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High blood pressure
Hypertension; HBP
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.
Blood pressure readings are given as two numbers. The top number is called the systolic blood pressure. The bottom number is called the 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 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 your blood pressure is 140/90 mm Hg or above most of the time.
- If your blood pressure numbers are 120/80 or higher, but below 140/90, it is called pre-hypertension.
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.
Causes
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
Eat too much salt
Sodium is an element that the body needs to work properly. Salt contains sodium.
ImageRead Article Now Book Mark Article - Have a family history of high blood pressure
- Have diabetes
- Smoke
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
Chronic kidney disease
Chronic kidney disease is the slow loss of kidney function over time. The main job of the kidneys is to remove wastes and excess water from the body...
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Disorders of the adrenal gland (such as
pheochromocytoma
or
Cushing syndrome
)
Pheochromocytoma
Pheochromocytoma is a rare tumor of adrenal gland tissue. It results in the release of too much epinephrine and norepinephrine, hormones that contro...
ImageRead Article Now Book Mark ArticleCushing syndrome
Cushing syndrome is a disorder that occurs when your body has a high level of the hormone cortisol.
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Hyperparathyroidism
Hyperparathyroidism
Hyperparathyroidism is a disorder in which the parathyroid glands in your neck produce too much parathyroid hormone (PTH).
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Pregnancy or
preeclampsia
Preeclampsia
Preeclampsia is when a pregnant woman develops high blood pressure and protein in the urine after the 20th week of pregnancy.
ImageRead Article Now Book Mark Article - Medicines such as birth control pills, diet pills, some cold medicines, and migraine medicines
-
Narrowed artery that supplies blood to the kidney (
renal artery stenosis
)
Renal artery stenosis
Renovascular hypertension is high blood pressure due to narrowing of the arteries that carry blood to the kidneys. This condition is also called ren...
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Symptoms
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:
Malignant hypertension
Malignant hypertension is very high blood pressure that comes on suddenly and quickly.
- Severe headache
- Nausea and vomiting
- Confusion
- Vision changes
- Nosebleeds
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.
Measure your blood pressure
Blood pressure is a measurement of the force on the walls of your arteries as your heart pumps blood through your body. You can measure your blood pr...
Adults aged 18 to 39 years should have their blood pressure checked:
- Every 3 to 5 years, if their blood pressure was less than 120/80 mm Hg at their most recent reading.
- Every year if you have high blood pressure, diabetes, heart disease, kidney problems, or certain other conditions, have your blood pressure checked more often.
Adults aged 40 and over should have their blood pressure checked at least once every year.
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 the proper sized cuff and a digital readout.
Home blood pressure monitor
Your health care provider may ask you to keep track of your blood pressure at home. To do this, you will need to get a home blood pressure monitor. ...
Read Article Now Book Mark Article - 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:
- High cholesterol level
-
Heart disease, using tests such as an
echocardiogram
or
electrocardiogram
Echocardiogram
An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a s...
ImageRead Article Now Book Mark ArticleElectrocardiogram
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
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Kidney disease, using tests such as a
basic metabolic panel
and
urinalysis
or ultrasound of the kidneys
Basic metabolic panel
The basic metabolic panel is a group of blood tests that provides information about your body's metabolism.
Read Article Now Book Mark ArticleUrinalysis
Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds th...
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Treatment
The goal of treatment is to reduce your blood pressure so that you have a lower risk of complications. You and your provider should set a blood pressure goal for you.
If you have pre-hypertension, your provider will recommend lifestyle changes to bring your blood pressure down to a normal range. Medicines are rarely used for pre-hypertension.
LIFESTYLE CHANGES
You can do many things to help control your blood pressure at home, including:
-
Eat a
heart-healthy diet
, including potassium and fiber.
Heart-healthy diet
Making changes to your diet is a proven way to help control high blood pressure. These changes can also help you lose weight and lower your chance o...
ImageRead Article Now Book Mark Article - Drink plenty of water.
- Exercise regularly for at least 30 minutes of aerobic exercise a day.
- If you smoke, quit.
- Limit how much alcohol you drink to 1 drink a day for women, and 2 a day for men.
- 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 BP 2 or more times. Medicines will likely be started if your BP readings remain at or above these levels:
- Top number (systolic pressure) of 140 or more in people younger than 60 years
- Top number of 150 or more in people 60 years and older
- Bottom number (diastolic pressure) of 90 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 130 to 140/80 mm Hg.
There are many different medicines to treat high blood pressure .
Medicines to treat high blood pressure
Treating high blood pressure will help prevent problems such as heart disease, stroke, loss of eyesight, chronic kidney disease, and other blood vess...
- Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take 2 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.
Outlook (Prognosis)
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:
- Bleeding from the aorta, the large blood vessel that supplies blood to the abdomen, pelvis, and legs
-
Chronic kidney disease
Chronic kidney disease
Chronic kidney disease is the slow loss of kidney function over time. The main job of the kidneys is to remove wastes and excess water from the body...
ImageRead Article Now Book Mark Article -
Heart attack and
heart failure
Heart failure
Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptom...
ImageRead Article Now Book Mark Article - Poor blood supply to the legs
-
Problems with your vision
Problems with your vision
High blood pressure can damage blood vessels in the retina. The retina is the layer of tissue at the back part of the eye. It changes light and ima...
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Stroke
Stroke
A risk factor is something that increases your chance of getting a disease or health problem. Some risk factors for stroke you cannot change. Some ...
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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.
Prevention
Most people can prevent high blood pressure from occurring by following lifestyle changes designed to bring blood pressure down.
