High Blood Pressure (Hypertension)

What is high blood pressure?

High blood pressure is when the force of blood pushing against your artery walls is consistently too high. This damages your arteries over time and can lead to serious complications like heart attack and stroke. “Hypertension” is another word for this common condition.

Healthcare providers call high blood pressure a “silent killer” because you usually don’t have any symptoms. So, you may not be aware that anything is wrong, but the damage is still occurring within your body.

Blood pressure (BP) is the measurement of the pressure or force of blood pushing against blood vessel walls. Your BP reading has two numbers:

• The top number is the systolic blood pressure, which measures the pressure on your artery walls when your heart beats or contracts.
• The bottom number is the diastolic blood pressure. This measures the pressure on your artery walls between beats when your heart is relaxing.

Healthcare providers measure blood pressure in millimeters of mercury (mmHg).

How do I know if I have high blood pressure?

Getting your blood pressure checked is the only way to know if it’s too high. You can do this by seeing a healthcare provider for a yearly checkup, even if you feel healthy. You won’t feel sick if you have high blood pressure. So, these checkups are crucial and can be life-saving. If your BP is above the normal range, your provider will recommend lifestyle changes and/or medications to lower your numbers.

What is considered high blood pressure?

Definitions of high blood pressure vary slightly depending on where you live. In the U.S., healthcare providers define high blood pressure (hypertension) as:

• A top number (systolic blood pressure) of at least 130 mmHg, and/or
• A bottom number (diastolic blood pressure) of at least 80 mmHg.

In Europe, healthcare providers define hypertension as:

• A top number of at least 140 mmHg, and/or
• A bottom number of at least 90 mmHg.

How common is high blood pressure?

High blood pressure is very common. It affects 47% of adults in the U.S. This equals about 116 million people. Of those, 37 million have a blood pressure of at least 140/90 mmHg.

High blood pressure caused or contributed to over 670,000 deaths in the U.S. in 2020.

The World Health Organization estimates that globally, over 1.2 billion people ages 30 to 79 have hypertension. About 2 in 3 of those individuals live in low- or middle-income countries.

What are the signs and symptoms of high blood pressure?

Usually, high blood pressure causes no signs or symptoms. That’s why healthcare providers call it a “silent killer.” You could have high blood pressure for years and not know it. In fact, the World Health Organization estimates that 46% of adults with hypertension don’t know they have it.

When your blood pressure is 180/120 mmHg or higher, you may experience symptoms like headaches, heart palpitations or nosebleeds. Blood pressure this high is a hypertensive crisis that requires immediate medical care.

What are the types of high blood pressure?

Your provider will diagnose you with one of two types of high blood pressure:

• Primary hypertension. Causes of this more common type of high blood pressure (about 90% of all adult cases in the U.S.) include aging and lifestyle factors like not getting enough exercise.
• Secondary hypertension. Causes of this type of high blood pressure include different medical conditions or a medication you’re taking.

Primary and secondary high blood pressure (hypertension) can co-exist. For example, a new secondary cause can make blood pressure that’s already high get even higher.

You might also hear about high blood pressure that comes or goes in certain situations. These hypertension types are:

• White coat hypertension: Your BP is normal at home but elevated in a healthcare setting.
• Masked hypertension: Your BP is normal in a healthcare setting but elevated at home.
• Sustained hypertension: Your BP is elevated in healthcare settings and at home.
• Nocturnal hypertension: Your BP goes up when you sleep.

What causes hypertension?

Primary hypertension doesn’t have a single, clear cause. Usually, many factors come together to cause it. Common causes include:

• Unhealthy eating patterns (including a diet high in sodium).
• Lack of physical activity.
• High consumption of beverages containing alcohol.

Secondary hypertension has at least one distinct cause that healthcare providers can identify. Common causes of secondary hypertension include:

• Certain medications, including immunosuppressants, NSAIDs and oral contraceptives (the pill).
• Kidney disease.
• Obstructive sleep apnea.
• Primary aldosteronism (Conn’s syndrome).
• Recreational drug use (including amphetamines and cocaine).
• Renal vascular diseases, which are conditions that affect blood flow in your kidneys’ arteries and veins. Renal artery stenosis is a common example.
• Tobacco use (including smoking, vaping and using smokeless tobacco).

