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High blood pressure

Definition

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 mmHg).

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 mmHg most of the time.
  • High blood pressure (hypertension) is when your blood pressure is 140/90 mmHg 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.

Alternative Names

Hypertension; HBP

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
  • 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:

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 include:

  • Severe headache
  • Nausea or vomiting
  • Confusion
  • Vision changes
  • Nosebleeds

Exams and Tests

Your health care 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.

  • All adults should have their blood pressure checked every 1 to 2 years if their blood pressure was less than 120/80 mmHg at their most recent reading.
  • If you have high blood pressure, diabetes, heart disease, kidney problems, or certain other conditions, have your blood pressure checked more often. 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.
  • 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:

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.
  • 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 mmHg.

There are many different medicines to treat high blood pressure.

  • Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two 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
  • Heart attack and heart failure
  • Poor blood supply to the legs
  • Problems with your vision
  • Stroke

When to Contact a Medical Professional

If you have high blood pressure, you will have regular checkups with your health care 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

American Diabetes Association. Standards of medical care in diabetes-2015 abridged for primary care providers. Clin Diabetes. 2015 Apr;33(2):97-111. PMID: 25897193 www.ncbi.nlm.nih.gov/pubmed/25897193.

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 Dec;45(12):3754-832. Epub 2014 Oct 28. PMID: 25355838 www.ncbi.nlm.nih.gov/pubmed/25355838.

Peterson ED, Gaziano JM, Greenland P. Recommendations for treating hypertension: what are the right goals and purposes? JAMA. 2014 Feb 5;311(5):474-6. PMID: 24352710 www.ncbi.nlm.nih.gov/pubmed/24352710.

Victor RG. Systemic hypertension: Mechanisms and diagnosis. In: Mann DL, Zipes DP, Libby P, et al, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 43.

Victor RG, Libby P. Systemic hypertension: Management. In: Mann DL, Zipes DP, Libby P, et al, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 44.

Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, 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 Jan;16(1):14-26. Epub 2013 Dec 17. PMID: 24341872 www.ncbi.nlm.nih.gov/pubmed/24341872.

Wright JT Jr, Fine LJ, Lackland DT, Ogedegbe G, Dennison Himmelfarb CR. Evidence supporting a systolic blood pressure goal of less than 150 mm hg in patients aged 60 years or older: the minority view. Ann Intern Med. 2014 Apr 1;160(7):499-503. PMID: 24424788 www.ncbi.nlm.nih.gov/pubmed/24424788.

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. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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Outcome Data

Hospitalizations, length of stay, charges, and readmission rate for High Blood Pressure


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