High blood pressure
Blood pressure is a measurement of the force exerted against the walls of your arteries as your heart pumps blood to your body. Hypertension is the term used to describe high blood pressure.
Untreated high blood pressure can lead to many medical problems. These include heart disease, stroke, kidney failure, eye problems, and other health issues.
Blood pressure readings are given as two numbers. The top number is called systolic blood pressure. The bottom number is called diastolic blood pressure. For example, 120 over 80 (written as 120/80 mm Hg).
One or both of these numbers can be too high. (Note: These numbers apply to people who are not taking medicines for blood pressure and who are not ill.)
- Normal blood pressure is when your blood pressure is lower than 120/80 mm Hg most of the time.
- High blood pressure (hypertension) is when one or both of your blood pressure readings are higher than 130/80 mm Hg most of the time.
- If the top blood pressure number is between 120 and 130 mm Hg, and the bottom blood pressure number is less than 80 mm Hg, it is called elevated blood pressure.
If you have heart or kidney problems, or you had a stroke, your doctor may want your blood pressure to be even lower than that of people who do not have these conditions.
If your doctor told you that you have high blood pressure, you may have wondered, what’s the big deal? Well high blood pressure IS a big deal, because it can lead to a heart attack, stroke, vision loss, and kidney disease, sometimes before you even realize you have it. When you have high blood pressure, you’ll want to control it before it can lead to these dangerous complications. Let’s talk about high blood pressure, otherwise known as hypertension. Blood pressure measures the force at which your blood rushes against the walls of your arteries as your heart pumps it through your body. The higher the force, meaning the higher your blood pressure, the harder your heart has to work. High blood pressure damages not only your heart but also your arteries. When your doctor or nurse measures your blood pressure, you’ll see two numbers. The top number is called systolic blood pressure. That’s the force of blood in your arteries whenever your heart beats. The bottom number measures diastolic blood pressure, or the force of blood in between heartbeats. You’re more likely to have high blood pressure if you don’t exercise regularly, you’re obese, you eat too much salt, you have diabetes, you smoke, or you have a family history of high blood pressure. Most of the time, you won’t know that you have high blood pressure. That’s because high blood pressure usually doesn’t cause symptoms. Unless you get your blood pressure checked, you may have no idea there’s a problem until you develop heart disease or another complication. If your blood pressure is high, a few simple lifestyle changes can help bring it back down, and prevent its complications. Eat a heart-healthy diet that includes plenty of fresh fruits and vegetables, whole grains, and low-fat dairy, avoid fatty, salty, and sugary foods, exercise at least 30 minutes a day, limit salt to 1,500 milligrams or less a day, that’s less than a teaspoon per day, and if you smoke, now is the perfect time to quit. Ask your doctor for tips on how to kick the habit. If these measures don’t work, your doctor may prescribe one or more medicines to control your blood pressure. Because high blood pressure can sneak in without warning, stop it before it starts. Stay healthy, and your blood pressure checked at least once a year. If you already have high blood pressure, follow your doctor’s advice to get it under control.
Many factors can affect blood pressure, including:
- The amount of water and salt you have in your body
- The condition of your kidneys, nervous system, or blood vessels
- Your hormone levels
You are more likely to be told your blood pressure is too high as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure increases your chance of having a stroke, heart attack, heart failure, kidney disease, or early death.
You have a higher risk of high blood pressure if you:
- Are African American
- Are obese
- Are often stressed or anxious
- Drink too much alcohol (more than 1 drink per day for women and more than 2 drinks per day for men)
- Eat too much salt
- Have a family history of high blood pressure
- Have diabetes
Most of the time, no cause of high blood pressure is found. This is called essential hypertension.
High blood pressure that is caused by another medical condition or medicine you are taking is called secondary hypertension. Secondary hypertension may be due to:
- Chronic kidney disease
- Disorders of the adrenal gland (such as pheochromocytoma or Cushing syndrome)
- Pregnancy or preeclampsia
- Medicines such as birth control pills, diet pills, some cold medicines, migraine medicines, corticosteroids, some antipsychotics, and certain medicines used to treat cancer
- Narrowed artery that supplies blood to the kidney (renal artery stenosis)
- Obstructive sleep apnea (OSA)
Most of the time, there are no symptoms. For most people, high blood pressure is found when they visit their health care provider or have it checked elsewhere.
Because there are no symptoms, people can develop heart disease and kidney problems without knowing they have high blood pressure.
Malignant hypertension is a dangerous form of very high blood pressure. Symptoms may include:
- Severe headache
- Nausea and vomiting
- Vision changes
Exams and Tests
Diagnosing high blood pressure early can help prevent heart disease, stroke, eye problems, and chronic kidney disease.
Your provider will measure your blood pressure many times before diagnosing you with high blood pressure. It is normal for your blood pressure to be different based on the time of day.
