High Blood Pressure (Hypertension)

Overview

What is high blood pressure (hypertension)?

Blood pressure is the measurement of the pressure or force of blood pushing against blood vessel walls. When you have hypertension (high blood pressure), it means the pressure against the blood vessel walls in your body is consistently too high. High blood pressure is often called the “silent killer” because you may not be aware that anything is wrong, but the damage is still occurring within your body.

Your blood pressure reading has two numbers. The top number is the systolic blood pressure, which measures the pressure on the blood vessel walls when your heart beats or contracts. The bottom number is the diastolic blood pressure, which measures the pressure on your blood vessels between beats when your heart is relaxing.

For example, a blood pressure of 110/70 is within the normal range, but a blood pressure of 135/85 is stage 1 (mild) hypertension, and so on (see table).

CategoryBlood Pressure
NormalUnder 130/80 mmHg
Stage I Hypertension (mild)130-139/OR diastolic between 80-89 mmHg
Stage 2 Hypertension (moderate)140/90 mmHg or higher
Hypertensive Crisis (get emergency care)180/120 mmHg or higher

What are the types of high blood pressure?

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

  • Primary (also called essential) high blood pressure. Causes of this most common type of high blood pressure include aging and unhealthy habits like not getting enough exercise.
  • Secondary high blood pressure. Causes of this type of high blood pressure include different medical problems (for example kidney or hormonal problems) or sometimes a medication you’re taking.

What can happen if high blood pressure is not treated?

Untreated hypertension may lead to serious health problems including:

Can high blood pressure affect pregnancy?

High blood pressure complicates about 10% of all pregnancies. There are several different types of high blood pressure during pregnancy and they range from mild to serious. The forms of high blood pressure during pregnancy include:

Chronic hypertension: High blood pressure which is present before pregnancy.

Gestational hypertension: High blood pressure in the latter part of pregnancy.

Preeclampsia: This is a dangerous condition that typically develops in the latter half of pregnancy and results in hypertension, protein in the urine and generalized swelling in the pregnant person. It can affect other organs in the body and cause seizures (eclampsia).

Chronic hypertension with superimposed preeclampsia: Pregnant people who have chronic hypertension are at increased risk for developing preeclampsia.

Your provider will check your blood pressure regularly during prenatal appointments, but if you have concerns about your blood pressure, be sure to talk with your provider.

Symptoms and Causes

How do I know if I have high blood pressure?

High blood pressure usually doesn’t cause symptoms. The only way to know if you have high blood pressure is to have your provider measure it. Know your numbers so you can make the changes that help prevent or limit damage.

What are the risk factors for high blood pressure?

You are more likely to have high blood pressure if you:

  • Have family members who have high blood pressure, cardiovascular disease or diabetes.
  • Are of African descent.
  • Are older than 55.
  • Are overweight.
  • Don’t get enough exercise.
  • Eat foods high in sodium (salt).
  • Smoke or use tobacco products.
  • Are a heavy drinker (more than two drinks a day in men and more than one drink a day in women).

Diagnosis and Tests

How is high blood pressure diagnosed?

Since high blood pressure doesn’t have symptoms, your healthcare provider will need to check your blood pressure with a blood pressure cuff. Providers usually check your blood pressure at every annual checkup or appointment. If you have high blood pressure readings at two appointments or more, your provider may tell you that you have high blood pressure.

What tests will be done to diagnose this condition?

Providers use a blood pressure cuff to measure your blood pressure.

Management and Treatment

What should I do if I have high blood pressure?

If your healthcare provider has diagnosed you with high blood pressure, they will talk with you about your recommended blood pressure target or goal. They may suggest that you:

  • Check your blood pressure regularly with a home blood pressure monitor. These are automated electronic monitors and are available at most pharmacies or online.
  • Eat healthy foods that are low in salt and fat.
  • Reach and maintain your best body weight.
  • Limit alcohol to no more than two drinks each day for men and less than one drink each day for women. One drink is defined as 1 ounce of alcohol, 5 ounces of wine, or 12 ounces of beer.
  • Be more physically active.
  • Quit smoking and/or using tobacco products.
  • Work on controlling anger and managing stress.

What diet helps control high blood pressure?

  • Eat foods that are lower in fat, salt and calories, such as skim or 1% milk, fresh vegetables and fruits, and whole-grain rice and pasta. (Ask your healthcare provider for a more detailed list of low sodium foods to eat.)
  • Use flavorings, spices and herbs to make foods tasty without using salt. The optimal recommendation for salt in your diet is to have less than 1,500 milligrams of sodium a day. Don't forget that most restaurant foods (especially fast foods) and many processed and frozen foods contain high levels of salt. Use herbs and spices that do not contain salt in recipes to flavor your food. Don’t add salt at the table. (Salt substitutes usually have some salt in them.)
  • Avoid or cut down on foods high in fat or salt, such as butter and margarine, regular salad dressings, fatty meats, whole milk dairy products, fried foods, processed foods or fast foods and salted snacks.
  • Ask your provider if you should increase potassium in your diet. Discuss the Dietary Approaches to Stop Hypertension (DASH) diet with your provider. The DASH diet emphasizes adding fruits, vegetables and whole grains to your diet while reducing the amount of sodium. Since it’s rich in fruits and vegetables, which are naturally lower in sodium than many other foods, the DASH diet makes it easier to eat less salt and sodium.

What medications are used to treat high blood pressure?