Is high blood pressure genetic?

Researchers believe genes play a role in high blood pressure. If one or more of your close biological family members have high blood pressure, you have an increased risk of developing it, too.

What are the risk factors for high blood pressure?

Risk factors that make you more likely to have high blood pressure include:

• Having biological family members with high blood pressure, cardiovascular disease or diabetes.
• Being over age 55.
• Being Black.
• Having certain medical conditions, including chronic kidney disease, metabolic syndrome, obstructive sleep apnea or thyroid disease.
• Having overweight or obesity.
• Not getting enough exercise.
• Eating foods high in sodium.
• Smoking or using tobacco products.
• Drinking too much.

What are the complications of this condition?

Untreated hypertension may lead to serious health problems including:

• Coronary artery disease (CAD).
• Stroke.
• Heart attack.
• Peripheral artery disease.
• Kidney disease and kidney failure.
• Complications during pregnancy.
• Eye damage.
• Vascular dementia.

How is high blood pressure diagnosed?

Healthcare providers diagnose high blood pressure by measuring it with an arm cuff. Providers usually measure your blood pressure at annual checkups and other appointments.

If you have high blood pressure readings at two or more appointments, your provider may tell you that you have high blood pressure. They’ll talk to you about your medical history and lifestyle to identify possible causes.

Blood pressure categories

In 2017, the American College of Cardiology and American Heart Association issued new blood pressure guidelines. Healthcare providers in the U.S. use these when diagnosing and treating high blood pressure. The guidelines divide blood pressure readings into four categories, listed in the chart below. You have high blood pressure if you fall into the stage 1 hypertension or stage 2 hypertension categories.

In the U.S., a high blood pressure diagnosis means your top number is at least 130 and/or your bottom number is at least 80.

What are the treatments for high blood pressure?

High blood pressure treatments include lifestyle changes and medications. Healthcare providers recommend treatment based on your blood pressure readings, the causes of your high blood pressure and your underlying conditions.

Lifestyle changes to lower your blood pressure

You may be wondering if you can lower your blood pressure naturally. Yes, in some cases, it’s possible to lower your blood pressure without medication. For example, your provider may recommend starting with lifestyle changes if you have elevated blood pressure or stage 1 hypertension.

Here are some proven ways to lower your blood pressure naturally:

• Keep a weight that’s healthy for you. Your healthcare provider can give you a target range.
• Eat a healthy diet. An example is the DASH diet. This is a way of eating that’s full of fruits, vegetables, whole grains and low-fat dairy.
• Cut down on salt. Ideally, limit your sodium intake to no more than 1,500 milligrams (mg) per day. If this is too difficult at first, you can start by reducing your daily intake by at least 1,000 milligrams.
• Get enough potassium. Try to consume 3,500 to 5,000 milligrams per day, ideally through the foods you eat rather than supplements. Some foods high in potassium include bananas, avocados and potatoes (with skin).
• Exercise. Ask your healthcare provider for tips to get started. In general, start slow and work your way up to 150 minutes of aerobic exercise per week. Resistance training (like lifting light weights) is also helpful.
• Limit alcohol. If you choose to drink beverages containing alcohol, do so in moderation.

Sometimes, providers recommend lifestyle changes along with medications to lower your blood pressure.

Medications to lower your blood pressure

Four classes of blood pressure medications are “first-line” (most effective and commonly prescribed) when starting treatment:

• Angiotensin-converting enzyme (ACE) inhibitors block the production of the angiotensin II hormone, which the body naturally uses to manage blood pressure. When the medicine blocks angiotensin II, your blood vessels don’t narrow.
• Angiotensin II receptor blockers (ARBs) block this same hormone from binding with receptors in the blood vessels. ARBs work the same way as ACE inhibitors to keep blood vessels from narrowing.
• Calcium channel blockers prevent calcium from entering the muscle cells of your heart and blood vessels, allowing these vessels to relax.
• Diuretics (water or fluid pills) flush excess sodium from your body, reducing the amount of fluid in your blood. People often take diuretics with other high blood pressure medicines, sometimes in one combined pill.

Your provider may couple other medications with these first-line drugs to better manage your blood pressure.

