High blood pressure is a common condition in which the force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.
Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.
You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.
High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.
Although a few people with early-stage high blood pressure may have dull headaches, dizzy spells or a few more nosebleeds than normal, these signs and symptoms usually don't occur until high blood pressure has reached a severe or life-threatening stage.
When to see a doctor
You'll likely have your blood pressure taken as part of a routine doctor's appointment.
See your primary care doctor for a blood pressure reading at least every year starting at age 18.
Your doctor will likely recommend more frequent readings if you've already been diagnosed with high blood pressure or other risk factors for cardiovascular disease. Children age 3 and older will usually have their blood pressure measured as a part of their yearly checkups.
If you don't regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free, but these machines can give you inaccurate results.
There are two types of high blood pressure.
Primary (essential) hypertension
For most adults, there's no identifiable cause of high blood pressure. This type of high blood pressure, called essential hypertension or primary hypertension, tends to develop gradually over many years.
Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:
- Kidney problems
- Adrenal gland tumors
- Thyroid problems
- Certain defects in blood vessels you're born with (congenital)
- Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
- Illegal drugs, such as cocaine and amphetamines
- Alcohol abuse or chronic alcohol use
- Obstructive sleep apnea
- Age. The risk of high blood pressure increases as you age. Through early middle age, or about age 45, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
- Race. High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack, and kidney failure, also are more common in blacks.
- Family history. High blood pressure tends to run in families.
- Being overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
- Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
- Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow, increasing your blood pressure. Secondhand smoke also can increase your blood pressure.
- Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
- Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don't get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
- Too little vitamin D in your diet. Vitamin D may affect an enzyme produced by your kidneys that affects your blood pressure.
- Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than two drinks a day for men and more than one drink a day for women may affect your blood pressure.
- Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
- Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease and sleep apnea.
Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.
The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.
Uncontrolled high blood pressure can lead to:
- Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
- Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
- Heart failure. To pump blood against the higher pressure in your vessels, your heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure.
- Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
- Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
- Metabolic syndrome. This syndrome is a cluster of disorders of your body's metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL); or "good," cholesterol; high blood pressure; and high insulin levels.
- If you have high blood pressure, you're more likely to have other components of metabolic syndrome. The more components you have, the greater your risk of developing diabetes, heart disease or stroke.
- Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.
No special preparations are necessary to have your blood pressure checked. You might want to wear a short-sleeve shirt to your appointment so that the blood pressure cuff can fit around your arm properly. You might want to avoid caffeinated food and drinks right before your test.
Because some medications, such as over-the-counter cold medicines, pain medications, antidepressants, birth control pills and others, can raise your blood pressure, it might be a good idea to bring a list of medications and supplements you take to your doctor's appointment. Don't stop taking any prescription medications that you think may affect your blood pressure without your doctor's advice. Because appointments can be brief, and 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 for your appointment, and what to expect from your doctor.
What you can do
- Write down key personal information, including a family history of high blood pressure, high cholesterol, heart disease, stroke or diabetes, and any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Take a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Be prepared to discuss your diet and exercise habits. If you don't already follow a diet or exercise routine, be ready to talk to your doctor about any challenges you might face in getting started.
It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against high blood pressure and its complications, including heart attack and stroke.
To measure your blood pressure, your doctor or a specialist will usually place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge.
A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).
Blood pressure measurements fall into four general categories:
- Normal blood pressure. Your blood pressure is normal if it's below 120/80 mm Hg. However, some doctors recommend 115/75 mm Hg as a better goal. Once blood pressure rises above 115/75 mm Hg, the risk of cardiovascular disease begins to increase.
- Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Prehypertension tends to get worse over time.
- Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg.
- Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.
Your doctor will likely take blood pressure readings at one or more separate appointments before diagnosing you with high blood pressure. Your doctor may also ask you to record your blood pressure at home and at work to provide additional information.
If you have any type of high blood pressure, your doctor will review your medical history and conduct a physical examination.
Your doctor may also recommend routine tests, such as a urine test (urinalysis), blood tests and an electrocardiogram — a test that measures your heart's electrical activity. Your doctor may also recommend additional tests, such as a cholesterol test, to check for more signs of heart disease.
Taking your blood pressure at home
An important way to check if your blood pressure treatment is working, or to diagnose worsening high blood pressure, is to monitor your blood pressure at home. Home blood pressure monitors are widely available, and you don't need a prescription to buy one.
Changing your lifestyle can go a long way toward controlling high blood pressure. Your doctor may recommend you eat a healthy diet with less salt, exercise regularly, quit smoking and maintain a healthy weight. But sometimes lifestyle changes aren't enough.