References
Chamberlain JJ, Rhinehart AS, Shaefer CF Jr, Neuman A. Diagnosis and management of diabetes: Synopsis of the 2016 American Diabetes Association Standards of Medical Care in Diabetes. Ann Intern Med . 2016;164(8):542-552. PMID: 26928912 www.ncbi.nlm.nih.gov/pubmed/26928912 .
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 www.ncbi.nlm.nih.gov/pubmed/24352797 .
Meschia JF, Bushnell C, Boden-Albala B, Braun LT, et al. 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 www.ncbi.nlm.nih.gov/pubmed/25355838 .
Palmer SC, Mavridis D, Navarese E, et al. Comparative efficacy and safety of blood pressure-lowering agents in adults with diabetes and kidney disease: a network meta-analysis. Lancet . 2015;385(9982):2047-2056. PMID: 26009228 www.ncbi.nlm.nih.gov/pubmed/26009228 .
Siu AL; U.S. Preventive Services Task Force. Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med . 2015;163(10):778-786. PMID: 26458123 www.ncbi.nlm.nih.gov/pubmed/26458123 .
Victor RG, Libby P. Systemic hypertension: Management. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 44.
Victor RG. Systemic hypertension: Mechanisms and diagnosis. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 43.
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 www.ncbi.nlm.nih.gov/pubmed/24341872 .
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 www.ncbi.nlm.nih.gov/pubmed/26559744 .
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Blood pressure
Animation
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Hypertension
Animation
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Hypertension overview
Animation
-
Hypertension treatments
Animation
-
Cardiac hypertension hypertrophy
Animation
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Monitoring blood pressure - illustration
Hypertension is a disorder characterized by chronically high blood pressure. It must be monitored, treated and controlled by medicines, lifestyle changes, or a combination of both.
Monitoring blood pressure
illustration
-
Untreated hypertension - illustration
Hypertension is a disorder characterized by chronically high blood pressure. It must be monitored, treated and controlled by medicines, lifestyle changes, or a combination of both.
Untreated hypertension
illustration
-
Lifestyle changes - illustration
Hypertension is a disorder characterized by chronically high blood pressure. It must be monitored, treated and controlled by medicines, lifestyle changes, or a combination of both.
Lifestyle changes
illustration
-
DASH diet - illustration
A diet that is effective in lowering blood pressure is called Dietary Approaches to Stop Hypertension (DASH).
DASH diet
illustration
-
High blood pressure tests - illustration
Routine lab tests are recommended before beginning treatment of high blood pressure to determine organ or tissue damage or other risk factors. These lab tests include urinalysis, blood cell count, blood chemistry (potassium, sodium, creatinine, fasting glucose, total cholesterol and HDL cholesterol), and an ECG (electrocardiogram). Additional tests may be recommended based on your condition.
High blood pressure tests
illustration
-
Blood pressure check - illustration
To measure blood pressure, your doctor uses an instrument call a sphygmomanometer, which is more often referred to as a blood pressure cuff. The cuff is wrapped around your upper arm and inflated to stop the flow of blood in your artery. As the cuff is slowly deflated, your doctor uses a stethoscope to listen to the blood pumping through the artery. These pumping sounds register on a gauge attached to the cuff. The first pumping sound your doctor hears is recorded as the systolic pressure, and the last sound is the diastolic pressure.
Blood pressure check
illustration
-
Blood pressure - illustration
Blood pressure is the force applied against the walls of the arteries as the heart pumps blood through the body. The pressure is determined by the force and amount of blood pumped and the size and flexibility of the arteries.
Blood pressure
illustration
-
Blood pressure
Animation
-
Hypertension
Animation
-
Hypertension overview
Animation
-
Hypertension treatments
Animation
-
Cardiac hypertension hypertrophy
Animation
-
Monitoring blood pressure - illustration
Hypertension is a disorder characterized by chronically high blood pressure. It must be monitored, treated and controlled by medicines, lifestyle changes, or a combination of both.
Monitoring blood pressure
illustration
-
Untreated hypertension - illustration
Hypertension is a disorder characterized by chronically high blood pressure. It must be monitored, treated and controlled by medicines, lifestyle changes, or a combination of both.
Untreated hypertension
illustration
-
Lifestyle changes - illustration
Hypertension is a disorder characterized by chronically high blood pressure. It must be monitored, treated and controlled by medicines, lifestyle changes, or a combination of both.
Lifestyle changes
illustration
-
DASH diet - illustration
A diet that is effective in lowering blood pressure is called Dietary Approaches to Stop Hypertension (DASH).
DASH diet
illustration
-
High blood pressure tests - illustration
Routine lab tests are recommended before beginning treatment of high blood pressure to determine organ or tissue damage or other risk factors. These lab tests include urinalysis, blood cell count, blood chemistry (potassium, sodium, creatinine, fasting glucose, total cholesterol and HDL cholesterol), and an ECG (electrocardiogram). Additional tests may be recommended based on your condition.
High blood pressure tests
illustration
-
Blood pressure check - illustration
To measure blood pressure, your doctor uses an instrument call a sphygmomanometer, which is more often referred to as a blood pressure cuff. The cuff is wrapped around your upper arm and inflated to stop the flow of blood in your artery. As the cuff is slowly deflated, your doctor uses a stethoscope to listen to the blood pumping through the artery. These pumping sounds register on a gauge attached to the cuff. The first pumping sound your doctor hears is recorded as the systolic pressure, and the last sound is the diastolic pressure.
Blood pressure check
illustration
-
Blood pressure - illustration
Blood pressure is the force applied against the walls of the arteries as the heart pumps blood through the body. The pressure is determined by the force and amount of blood pumped and the size and flexibility of the arteries.
Blood pressure
illustration
-
High blood pressure
(In-Depth)
-
High blood pressure
(Alt. Medicine)
Review Date: 4/20/2015
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Internal review and update on 07/24/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
