Hypertension (High Blood Pressure)

Hypertension, or high blood pressure, means the force of blood pushing against your artery walls is too high. This makes your heart work harder to pump blood through your body. Over time, hypertension damages your arteries and heart. It can lead to serious complications, like a heart attack or stroke. Because high blood pressure usually doesn’t cause symptoms, it’s often known as a “silent killer.”

Healthcare providers measure blood pressure (BP) in millimeters of mercury (mmHg). Your reading has two numbers:

• Systolic blood pressure: This is the top number. It’s the pressure on your artery walls when your heart contracts.
• Diastolic blood pressure: This is the bottom number. It’s the pressure between beats when your heart relaxes.

What’s considered high blood pressure varies slightly based on where you live. In the U.S., healthcare providers define it as:

• A top number (systolic BP) of 130 mmHg or higher, OR
• A bottom number (diastolic BP) of 80 mmHg or higher

In Europe, providers define hypertension as a top number of 140 or higher, or a bottom number of 90 or higher.

High blood pressure is very common. It affects nearly half of all adults in the U.S. It’s a major risk factor for cardiovascular disease.

Types of hypertension

There are two main types of high blood pressure, based on what’s causing it:

• Primary hypertension: This means your genetics, family history and age are the primary causes of your high blood pressure.
• Secondary hypertension: This means there’s an identifiable cause, like a medical condition, medication or addictive substance, that is making your blood pressure high.

You might also hear about high blood pressure that occurs in certain situations. These types are:

• White coat hypertension: Your BP is normal at home, but high in a healthcare setting.
• Masked hypertension: Your BP is normal in a healthcare setting but high at home.
• Sustained hypertension: Your BP is high no matter where you are.
• Nocturnal hypertension: Your BP goes up when you sleep.

Symptoms of high blood pressure

Hypertension usually has no symptoms. You could have it for years without feeling any clues. In fact, the World Health Organization estimates that 46% of adults with hypertension don’t know they have it.

If your blood pressure is extremely high, you may have symptoms like:

• Changes to your mental function
• Chest pain
• Dizziness
• Edema (swelling)
• Heart palpitations
• Peeing less than usual
• Seizures
• Severe headache
• Signs of stroke, like sudden facial droop, slurred speech or sudden arm/leg weakness
• Vision changes, like eye pain, vision loss or sudden blurry vision

This is called a hypertensive emergency. Call 911 or your local emergency services number right away if your blood pressure is 180/120 or higher and you have any of the symptoms above. If you’re pregnant, call for help if your BP is 160/110 or higher with symptoms.

What causes high blood pressure?

Healthcare providers can’t find a single cause of hypertension for most people. Instead, many factors can come together to make your blood pressure higher. These include:

• Being over age 55
• Having a history of the condition in your biological family
• Smoking or using tobacco products
• Having overweight/obesity
• Eating foods high in sodium
• Not getting enough physical activity
• Drinking too much alcohol

In some cases, providers can find a specific cause of your high blood pressure, like an underlying condition, medication or substance. Here are some examples:

• Conditions, like obstructive sleep apnea, renal artery stenosis, primary aldosteronism and thyroid disease
• Medications, like those that manage ADHD, inflammation, autoimmune disease and mental health conditions
• Addictive substances, like alcohol, nicotine and cocaine

Complications of this condition

Untreated hypertension damages your arteries and overworks your heart. Over time, it may lead to:

• AFib: A chaotic rhythm in your heart that affects how well it can pump blood
• Chronic kidney disease: Problems with your kidney function that can get worse over time
• Cognitive impairment and dementia: Changes to your thinking, memory and personality
• Coronary artery disease: Narrowed or blocked arteries in your heart
• Heart attack: A sudden lack of blood flow to your heart
• Heart failure: A long-term condition that affects your heart’s pumping ability
• Hypertensive retinopathy: Damage to your eyes that may lead to vision loss
• Peripheral artery disease: Narrowed or blocked arteries in your legs or arms
• Erectile dysfunction: Difficulty in obtaining an erection
• Stroke: A sudden lack of blood flow to your brain that can cause long-term neurological changes

How doctors diagnose this condition

Healthcare providers measure your blood pressure at your yearly check-ups and other appointments. This lets them see if it’s normal or too high. They’ll diagnose you with hypertension if your numbers are high at two separate visits (with at least two readings taken each time).

What are the different stages of hypertension?

There are two main stages of hypertension:

• Stage 1 means your top number is in the 130s, or your bottom number is in the 80s.
• Stage 2 means your top number is 140 or higher, or your bottom number is 90 or higher.