All adults over the age of 18 should have their blood pressure checked every year. More frequent measurement may be needed for those with a history of high blood pressure readings or those with risk factors for high blood pressure.
Blood pressure readings taken at home may be a better measure of your current blood pressure than those taken at your provider’s office.
- Make sure you get a good quality, well-fitting home blood pressure monitor. It should have a properly-sized cuff and a digital readout.
- Practice with your provider to make sure you are taking your blood pressure correctly.
- You should be relaxed and seated for several minutes prior to taking a reading.
- Bring your home monitor to your appointments so your provider can make sure it is working correctly.
Your provider will do a physical exam to look for signs of heart disease, damage to the eyes, and other changes in your body.
Tests may also be done to look for:
The goal of treatment is to reduce your blood pressure so that you have a lower risk of health problems caused by high blood pressure. You and your provider should set a blood pressure goal for you.
Whenever thinking about the best treatment for high blood pressure, you and your provider must consider other factors such as:
- Your age
- The medicines you take
- Your risk of side effects from possible medications
- Other medical conditions you may have, such as a history of heart disease, stroke, kidney problems, or diabetes
If your blood pressure is between 120/80 and 130/80 mm Hg, you have elevated blood pressure.
- Your provider will recommend lifestyle changes to bring your blood pressure down to a normal range.
- Medicines are rarely used at this stage.
If your blood pressure is higher than 130/80, but lower than 140/90 mm Hg, you have Stage 1 high blood pressure. When thinking about the best treatment, you and your provider must consider:
- If you have no other diseases or risk factors, your provider may recommend lifestyle changes and repeat the measurements after a few months.
- If your blood pressure remains above 130/80, but lower than 140/90 mm Hg, your provider may recommend medicines to treat high blood pressure.
- If you have other diseases or risk factors, your provider may be more likely to start medicines at the same time as lifestyle changes.
If your blood pressure is higher than 140/90 mm Hg, you have Stage 2 high blood pressure. Your provider will most likely start you on medicines and recommend lifestyle changes.
Before making a final diagnosis of either elevated blood pressure or high blood pressure, your provider should ask you to have your blood pressure measured at home, at your pharmacy, or somewhere else besides their office or a hospital.
You can do many things to help control your blood pressure, including:
- Eat a heart-healthy diet, including potassium and fiber.
- Drink plenty of water.
- Get at least 40 minutes of moderate to vigorous aerobic exercise at least 3 to 4 days a week.
- If you smoke, quit.
- Limit how much alcohol you drink to 1 drink a day for women, and 2 a day for men or less.
- Limit the amount of sodium (salt) you eat. Aim for less than 1,500 mg per day.
- Reduce stress. Try to avoid things that cause you stress, and try meditation or yoga to de-stress.
- Stay at a healthy body weight.
Your provider can help you find programs for losing weight, stopping smoking, and exercising.
You can also get a referral to a dietitian, who can help you plan a diet that is healthy for you.
How low your blood pressure should be and at what level you need to start treatment is individualized, based on your age and any medical problems you have.
MEDICINES FOR HYPERTENSION
Most of the time, your provider will try lifestyle changes first, and check your blood pressure two or more times. Medicines will likely be started if your blood pressure readings remain at or above these levels:
- Top number (systolic pressure) of 130 or more
- Bottom number (diastolic pressure) of 80 or more
If you have diabetes, heart problems, or a history of a stroke, medicines may be started at lower blood pressure reading. The most commonly used blood pressure targets for people with these medical problems are below 120 to 130/80 mm Hg.
There are many different medicines to treat high blood pressure.
- Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two or more drugs.
- It is very important that you take the medicines prescribed to you.
- If you have side effects, your doctor can substitute a different medicine.
Most of the time, high blood pressure can be controlled with medicine and lifestyle changes.
When blood pressure is not well-controlled, you are at risk for:
When to Contact a Medical Professional
If you have high blood pressure, you will have regular checkups with your provider.
Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked during your regular check-up, especially if someone in your family has or had high blood pressure.
Call your provider right away if home monitoring shows that your blood pressure is still high.
Most people can prevent high blood pressure from occurring by following lifestyle changes designed to bring blood pressure down.
American Diabetes Association. 10. Cardiovascular disease and risk management: standards of medical care in diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S111-S134. PMID: 31862753
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11);e596-e646. PMID: 30879355
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. PMID: 24352797
Meschia JF, Bushnell C, Boden-Albala B, et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology; Council on Hypertension. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(12):3754-3832. PMID: 25355838
Victor RG. Systemic hypertension: mechanisms and diagnosis. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 46.
Victor RG, Libby P. Systemic hypertension: management. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 47.
Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens (Greenwich). 2014;16(1):14-26. PMID: 24341872
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):e127-e248. PMID: 29146535
Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016;387(10017):435-443. PMID: 26559744
Last reviewed on: 1/27/2020
Reviewed by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.