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High blood pressure (hypertension)

Medically reviewed by Drugs.com. Last updated on Feb 29, 2024.

Overview

High blood pressure is a common condition that affects the body's arteries. It's also called hypertension. If you have high blood pressure, the force of the blood pushing against the artery walls is consistently too high. The heart has to work harder to pump blood.

Blood pressure is measured in millimeters of mercury (mm Hg). In general, hypertension is a blood pressure reading of 130/80 mm Hg or higher.

The American College of Cardiology and the American Heart Association divide blood pressure into four general categories. Ideal blood pressure is categorized as normal.

Blood pressure higher than 180/120 mm Hg is considered a hypertensive emergency or crisis. Seek emergency medical help for anyone with these blood pressure numbers.

Untreated, high blood pressure increases the risk of heart attack, stroke and other serious health problems. It's important to have your blood pressure checked at least every two years starting at age 18. Some people need more-frequent checks.

Healthy lifestyle habits —such as not smoking, exercising and eating well — can help prevent and treat high blood pressure. Some people need medicine to treat high blood pressure.

Symptoms

Most people with high blood pressure have no symptoms, even if blood pressure readings reach dangerously high levels. You can have high blood pressure for years without any symptoms.

A few people with high blood pressure may have:

However, these symptoms aren't specific. They usually don't occur until high blood pressure has reached a severe or life-threatening stage.

When to see a doctor

Blood pressure screening is an important part of general health care. How often you should get your blood pressure checked depends on your age and overall health.

Ask your provider for a blood pressure reading at least every two years starting at age 18. If you're age 40 or older, or you're 18 to 39 with a high risk of high blood pressure, ask for a blood pressure check every year.

Your care provider will likely recommend more-frequent readings if have high blood pressure or other risk factors for heart disease.

Children age 3 and older may have blood pressure measured as a part of their yearly checkups.

If you don't regularly see a care provider, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. Free blood pressure machines are also available in some stores and pharmacies. The accuracy of these machines depends on several things, such as a correct cuff size and proper use of the machines. Ask your health care provider for advice on using public blood pressure machines.

Causes

Blood pressure is determined by two things: the amount of blood the heart pumps and how hard it is for the blood to move through the arteries. The more blood the heart pumps and the narrower the arteries, the higher the blood pressure.

There are two main types of high blood pressure.

Primary hypertension, also called essential hypertension

For most adults, there's no identifiable cause of high blood pressure. This type of high blood pressure is called primary hypertension or essential hypertension. It tends to develop gradually over many years. Plaque buildup in the arteries, called atherosclerosis, increases the risk of high blood pressure.

Secondary hypertension

This type of high blood pressure is caused by an underlying condition. It tends to appear suddenly and cause higher blood pressure than does primary hypertension. Conditions and medicines that can lead to secondary hypertension include:

Sometimes just getting a health checkup causes blood pressure to increase. This is called white coat hypertension.

Risk factors

High blood pressure has many risk factors, including:

High blood pressure is most common in adults. But kids can have high blood pressure too. High blood pressure in children may be caused by problems with the kidneys or heart. But for a growing number of kids, high blood pressure is due to lifestyle habits such as an unhealthy diet and lack of exercise.

Complications

The excessive pressure on the artery walls caused by high blood pressure can damage blood vessels and body organs. The higher the blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to complications including:

Diagnosis

To diagnose high blood pressure, your health care provider examines you and asks questions about your medical history and any symptoms. Your provider listens to your heart using a device called a stethoscope.

Your blood pressure is checked using a cuff, usually placed around your arm. It's important that the cuff fits. If it's too big or too small, blood pressure readings can vary. The cuff is inflated using a small hand pump or a machine.

The first time your blood pressure is checked, it should be measured in both arms to see if there's a difference. After that, the arm with the higher reading should be used.

Blood pressure is measured in millimeters of mercury (mm Hg). A blood pressure reading has two numbers.

High blood pressure (hypertension) is diagnosed if the blood pressure reading is equal to or greater than 130/80 mm Hg. A diagnosis of high blood pressure is usually based on the average of two or more readings taken on separate occasions.

Blood pressure is grouped according to how high it is. This is called staging. Staging helps guide treatment.

Sometimes the bottom blood pressure reading is normal (less than 80 mm Hg) but the top number is high. This is called isolated systolic hypertension. It's a common type of high blood pressure in people older than 65.

Tests

If you are diagnosed with high blood pressure, your provider may recommend tests to check for a cause.

