Illness & Conditions - Special Health Issues
Covers causes and symptoms of high blood pressure. Explains systolic and diastolic pressure numbers. Looks at treatment and prevention steps. Includes risks of untreated high blood pressure such as heart attack, stroke, and kidney failure.
High Blood Pressure
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).
An ideal blood pressure for an adult is less than 120/80. High blood pressure is 140/90 or higher. 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.
About 1 out of 3 adults in the United States has high blood pressure. 1
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 severe headaches and vision problems. 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 two separate occasions. It is usually measured 1 to 4 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?
If you have high blood pressure, your doctor will give you a blood pressure goal. Your goal will be based on your health and your age. An example of a goal is to keep your blood pressure below 140/90.
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.
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 may also check your risk for other problems, such as heart attack and stroke.
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:
Health Tools help you make wise health decisions or take action to improve your health.
Frequently Asked Questions
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:
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 .
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:
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:
Other possible risk factors include:
When to Call a Doctor
Call your doctor now or seek immediate care if:
These are symptoms of malignant high blood pressure or hypertensive crisis.
Call a doctor if:
Adults are encouraged to have their blood pressure checked regularly.
Who to see
Your blood pressure can be checked:
For diagnosis and management of high blood pressure, see:
Exams and Tests
The main test for high blood pressure is simple, fast, and painless. These are the usual steps:
If this test shows that your blood pressure is high, your doctor will likely have you come in for a follow-up visit to be tested again. 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. 2
Your doctor can let you know how often you should get your blood pressure checked. It may depend on what your blood pressure is and your risk for heart disease. You can get your blood pressure checked during any routine medical visit.
You might get your blood pressure checked:
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.
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 a heart attack and stroke.
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?
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:
Your doctor will give you a blood pressure goal. An example of a goal is to keep blood pressure below 140/90. Your goal may be lower or higher based on your health and age. Your blood pressure goal can help you prevent problems caused by high blood pressure.
Treating high blood pressure with lifestyle changes
For some people, lifestyle changes may be enough to lower their blood pressure. Whether this is an option for you depends on how high your blood pressure is and whether you have other health problems, such as diabetes or heart disease.
Your doctor may suggest that you make one or more of the following changes:
For tips on how to do these things, see the Living With High Blood Pressure section of this topic.
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.
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.
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:
For help with all of these, see the Living With High Blood Pressure section of this topic.
Living With High Blood Pressure
A heart-healthy lifestyle is always important, even if you take medicines too. 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 and lower your risk for heart attack and stroke:
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:
For help making lifestyle changes, see the topic Change a Habit by Setting Goals.
Deciding whether to treat high blood pressure with medicine and choosing the best medicine may depend on:
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.
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.
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.
What to think about
Complementary medicine is treatment that you use in addition to your doctor's standard care. Tell your doctor if you are using, or if you plan to use, complementary medicine to help lower your blood pressure. These treatments do not replace lifestyle changes or medicine for high blood pressure. You and your doctor can decide which therapy might be best for you.
Complementary treatments that help manage stress and improve quality of life may help lower 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 treatment to reduce risk of heart disease
There are some dietary supplements that you may hear about to lower the risk of heart disease, heart attack, and stroke. It is not clear if some vitamins, minerals, and multivitamins can lower risk. But it is clear that some supplements, such as vitamin E and beta-carotene, do not lower risk. 3
Talk with your doctor about the best ways to lower your risk of heart disease, heart attack, and stroke. Tell your doctor if you plan to use dietary supplements or vitamins. Your doctor can make sure they are safe for you.
Other Places To Get Help
Current as of: April 9, 2014
Go AS, et al. (2013). Heart disease and stroke statistics–2013 update: A report from the American Heart Association. Circulation, 127(1): e6–e245.
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.
U.S. Preventive Services Task Force (2014). Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsvita.htm. Accessed March 28, 2014.
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