On either end of these stages, there are other categories that providers use to guide treatment decisions:

• Elevated blood pressure is blood pressure that’s a bit above normal but not yet diagnosed as hypertension.
• Severe hypertension is dangerously high blood pressure that’s not yet causing organ damage.
• A hypertensive emergency is dangerously high blood pressure that’s damaging your organs. It causes symptoms and is a medical emergency.

This chart lists these categories and the thresholds for each:

High systolic blood pressure vs. high diastolic blood pressure

It’s common for both your top number (systolic) and your bottom number (diastolic) to be too high. But it’s also possible for just one to be in the hypertensive range. You might hear your provider use these terms to describe your blood pressure:

• Isolated systolic hypertension, or high systolic blood pressure: Your top number is 130 or higher, but your bottom number is below 80. This is more likely to happen as you get older and your arteries get stiffer.
• Isolated diastolic hypertension, or high diastolic blood pressure: Your bottom number is 80 or higher, but your top number is below 130. This is less common overall and typically affects younger adults.

How is high blood pressure treated?

Hypertension treatments include medications to lower your blood pressure and changes to your daily habits. Common medicines prescribed for high blood pressure include diuretics, beta-blockers, calcium channel blockers, ACE inhibitors and ARBs. Your provider will recommend the right treatment plan for you based on your blood pressure readings, the cause of your high blood pressure and any other conditions you may have.

In general, changes to your habits — sometimes called “lifestyle changes” — are a key part of treatment for everyone. This is true even if you’re taking medicine. In some cases, providers recommend making changes for a while before starting medicine. It depends on your medical history and risk for a heart attack or stroke.

Changes you can make to lower your blood pressure include:

• Keep a weight that’s healthy for you. Your healthcare provider can give you a target range.
• Eat nutritious foods. A couple of examples are the DASH diet and the Mediterranean diet. These ways of eating are full of fruits, vegetables, whole grains and low-fat dairy. They’re also low in sodium and cholesterol.
• Cut down on sodium. Try to limit your sodium intake to no more than 1,500 milligrams (mg) per day. If this is too hard at first, start by reducing your daily intake by at least 1,000 mg.
• Get enough potassium. Try to get 3,500 to 5,000 milligrams per day. Ideally, this should be through foods rather than supplements. Some foods high in potassium include bananas, avocados and potatoes (with skin).
• Get enough physical activity. Ask your healthcare provider what’s safe for you and how to get started. In general, start slow and work your way up to 150 minutes of aerobic exercise per week. Strength training is also helpful for your heart and whole body.
• Quit smoking. Quitting lowers your blood pressure and has many other benefits. Your provider will help you make a plan. This may include support groups, nicotine replacement therapy and prescription medicine that can make quitting easier.
• Limit or avoid alcohol. If you choose to drink, do so in moderation. This means one or fewer drinks per day for females, and two or fewer per day for males. The fewer drinks, the better.

Doing these things can also help prevent high blood pressure if your numbers are currently in the normal range.

When should I see my healthcare provider?

See your healthcare provider for yearly check-ups. They’ll measure your blood pressure and look for changes over time. High blood pressure usually doesn’t cause symptoms or make you feel any different. So, these check-ups are crucial and even lifesaving.

Call your provider if you notice your BP is higher than usual when you check it at home. They may ask you to come in so they can measure it.

If you’re pregnant, call your provider if your BP is ever 160/110 or higher (but if you have symptoms, seek emergency care instead).

What can I expect if I have high blood pressure?

Once you’re diagnosed with hypertension, you’ll work closely with your healthcare provider to manage it. It’s important to:

• Take your medicines as prescribed. If you have any side effects, tell your provider. They may change the dose or prescribe something else for you. Don’t skip doses or stop taking your medicine unless your provider says you should.
• Make the changes your provider recommends. These might include quitting smoking, eating less sodium or moving around more.
• Check your blood pressure at home. Your provider may recommend that you do this and keep a log. Make sure your device is validated (tested for accuracy). Your provider may also ask you to bring your device to the office to ensure the readings match theirs.
• Tell your provider about any changes to your health. They may need to adjust your treatment plan over time. Tell them if you get any new diagnoses, start taking new medicines or become pregnant.

How long does high blood pressure last?

If you have primary hypertension, you’ll need to manage it for the rest of your life. Your healthcare provider will help you do this. Secondary hypertension can often be reversed by treating or removing the underlying cause. Your provider will explain how treatment can help and what to expect.