High Blood Pressure

Cause

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:

• Aging.
• Drinking more than 2 alcoholic drinks a day for men or more than 1 alcoholic drink a day for women.
• Eating a lot of sodium (salt).
• Being overweight or obese.
• Not exercising.
• Being under a lot of stress.
• Eating a diet low in potassium, magnesium, and calcium.

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.

Symptoms

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 exam 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 120 or higher) may lead to hypertensive emergency. This is also called malignant hypertension. A hypertensive emergency needs immediate care. The symptoms can include:

• Severe headache.
• Blurry vision.

What Happens

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:

• Coronary artery disease and heart attack.
• Heart failure.
• Stroke.
• Kidney failure.
• Peripheral arterial disease.
• Eye damage (retinopathy) that can lead to vision loss and blindness.

What Increases Your Risk

Things that increase your risk (risk factors) for high blood pressure include:

• A family history of high blood pressure.
• Aging.
• Eating a lot of sodium (salt).
• Drinking more than 2 alcoholic drinks a day for men or more than 1 alcoholic drink a day for women.
• Being overweight or obese.
• Lack of exercise or physical activity.
• Race. African Americans are more likely to get high blood pressure, often have more severe high blood pressure, and are more likely to get the condition at an earlier age than others. Why they are at greater risk is not known.

Other possible risk factors include:

• Low intake of potassium, magnesium, and calcium.
• Sleep apnea and sleep-disordered breathing.
• Long-term use of pain medicines like NSAIDs—for example, naproxen (such as Aleve) or ibuprofen (such as Motrin or Advil)—or COX-2 inhibitors, such as celecoxib (Celebrex). Aspirin does not increase your risk for getting high blood pressure.

When To Call

Call 911 anytime you think you may need emergency care. This may mean having symptoms that suggest that your blood pressure is causing a serious heart or blood vessel problem. Your blood pressure may be over 180/120.

For example, call 911 if:

• You have symptoms of a heart attack. These may include:
  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.
• You have symptoms of a stroke. These may include:
  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.
  • A sudden, severe headache that is different from past headaches.
• You have severe back or belly pain.

Do not wait until your blood pressure comes down on its own. Get help right away.

Call your doctor now or seek immediate care if:

• Your blood pressure is much higher than normal (such as 180/120 or higher), but you don't have symptoms.
• You think high blood pressure is causing symptoms, such as:
  • Severe headache.
  • Blurry vision.

Watch closely for changes in your health, and be sure to contact your doctor if:

• Your blood pressure measures higher than your doctor recommends at least 2 times. That means the top number is higher or the bottom number is higher, or both.
• You think you may be having side effects from your blood pressure medicine.

Your blood pressure can be checked:

• At a clinic where you work or go to school.
• At drugstores, health fairs, fitness centers, community centers, fire stations, and ambulance stations.

Exams and Tests

The main test for high blood pressure is simple, fast, and painless. These are the usual steps:

1. You sit quietly for 5 minutes before the test, with both feet flat on the floor.
2. You sit down with your arm resting on the arm of the chair so that your arm is level with your heart.
3. An inflatable sleeve, called a cuff, is wrapped around your upper arm. It's attached to a dial that will show your blood pressure numbers.
4. The nurse (or other health professional) seals the cuff and pumps it up. You feel tight pressure as the cuff cuts off the blood flow in your arm.
5. Next, the nurse slowly loosens the cuff while using a stethoscope to listen to the heartbeat in your inner elbow. When the cuff is just loose enough that blood starts to flow again and the nurse can hear it, that is your systolic blood pressure.
6. The cuff is slowly loosened some more. When it's loose enough that your heartbeat can no longer be heard through the stethoscope, that is your diastolic blood pressure.

After measuring your blood pressure, your doctor may ask you to test it again when you are home.^{footnote 4, footnote 5} This is because your blood pressure can change throughout the day. And sometimes blood pressure is high only because you are seeing a doctor. This is called white-coat hypertension. To diagnose high blood pressure, your doctor needs to know if your blood pressure is high throughout the day.

So your doctor may ask you to monitor your blood pressure at home to make sure that it actually is high. You may get an ambulatory blood pressure monitor or a home blood pressure monitor. These devices measure your blood pressure several times throughout the day.

Regular blood pressure checks

All adults should have their blood pressure checked regularly.^{footnote 5}

Your doctor can let you know how often you should get your blood pressure checked. It may depend on what your blood pressure is and your risk for heart disease. You can get your blood pressure checked during any routine medical visit.