Taking your blood pressure at home

Your health care provider may ask you to regularly check your blood pressure at home. Home monitoring is a good way to keep track of your blood pressure. It helps your care providers know if your medicine is working or if your condition is getting worse.

Home blood pressure monitors are available at local stores and pharmacies.

For the most reliable blood pressure measurement, the American Heart Association recommends using a monitor with a cuff that goes around your upper arm, when available.

Devices that measure your blood pressure at your wrist or finger aren't recommended by the American Heart Association because they can provide less reliable results.

Blood pressure measurement

A blood pressure reading measures the pressure in the arteries when the heart beats (top number, called systolic pressure) and between heartbeats (bottom number, called diastolic pressure). To measure blood pressure, an inflatable cuff is usually placed around the arm. A machine or small hand pump is used to inflate the cuff. In this image, a machine records the blood pressure reading. This is called an automated blood pressure measurement.

Treatment

Changing your lifestyle can help control and manage high blood pressure. Your health care provider may recommend that you make lifestyle changes including:

Sometimes lifestyle changes aren't enough to treat high blood pressure. If they don't help, your provider may recommend medicine to lower your blood pressure.

Medications

The type of medicine used to treat hypertension depends on your overall health and how high your blood pressure is. Two or more blood pressure drugs often work better than one. It can take some time to find the medicine or combination of medicines that works best for you.

When taking blood pressure medicine, it's important to know your goal blood pressure level. You should aim for a blood pressure treatment goal of less than 130/80 mm Hg if:

The ideal blood pressure goal can vary with age and health conditions, particularly if you're older than age 65.

Medicines used to treat high blood pressure include:

Other medicines sometimes used to treat high blood pressure

If you're having trouble reaching your blood pressure goal with combinations of the above medicines, your provider may prescribe:

Always take blood pressure medicines as prescribed. Never skip a dose or abruptly stop taking blood pressure medicines. Suddenly stopping certain ones, such as beta blockers, can cause a sharp increase in blood pressure called rebound hypertension.

If you skip doses because of cost, side effects or forgetfulness, talk to your care provider about solutions. Don't change your treatment without your provider's guidance.

Treating resistant hypertension

You may have resistant hypertension if:

Having resistant hypertension doesn't mean your blood pressure will never get lower. If you and your provider can determine the cause, a more effective treatment plan can be created.

Treating resistant hypertension may involve many steps, including:

High blood pressure during pregnancy

If you have high blood pressure and are pregnant, discuss with your care providers how to control blood pressure during your pregnancy.

Potential future treatments

Researchers have been studying the use of heat to destroy specific nerves in the kidney that may play a role in resistant hypertension. The method is called renal denervation. Early studies showed some benefit. But more-robust studies found that it doesn't significantly lower blood pressure in people with resistant hypertension. More research is underway to determine what role, if any, this therapy may have in treating hypertension.

Self care

A commitment to a healthy lifestyle can help prevent and manage high blood pressure. Try these heart-healthy strategies:

Alternative medicine

Diet and exercise are the best ways to lower blood pressure. But some supplements are promoted as heart healthy. These supplements include:

Researchers are also studying whether vitamin D can reduce blood pressure, but evidence is conflicting. More research is needed.

Talk to your care provider before adding any supplements to your blood pressure treatment. Some can interact with medicines, causing harmful side effects that could be life-threatening.

Deep breathing or mindfulness are alternative medicine techniques that can help you relax. These practices may temporarily reduce blood pressure.

Coping and support

High blood pressure isn't something that you can treat and then ignore. It's a condition that requires regular health checkups. Some things you can do to help manage the condition are:

Preparing for your appointment

If you think you may have high blood pressure, make an appointment with your health care provider for a blood pressure test. You might want to wear a short-sleeved shirt to your appointment so it's easier to place the blood pressure cuff around your arm.

No special preparations are necessary for a blood pressure test. To get an accurate reading, avoid caffeine, exercise and tobacco for at least 30 minutes before the test.

Because some medicines can raise blood pressure, bring a list of all medicines, vitamins and other supplements you take and their doses to your medical appointment. Don't stop taking any medicines without your provider's advice.

Appointments can be brief. Because there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready.

What you can do

Preparing a list of questions can help you and your provider make the most of your time together. List your questions from most important to least important in case time runs out. For high blood pressure, some basic questions to ask your provider include:

Don't hesitate to ask any other questions that you might have.

What to expect from your doctor

Your health care provider is likely to ask you questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your provider may ask:

What you can do in the meantime

It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and getting more exercise. These are the main ways to protect yourself against high blood pressure and its complications, including heart attack and stroke.

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