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
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
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."
High blood pressure is 140/90 or higher. Adults should have a blood pressure of less than 120/80.
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
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,
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
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 headaches, vision problems, nausea, and vomiting. 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.
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 three or more separate occasions. It is usually measured
1 to 2 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.
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 will
also consider how likely you are to develop other diseases, especially heart
You can help lower your blood pressure by making healthy
changes in your lifestyle. If those lifestyle changes don't work, you may also
need to take pills. Either way, you will need to control your high blood
pressure throughout your life.
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.
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.
Learning about high blood pressure:
Living with high blood pressure:
Experts know that
many different factors are linked to high blood pressure. But experts still
don't fully understand the exact cause. Factors 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.
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
People who have
high blood pressure usually don't
have any symptoms. Most people with high blood pressure feel fine. It's during
a routine exam or a doctor visit for another problem that they find out that they
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
Healthy arteries have smooth inner walls. Your blood flows
through them without a problem. The blood vessels stay strong and
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:
Things that increase your risk (risk factors) for
high blood pressure include:
Other possible risk factors include:
Call a doctor immediately if you
high blood pressure and:
These are symptoms of malignant high blood pressure or hypertensive crisis.
Call a doctor if:
Adults are encouraged to have their blood pressure checked
Your blood pressure can be
For diagnosis and management of high blood pressure,
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 two more times to be tested.
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 get your blood pressure
measured away from the doctor's office.
All adults should have their blood pressure checked regularly.
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.
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
coronary artery disease.
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?
high blood pressure can lead to fatal
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
For most people, the goal of treatment is to get
the blood pressure below 140/90. But a person's goal may be lower. Your doctor will give you a blood pressure goal that is based on your health. For example, your goal may be lower if you have other conditions such
coronary artery disease, or
chronic kidney disease.
Treating high blood
pressure usually is a lifelong effort.
Blood pressure of 120–139 over 80–89
High blood pressure of 140–159 over 90–99
Lifestyle changes, possibly
High blood pressure of 160 over 100 or
Medicines plus lifestyle
High blood pressure plus organ damage or
other risk factors for heart disease
Medicines plus serious lifestyle changes
and treatment for the other health problems
Secondary high blood pressure
Medicines, treatment of the condition
causing your high blood pressure, or both
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.
One Woman's Story:
"I could never have imagined I could get
(my blood pressure) down so low by losing weight. I feel sure it was the WAY I
lost weight, with DASH."—Izzy
Read more about Izzy and how she uses the DASH eating plan.
If lifestyle changes don't work to
lower your blood pressure, you probably need to take daily medicines as
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.
One Man's Story:
learned that it doesn't matter how healthy you feel—if you have high blood
pressure, you're sick and you'd better do something about it."—Tyrell
Read more about Tyrell and why he started taking his medicines properly.
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.
Lifestyle changes are important to help control
high blood pressure, especially if you have other risk
coronary artery disease and
Even if your doctor has
prescribed medicine for you, you can still take many steps at home to lower
your blood pressure and reduce your risk. Some people can even take less
medicine after making these changes.
lifestyle changes to help lower your blood pressure:
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.
lesson I learned is that everything we do routinely is a habit. And habits can
be changed. I'm living proof."—Izzy
Read more about Izzy and how she changed her eating habits.
soon as I mentioned [to my wife] that I needed help, she got out a pen and some
paper and started writing out a walking schedule."—Arturo
Read more about Arturo and how he got support for his lifestyle changes.
Deciding whether to treat
high blood pressure with medicine and choosing the
best medicine are based mainly 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
heart attack and
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.
few months I was really good about taking (my pills) every day. But they made
me a little tired, and I got tired of being tired."—Tyrell
Read more about Tyrell and why he returned to taking his medicine every day.
complementary medicine treatments that help reduce stress
and improve quality of life may have some effect on blood pressure. These
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
Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
The Centers for Disease Control and Prevention (CDC) is
an agency of the U.S. Department of Health and Human Services. The CDC works
with state and local health officials and the public to achieve better health
for all people. The CDC creates the expertise, information, and tools that
people and communities need to protect their health—by promoting health,
preventing disease, injury, and disability, and being prepared for new health
HeartHub for Patients is a website from the American Heart
Association. It provides patient-focused information, tools, and resources
about heart diseases and stroke. The site helps you understand and manage your
health. It includes online tools that explain your risks and treatment options.
The site includes articles, the latest news in health and research, videos,
interactive tools, forums and community groups, and e-newsletters.
The website includes health centers that cover heart rhythm problems,
cardiac rehabilitation, caregivers, cholesterol, diabetes, heart attack, heart
failure, high blood pressure, peripheral artery disease, and stroke.
HeartHub for Patients also links to Heart360.org, another American Heart Association
website. Heart360 is a tool that helps you send and receive medical
information with your doctor. It also helps you monitor your health at home. It
gives you access to tools to manage and monitor high blood pressure, diabetes,
high cholesterol, physical activity, and nutrition.
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
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November 12, 2012
E. Gregory Thompson, MD - Internal Medicine
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