man and a woman

One Man's Story:

Arturo, 58

"As soon as I mentioned [to my wife] that I needed help, she got out a pen and some paper and started writing out a walking schedule."—Arturo

Read more about Arturo and how he got support for his lifestyle changes.

Medications

Deciding whether to treat high blood pressure with medicine and choosing the best medicine are based mainly on:

  • How high your blood pressure is.
  • Whether you have signs that high blood pressure has caused organ damage, such as an enlarged heart or early damage to your arteries, kidneys, or eyes.
  • Whether you have other medical conditions, such as coronary artery disease, diabetes, or kidney or lung disease or risk factors for heart disease, such as diabetes or high cholesterol.
  • Whether you think you can succeed at making lifestyle changes.

Doctors usually prescribe a single, low-dose medicine first. If blood pressure is not controlled, your doctor may change the dosage or try a different medicine or combination of medicines. It is common to try several medicines before blood pressure is successfully controlled. Many people need more than one medicine to get the best results.

Click here to view a Decision Point.High Blood Pressure: Should I Take Medicine?

Medicine choices

Medicine choices include:

All of these medicines are effective for lowering the risk of heart attack and stroke.

Work with your doctor to find the right medicine or combination of medicines that have the fewest side effects and work well for you. And be sure to take your medicines regularly as prescribed.

Click here to view an Actionset.High Blood Pressure: Taking Medicines Properly
Taking Medicines as Prescribed
Dealing With Medicine Side Effects and Interactions

You may have regular blood tests to monitor how the medicine is working in your body. Your doctor will likely let you know when you need to have the tests.

A man

One Man's Story:

Tyrell, 35

"For a few months I was really good about taking (my pills) every day. But they made me a little tired, and I got tired of being tired."—Tyrell

Read more about Tyrell and why he returned to taking his medicine every day.

What to think about

  • The medicine your doctor chooses may be based on other health problems you have. For example, doctors often prescribe ACE inhibitors for people who have diabetes or heart failure.
  • Some people who get a cough while taking ACE inhibitors do well with ARBs, which usually don't cause a cough.
  • Check with your doctor before you take any nonsteroidal anti-inflammatory drugs (NSAIDs)—for example, aspirin or ibuprofen—with high blood pressure medicines. NSAIDs may raise blood pressure and keep your blood pressure medicines from working well. NSAIDs may also interact with your blood pressure medicine and cause kidney problems.
  • Don't take any other prescription medicines, over-the-counter medicines, vitamins, or supplements unless you talk to your doctor first. Medicines can interact with each other and keep blood pressure medicines from working right or cause a bad reaction.

Other Treatment

Alternative or complementary medicine treatments that help reduce stress and improve quality of life may have some effect on blood pressure. These treatments include:

Many of the complementary medicine options listed above don't cost much and are probably not harmful. But it is best to work with your doctor when using these other methods along with traditional medical treatments.

Other Places To Get Help

Organizations

American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX  75231
Phone: 1-800-AHA-USA1 (1-800-242-8721)
Web Address: www.heart.org
 

Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support.


CardioSmart
Web Address: www.cardiosmart.org

National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone: (301) 592-8573
Fax: (240) 629-3246
TDD: (240) 629-3255
Email: nhlbiinfo@nhlbi.nih.gov
Web Address: www.nhlbi.nih.gov
 

The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:

  • Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases).
  • Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia.
  • Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

References

Citations

  1. Go AS, et al. (2013). Heart disease and stroke statistics–2013 update: A report from the American Heart Association. Circulation, 127(1): e6–e245.
  2. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC Express (NIH Publication No. 03–5233). Bethesda, MD: U.S. Department of Health and Human Services.
  3. U.S. Department of Health and Human Services, U.S. Department of Agriculture (2010). Dietary Guidelines for Americans, 2010, 7th ed. Washington, DC: U.S. Government Printing Office. Also available online: http://health.gov/dietaryguidelines/2010.asp.

Other Works Consulted

  • American Heart Association (2006). Diet and lifestyle recommendations revision 2006. Circulation, 114(1): 82–96. [Erratum in Circulation, 114(1): e27.]
  • Aronow WS, et al. (2011). ACCF/AHA 2011 Expert consensus document on hypertension in the elderly: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation, 123(21): 2434–2506.
  • Atkins GB, et al. (2011). Diagnosis and treatment of hypertension. In V Fuster et al., eds., Hurst's the Heart, 13th ed., vol. 2, pp. 1585–1605. New York: McGraw-Hill.
  • Cheriyan J, et al. (2010). Primary prevention of CVD: treating hypertension, search date December 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  • Diao D, et al. (2012). Pharmacotherapy for mild hypertension. Cochrane Database of Systematic Reviews (8).
  • Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (2011). Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics, 128(Suppl 5): S213–S256.
  • Falkner B, Daniels SR (2004). Summary of the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Hypertension, 44(4): 387–388.
  • Henri HC, Rudd P (2007). Hypertension: Context and management. In EJ Topol, ed., Textbook of Cardiovascular Medicine, 3rd ed., pp. 88–108. Philadelphia: Lippincott Williams and Wilkins.
  • Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC Express (NIH Publication No. 03–5233). Bethesda, MD: U.S. Department of Health and Human Services.
  • National Heart, Lung, and Blood Institute (2006). Your Guide to Lowering Your Blood Pressure With DASH (NIH Publication No. 06-4082). Available online: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf.
  • Pickering TG, et al. (2008). Call to action on use and reimbursement for home blood pressure monitoring. A joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension, 52(1): 10–29.
  • Rosendorff C, et al. (2007). Treatment of hypertension in the prevention and management of ischemic heart disease: A scientific statement from the American Heart Association Council for High Blood Pressure Research and the Council on Clinical Cardiology and Epidemiology and Prevention. Circulation, 115(21): 2761–2788.
  • Schwartz GL (2010). Hypertension. In EG Nabel, ed., ACP Medicine, section 3, chap. 12. Hamilton, ON: BC Decker.
  • U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.
  • U.S. Preventive Services Task Force (2007). Screening for high blood pressure: Reaffirmation recommendation statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf07/hbp/hbprs.htm.

Credits

By Healthwise Staff
E. Gregory Thompson, MD - Internal Medicine
Robert A. Kloner, MD, PhD - Cardiology
Last Revised October 31, 2013

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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