Talk to your provider about possible side effects. If you get side effects that concern you, call your provider. They may change your dose or try a different medication. Don’t stop taking the medicine on your own.

You should avoid some medications during pregnancy. So, be sure to tell your provider if you’re pregnant or could become pregnant.

Can I prevent high blood pressure?

Fortunately, there are things you can do to reduce your risk of developing high blood pressure. These include:

• Follow a healthy eating plan. This is an important step in keeping your blood pressure normal. The DASH diet (Dietary Approaches to Stop Hypertension) emphasizes adding fruits, vegetables and whole grains to your diet.
• Cut down on sodium. To prevent hypertension, you should reduce the amount of sodium in your diet. Try to keep it below 1,500 milligrams a day.
• Keep a healthy weight. Going hand-in-hand with a proper diet is keeping a weight that’s healthy for you. Losing excess weight with diet and exercise will help lower your blood pressure to healthier levels.
• Keep active. Even simple physical activities, such as walking, can lower your blood pressure (and your weight).
• Drink alcohol in moderation. Having more than one drink a day (for women or people assigned female at birth) or more than two drinks a day (for men or people assigned male at birth) can raise blood pressure. One drink is defined as 1 ounce (oz) of alcohol, 5 ounces of wine or 12 ounces of beer.

What can I expect if I have high blood pressure?

Since high blood pressure doesn’t cause symptoms, you probably won’t feel any different with a high blood pressure diagnosis. But it’s important to follow your provider’s instructions to bring your blood pressure down so it doesn’t cause complications later on.

Once high blood pressure leads to complications, you may start to feel symptoms of conditions like coronary artery disease or peripheral artery disease. These include:

• Stable angina.
• Shortness of breath.
• Leg pain.

Should I check my blood pressure at home?

Your provider may recommend you check your blood pressure regularly with a home blood pressure monitor. These are automated electronic monitors you can purchase at most pharmacies or online. For some people, 24-hour ambulatory blood pressure monitoring is necessary.

How long does high blood pressure last?

If you have primary high blood pressure, you’ll need to manage it for the rest of your life.

If you have secondary high blood pressure, your blood pressure will most likely come down after you receive treatment for the medical problem that caused it. If a medication caused your high blood pressure, switching to a different medicine may lower your blood pressure.

When should I see my healthcare provider?

See your provider for yearly checkups. They’ll monitor your blood pressure and recommend treatment, if needed, to help you stay healthy.

When should I go to the ER?

Call 911 or your local emergency number if you have sudden symptoms of a hypertensive crisis. These include:

• Shortness of breath.
• Headache.
• Chest pain.
• Blurry vision.
• Heart palpitations.
• Anxiety.
• Dizziness.
• Nosebleed.
• Vomiting.

What questions should I ask my doctor?

Questions that can help you learn more about your risk for high blood pressure or ways to manage existing high blood pressure include:

• What’s my average blood pressure reading?
• What’s an ideal blood pressure reading for me?
• Should I use a home blood pressure monitor?
• What lifestyle changes should I make?
• What kinds of exercise should I do?
• Do I need medications? If so, which ones and what are the side effects?
• Can I keep taking these medications if I get pregnant?
• Are there supplements or nonprescription medications I shouldn’t take?

Can supplements or foods lower blood pressure?

Research supports the DASH diet as a way to lower blood pressure naturally. Increasing potassium and reducing sodium through your food choices are specific strategies.

You may read about many other dietary methods for lowering your blood pressure. These methods don’t have the same level or quality of evidence to support their effectiveness. They include:

• Probiotics.
• Higher intake of protein, flaxseed, fish oil or fiber.
• Garlic.
• Dark chocolate.
• Tea or coffee.
• Calcium or magnesium supplements.
• Low-carb, vegetarian or Mediterranean diets.

Be a cautious consumer, and talk with your healthcare provider to learn more.

A note from Cleveland Clinic

High blood pressure is a serious but silent condition that can sneak up on you over the years. Seeing a healthcare provider for regular checkups can help you learn your numbers. If you don’t have access to care, learn about available community resources (such as wellness fairs) where blood pressure checks are available. Knowing your blood pressure levels is the first step toward making lifestyle changes that can help keep your arteries healthy.