The U.S. Preventive Services Task Force (USPSTF) makes these recommendations about how often to check your blood pressure:^{footnote 5}

• Get your blood pressure checked every year if any one of the following is true:
  • You're age 40 or older.
  • You're African-American.
  • You're overweight or obese.
  • The top number of your blood pressure is 130 to 139, or the bottom number is 85 to 89, or both.
• You can get your blood pressure checked every 3 to 5 years if all of the following are true:
  • You're age 18 to 39.
  • And the top number of your blood pressure is lower than 130, and the bottom number is lower than 85.
  • And you're not African-American, overweight, or obese.

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.

• High Blood Pressure: Checking Your Blood Pressure at Home

Other tests

Besides taking your blood pressure, your doctor will do a physical exam 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:

• Urine tests to check for kidney disease.
• Blood tests to check your levels of potassium, sodium, and cholesterol.
• A blood glucose test to check for diabetes.
• Tests to measure kidney function.
• An electrocardiogram (EKG, ECG) to find out whether there is any damage to the heart.

Your doctor may also check your risk of a heart attack and stroke.

If your doctor recommends a test, ask what it is for and why you need it. You can help decide if a test is right for you. Talk with your doctor to make that decision. For more information, see Heart Tests: When Do You Need Them?

Treatment Overview

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:

• Lifestyle changes.
• Daily medicines.

Your doctor will give you a goal for your blood pressure. This goal will be based on your health and your age. Your blood pressure goal can help you prevent problems caused by high blood pressure.

Treating high blood pressure with lifestyle changes

For some people, lifestyle changes may be enough to lower their blood pressure. Whether this is an option for you depends on how high your blood pressure is and whether you have other health problems, such as diabetes or heart disease.

Your doctor may suggest that you make one or more of the following changes:

• Lose weight. If you're overweight, losing extra pounds may bring your blood pressure down.
• Get more active. Regular aerobic exercise can help lower blood pressure.
• Stop smoking. Smoking increases your risk for heart attack and stroke.
• Limit alcohol. Limit alcohol to 2 drinks a day for men, 1 drink a day for women.
• Eat less sodium. To help lower blood pressure, try to eat less than 1,500 mg a day.
• Follow the DASH diet. The DASH (Dietary Approaches to Stop Hypertension) eating plan can help you lower your blood pressure.

For tips on how to do these things, see the Living With High Blood Pressure section of this topic.

Treating high blood pressure with medicines

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.

• High Blood Pressure: Should I Take Medicine?

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.

• High Blood Pressure: Taking Medicines Properly

Prevention

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:

• Stay at a healthy weight.
• Eat heart-healthy foods, and limit sodium.
• Get regular exercise.
• Limit alcohol.

For help with all of these, see the Living With High Blood Pressure section of this topic.

Living With High Blood Pressure

Heart-healthy lifestyle changes are important to help control high blood pressure. These changes can help lower your risk for coronary artery disease, heart attack, and stroke.

A heart-healthy lifestyle is always important, even if you take medicines too. Some people can even take less medicine after making these changes.

What changes do you need to make?

Make these lifestyle changes to help lower your blood pressure and lower your risk for heart attack and stroke:

• Lose extra weight. If you are overweight, losing as little as 10 lb (4.5 kg) may lower your blood pressure. It may also allow you to take less blood pressure medicine.
  • Healthy Eating: Starting a Plan for Change
  • Weight Management: Stop Negative Thoughts
• Eat heart-healthy foods. Getting enough of the nutrients found in fruits, vegetables, and dairy products helps lower blood pressure. Use the DASH eating plan as a guide. See the topic High Blood Pressure: Nutrition Tips.
  • High Blood Pressure: Using the DASH Diet
  • Heart-Healthy Eating
• Get active. Regular physical activity can lower blood pressure in those who have high blood pressure. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week.
  • Fitness: Adding More Activity to Your Life
• Drink less alcohol. Alcohol increases blood pressure. Drink it in moderation, if at all. That means no more than 2 drinks a day for men or 1 drink a day for women.
  • Quick Tips: Cutting Back on Drinking
• Cut back on sodium. Eating less sodium can help prevent and control high blood pressure. Try to limit the amount of sodium you eat to less than 1,500 mg a day.
  • Healthy Eating: Eating Less Sodium
  • Low-Salt Diets: Eating Out
• Manage stress. Your blood pressure increases when you are under stress. Relaxation techniques, including progressive muscle relaxation and meditation, may help lower mild high blood pressure. For more information, see the topic Stress Management.
  • Stress Management: Doing Progressive Muscle Relaxation
  • Stress Management: Doing Meditation
• Check your own blood pressure. A home blood pressure monitor makes it easy to keep track of your blood pressure. Seeing those small improvements can motivate you to keep going with your lifestyle changes.
  • High Blood Pressure: Checking Your Blood Pressure at Home

Quitting smoking is also important to reduce your risk of heart attack and stroke. For more information, see the topic Quitting Smoking.