In addition to lifestyle changes, your doctor may recommend medication to lower your blood pressure.
The category of medication your doctor prescribes depends on your blood pressure measurements and whether you also have other medical problems.
Medications to treat high blood pressure
- Thiazide diuretics. Diuretics, sometimes called water pills, are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume.
- Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force.
- Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. People with chronic kidney disease may benefit from ACE inhibitors as one of their medications.
- Angiotensin II receptor blockers (ARBs). These medications help relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels. People with chronic kidney disease may benefit from ARBs as one of their medications.
- Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for older people and blacks than do ACE inhibitors alone.
- Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects.
- Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure.
If you're having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:
- Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels.
- Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels.
- Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels.
- Vasodilators. These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
- Aldosterone antagonists. Examples are spironolactone (Aldactone) and eplerenone (Inspra). These drugs block the effect of a natural chemical that can lead to salt and fluid retention, which can contribute to high blood pressure.
Lifestyle changes to treat high blood pressure
No matter what medications your doctor prescribes to treat your high blood pressure, you'll need to make lifestyle changes to lower your blood pressure.
Your doctor may recommend several lifestyle changes, including:
- Eating a healthier diet with less salt (the Dietary Approaches to Stop Hypertension, or DASH, diet)
- Exercising regularly
- Quitting smoking
- Losing weight
If your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, you may have resistant hypertension.
Resistant hypertension is blood pressure that's resistant to treatment. People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension.
Having resistant hypertension doesn't mean your blood pressure will never get lower. In fact, if you can identify what's behind your persistently high blood pressure, there's a good chance you can meet your goal with the help of treatment that's more effective.
Your doctor can evaluate whether the medications and doses you're taking for your high blood pressure are appropriate. You may have to fine-tune your medications to come up with the most effective combination and doses.
In addition, you and your doctor can review medications you're taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent your high blood pressure medications from working effectively. Be open and honest with your doctor about all the medications or supplements you take.
If you don't take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you can't afford the medication, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions. Don't change your treatment without your doctor's guidance.
Lifestyle changes can help you control and prevent high blood pressure, even if you're taking blood pressure medication. Here's what you can do:
- Eat healthy foods. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and total fat.
- Decrease the salt in your diet. A lower sodium level — 1,500 milligrams (mg) a day — is appropriate for people 51 years of age or older, and individuals of any age who are African-American or who have hypertension, diabetes or chronic kidney disease.
- Otherwise healthy people can aim for 2,300 mg a day or less. While you can reduce the amount of salt you eat by putting down the saltshaker, you should also pay attention to the amount of salt that's in the processed foods you eat, such as canned soups or frozen dinners.
- Maintain a healthy weight. If you're overweight, losing even 5 pounds (2.3 kilograms) can lower your blood pressure.
- Increase physical activity. Regular physical activity can help lower your blood pressure and keep your weight under control. Strive for at least 30 minutes of physical activity a day.
- Limit alcohol. Even if you're healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women, and up to two drinks a day for men.
- Don't smoke. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your doctor to help you quit.
- Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too.
- Monitor your blood pressure at home. Home blood pressure monitoring can help you keep closer tabs on your blood pressure, show if medication is working, and even alert you and your doctor to potential complications.
- Fiber, such as blond psyllium and wheat bran
- Minerals, such as calcium and potassium
- Supplements that increase nitric oxide or widen blood vessels (vasodilators), such as cocoa, Coenzyme Q10 or garlic
- Omega-3 fatty acids, found in fatty fish, fish oil supplements or flaxseed
- Probiotics, found in fermented dairy products such as cultured yogurt, buttermilk, acidophilus milk, cultured sour cream and cheese
You can also practice relaxation techniques, such as yoga or deep breathing, to help you relax and reduce your stress level. These practices may temporarily reduce your blood pressure.
High blood pressure isn't a problem that you can treat and then ignore. It's a condition you need to manage for the rest of your life. To keep your blood pressure under control:
- Take your medications properly. If side effects or costs pose problems, don't stop taking your medications. Ask your doctor about other options.
- Schedule regular doctor visits. It takes a team effort to treat high blood pressure successfully. Your doctor can't do it alone, and neither can you. Work with your doctor to bring your blood pressure to a safe level, and keep it there.
- Adopt healthy habits. Eat healthy foods, lose excess weight and get regular physical activity. Limit alcohol. If you smoke, quit.
- Manage stress. Say no to extra tasks, release negative thoughts, maintain good relationships, and remain patient and optimistic.