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 lead to heart attack, 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 numbers: 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." Blood pressure is measured in millimetres of mercury (mm Hg).
High blood pressure is 140/90 or higher. Adults should have a blood pressure of less than 130/85. Many people fall into the category in between, called high-normal blood pressure. People with high-normal blood pressure need to make lifestyle changes to bring the blood pressure down and help prevent or delay high blood pressure.1
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, having a 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 condition called insulin resistance.
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.
Most people 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 disease.
You can help lower your blood pressure by making healthy changes in your lifestyle. If those lifestyle changes don't work well enough, 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.
|Decision Points focus on key medical care decisions that are important to many health problems.|
|High Blood Pressure: Should I Take Medicine?|
|Actionsets are designed to help people take an active role in managing a health condition.|
|Fitness: Adding More Activity to Your Life|
|Healthy Eating: Eating Less Sodium|
|Healthy Eating: Starting a Plan for Change|
|High Blood Pressure: Checking Your Blood Pressure at Home|
|High Blood Pressure: Taking Medicines Properly|
|High Blood Pressure: Using the DASH Diet|
|Low-Salt Diets: Eating Out|
|Quitting Smoking: Coping With Cravings and Withdrawal|
|Quitting Smoking: Getting Support|
|Stress Management: Doing Meditation|
|Stress Management: Doing Progressive Muscle Relaxation|
|Weight Management: Stop Negative Thoughts|
Learning about high blood pressure:
Living with high blood pressure:
Experts know that many things are linked to high blood pressure. But experts still don't fully understand the exact cause. Things 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.
Elevated blood 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 white-coat hypertension.
People who have high blood pressure usually don't have any symptoms. Most people who have high blood pressure feel fine. It's during a routine examination or a doctor visit for another problem that they find out that they have 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 include:
Healthy arteries have smooth inner walls. Your blood flows through them without a problem. The blood vessels stay strong and flexible.
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 your doctor now or seek immediate care if:
These are symptoms of malignant high blood pressure or hypertensive crisis.
Call a doctor if:
Adults are encouraged to have their blood pressure checked regularly.
Your blood pressure can be checked:
For diagnosis and management of high blood pressure, see:
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 take your blood pressure at home.
All adults should have their blood pressure checked regularly. Experts recommend:1
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.
A 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 examination 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?
Untreated high blood pressure can lead to 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 are:
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 as diabetes, heart failure, coronary artery disease, or chronic kidney disease.
Treating high blood pressure usually is a lifelong effort.
Blood pressure of 130–139 over 84–89 (high-normal blood pressure)
High blood pressure of 140–159 over 90–99
Lifestyle changes, possibly medicines
High blood pressure of 160 over 100 or higher
Medicines plus lifestyle changes
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
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
If lifestyle changes don't lower your blood pressure to your goal, you may need to take daily medicines as well.
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:
"I 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
A heart-healthy lifestyle 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.
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.
Make these 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.
One Woman's Story:
"A big lesson I learned is that everything we do routinely is a habit. And habits can be changed. I'm living proof."—Izzy
One Man's Story:
"As 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
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 risk of heart attack and stroke.
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.
One Man's Story:
"For a 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
Alternative or complementary medicine treatments that help reduce stress and improve quality of life may have some effect on blood pressure. These treatments include:
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 treatments.
|Dietitians of Canada|
|480 University Avenue|
|Toronto, ON M5G 1V2|
The Dietitians of Canada website provides a wide range of food and nutrition information, including fact sheets on frequently asked food and diet questions, quizzes and other tools to assess your diet habits, and meal planning guides.
|Heart and Stroke Foundation of Canada|
|222 Queen Street|
|Ottawa, ON K1P 5V9|
The Heart and Stroke Foundation of Canada works to improve the health of Canadians by preventing and reducing disability and death from heart disease and stroke through research, health promotion, and advocacy.
|3780 14th Avenue|
|Markham, ON L3R 9Y5|
Hypertension Canada: Understanding Hypertension provides educational information for people living with hypertension.
|U.S. National Heart, Lung, and Blood Institute (NHLBI)|
|P.O. Box 30105|
|Bethesda, MD 20824-0105|
The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:
- Canadian Hypertension Education Program (2011). 2011 Canadian Hypertension Education Program (CHEP) recommendations for the management of hypertension. Available online: http://hypertension.ca/chep-2011-recommendations-summaries.
Other Works Consulted
- American Heart Association (2006). Diet and lifestyle recommendations revision 2006. Circulation, 114(1): 82–96. [Erratum in Circulation, 114(1): e27.]
- Cheriyan J, et al. (2010). Primary prevention of CVD: treating hypertension, search date December 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (2011). Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics, 128(Suppl 5): S213–S256.
- Falkner B, Daniels SR (2004). Summary of the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Hypertension, 44(4): 387–388.
- Henri HC, Rudd P (2007). Hypertension: Context and management. In EJ Topol, ed., Textbook of Cardiovascular Medicine, 3rd ed., pp. 88–108. Philadelphia: Lippincott Williams and Wilkins.
- Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC Express (NIH Publication No. 03–5233). Bethesda, MD: U.S. Department of Health and Human Services.
- National Heart, Lung, and Blood Institute (2006). Your Guide to Lowering Your Blood Pressure With DASH (NIH Publication No. 06-4082). Available online: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf.
- Pickering TG, et al. (2008). Call to action on use and reimbursement for home blood pressure monitoring. A joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension, 52(1): 10–29.
- Rashidi A, et al. (2008). Diagnosis and treatment of hypertension. In V Fuster et al., eds., Hurst's The Heart, 12th ed., pp. 1610–1629. New York: McGraw-Hill Medical.
- Rosendorff C, et al. (2007). Treatment of hypertension in the prevention and management of ischemic heart disease: A scientific statement from the American Heart Association Council for High Blood Pressure Research and the Council on Clinical Cardiology and Epidemiology and Prevention. Circulation, 115(21): 2761–2788.
- Schwartz GL, Sheps SG (2006). Hypertension. In DC Dale, DD Federman, eds., ACP Medicine, section 1, chap 3. New York: WebMD.
- U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.
- U.S. Preventive Services Task Force (2007). Screening for high blood pressure. Available online: http://www.ahrq.gov/clinic/uspstf/uspshype.htm.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Robert A. Kloner, MD, PhD - Cardiology|
|Last Revised||June 6, 2011|
Last Revised: June 6, 2011
To learn more visit Healthwise.org
© 1995-2013 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.