Four classes of high blood pressure medications are considered “first line” (most effective and commonly prescribed) when starting treatment. Sometimes other medications are coupled with these first-line drugs to better control your high blood pressure. First-line, pressure-lowering medications are:

  • Angiotensin-converting enzyme (ACE) inhibitors block the production of the angiotensin II hormone, which the body naturally uses to control blood pressure. When angiotensin II is blocked, your blood vessels don’t narrow. Examples: lisinopril (Zestril® or Prinivil®), enalapril or captopril.
  • 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. Examples: metoprolol (Lopressor®; Toprol® XL), valsartan (Diovan® or Prexxartan®) or losartan.
  • Calcium channel blockers prevent calcium from entering the muscle cells of your heart and blood vessels, allowing these vessels to relax. Examples: amlodipine (Norvasc® or Katerzia®), nifedipine (Procardia®XL or Nifedical®XL), diltiazem (Cardizem®, Dilacor® XR or Tiazac®).
  • Diuretics (water or fluid pills) flush excess sodium from your body, reducing the amount of fluid in your blood. Diuretics are often used with other high blood pressure medicines, sometimes in one combined pill. Examples: indapamide, hydrochlorothiazide (Microzide® or Oretic®) or chlorothiazide.

Talk to your healthcare provider about what side effects and problems are possible when you take your blood pressure medicine. You should avoid some medications during pregnancy. 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.

Prevention

Can I prevent high blood pressure?

There are certain things you can do to help reduce your risk of developing high blood pressure. These include eating right, getting the right amount of exercise and controlling salt intake.

How can you reduce your risk of high blood pressure?

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

  • Eat right: A healthy diet 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 while reducing the amount of sodium. Since it’s rich in fruits and vegetables, which are naturally lower in sodium than many other foods, the DASH diet makes it easier to eat less salt and sodium.
  • Keep a healthy weight: Going hand-in-hand with a proper diet is keeping a healthy weight. Since being overweight increases your blood pressure, losing excess weight with diet and exercise will help lower your blood pressure to healthier levels.
  • Cut down on salt: The recommendation for salt in your diet is to have less than 1,500 milligrams of sodium a day (equal to about one teaspoon). To prevent hypertension, you should keep your salt intake below this level. Don't forget that most restaurant foods (especially fast foods) and many processed and frozen foods contain high levels of salt. Use herbs and spices that do not contain salt in recipes to flavor your food; do not add salt at the table. (Salt substitutes usually have some salt in them.)
  • 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) and two drinks a day (for men) can raise blood pressure.

Outlook / Prognosis

What can I expect if I have this condition?

Since high blood pressure doesn’t cause many symptoms at first, 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 serious illnesses later in life.

How long does high blood pressure last?

If you have primary high blood pressure, you’ll need to control 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.

What is the outlook for high blood pressure?

You can get seriously ill if you don’t treat your high blood pressure. However, if you take the medicines your provider ordered, you can control your blood pressure. Exercising and eating healthy foods also helps lower your blood pressure.

Living With

How can I be more active?

  • Check first with your healthcare provider before increasing your physical activity. Ask your provider what type and amount of exercise is right for you.
  • Choose aerobic activities such as walking, biking or swimming.
  • Start slowly and increase activity gradually. Aim for a regular routine of activity five times a week for 30 to 45 minutes each session.

What if lifestyle changes don’t help lower my blood pressure?

If diet, exercise and other lifestyle changes don’t work to lower your blood pressure, your healthcare provider will prescribe medications to help lower your blood pressure. Your provider will take into account other conditions you may have, such as heart or kidney disease and other drugs you’re taking when prescribing medications to treat your high blood pressure. Be sure to follow your provider’s dosing directions exactly.

What questions should I ask my provider?

  • Are there supplements or non-prescription medicines that I shouldn’t take?
  • Can I keep taking these medicines if I get pregnant?
  • What kinds of exercise should I do?

A note from Cleveland Clinic

If you don’t treat high blood pressure, it can put you at risk for developing serious illnesses later in life such as heart attack, kidney failure and stroke. But if you follow your provider’s instructions, you can control your blood pressure. Be sure to take any medicines your provider ordered as instructed. Keep taking them even if your blood pressure numbers begin to fall into the normal range. Living a healthy lifestyle by eating healthy foods, watching your weight and getting regular exercise is also a great way to help control your blood pressure.

Last reviewed by a Cleveland Clinic medical professional on 09/21/2021.

References

  • National Heart, Lung, and Blood Institute. High Blood Pressure. (https://www.nhlbi.nih.gov/health/health-topics/topics/hbp/) Accessed 9/20/2021.
  • Food and Drug Administration. High Blood Pressure (Hypertension): Medicines to Help You. (https://www.fda.gov/media/81967/download) Accessed 9/20/2021.
  • Centers for Disease Control and Prevention. High Blood Pressure. (https://www.cdc.gov/bloodpressure/) Accessed 9/20/2021.
  • JNC 8 Guidelines for the Management of Hypertension in Adults. Am Fam Physician. 2014 Oct 1;90(7):503-504. aafp.org. (http://www.aafp.org/afp/2014/1001/p503.html) Accessed 9/20/2021.
  • American College of Cardiology. New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension. (https://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017) Accessed 9/20/2021.
  • MedlinePlus. High Blood Pressure. (https://medlineplus.gov/highbloodpressure.html) Accessed 9/20/2021.

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