• Quitting Smoking: Getting Support
• Quitting Smoking: Coping With Cravings and Withdrawal

How do you make lifestyle changes?

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:

1. Have your own reason for making a change. If you do it because someone else wants you to, you're less likely to have success. When you have high blood pressure, the reason for making lifestyle changes is clear: to lower your blood pressure and your risk for a heart attack and stroke. If you don't feel ready now, learn more about high blood pressure and the damage it can do. When you truly want to make changes, you're ready for the next step.
2. Set goals. Include long-term goals as well as short-term goals that you can measure easily. Your doctor can help you figure out what your long-term goals should be for your blood pressure. Short-term goals are the small steps you take, week by week, to improve your health.
3. Measure improvements to your health. Before you make lifestyle changes, ask your doctor to check your blood pressure. Then, as you start to make changes, have your blood pressure checked often, and keep track of the numbers. You can buy a home blood pressure monitor that is easy to use.
4. Think about what might get in your way, and prepare for slip-ups. By thinking about these barriers now, you can plan ahead for how to deal with them if they happen. Use a personal action plan to write down your barriers and backup plans.
5. Get support from your family, your doctor, and your friends. Tell them about your long-term and short-term goals and how they can help.

Medicines

Deciding whether to treat high blood pressure with medicine and choosing the best medicine may depend on:

• How high your blood pressure is and what your blood pressure goal is.
• Whether you have signs that high blood pressure has caused organ damage, such as an enlarged heart or early damage to your arteries, kidneys, or eyes.
• Whether you have other medical conditions, such as coronary artery disease, diabetes, or kidney or lung disease or risk factors for heart disease, such as diabetes or high cholesterol.
• Whether you think you can succeed at making lifestyle changes.

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.

• High Blood Pressure: Should I Take Medicine?

Medicine choices

Medicine choices include:

• Diuretics.
• ACE inhibitors.
• Angiotensin II receptor blockers (ARBs).
• Beta-blockers.
• Calcium channel blockers.
• Direct renin inhibitors.
• Other medicines for high blood pressure, including alpha-blockers and vasodilators.

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.

What to think about

• The medicine your doctor chooses may be based on other health problems you have. For example, doctors often prescribe ACE inhibitors for people who have diabetes or heart failure.
• Some people who get a cough while taking ACE inhibitors do well with ARBs, which usually don't cause a cough.
• You may need to avoid some over-the-counter medicines. For example, check with your doctor before you take any nonsteroidal anti-inflammatory drugs (NSAIDs)—such as naproxen and ibuprofen—with high blood pressure medicines. NSAIDs may raise blood pressure and keep your blood pressure medicines from working well. NSAIDs may also interact with your blood pressure medicine and cause kidney problems.
• Don't take any other prescription medicines, over-the-counter medicines, vitamins, or supplements unless you talk to your doctor first. Medicines can interact with each other and keep blood pressure medicines from working right or cause a bad reaction.

Other Treatment

Complementary medicine

Complementary medicine is treatment that you use in addition to your doctor's standard care. Tell your doctor if you are using, or if you plan to use, complementary medicine to help lower your blood pressure. These treatments do not replace lifestyle changes or medicine for high blood pressure. You and your doctor can decide which therapy might be best for you.

Complementary treatments that help manage stress and improve quality of life may help lower blood pressure. These treatments include:

• Acupuncture.
• Biofeedback.
• Meditation.
• Stress management and relaxation.
• Yoga.

Most mind and body practices—such as acupuncture, meditation, and yoga—are safe when used under the care of a well-trained professional. Choose an instructor or practitioner as carefully as you would choose a doctor.

Other treatment to reduce risk of heart disease

There are some dietary supplements that you may hear about to lower the risk of heart disease, heart attack, and stroke. It is not clear if some vitamins, minerals, and multivitamins can lower risk. But it is clear that some supplements, such as vitamin E and beta-carotene, do not lower risk.^{footnote 6}

Talk with your doctor about the best ways to lower your risk of heart disease, heart attack, and stroke. Tell your doctor if you plan to use dietary supplements or vitamins. Your doctor can make sure they are safe for you.