High Blood Pressure

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High blood pressure is a common condition in which the force of the blood against your artery walls is high enough that it may eventually cause serious health problems. High blood pressure is estimated to cause 7.5 million deaths worldwide, about 12.8% of the total of all deaths according to the World Health Organization . It is also a major risk factor for coronary heart disease and stroke.

High blood pressure is especially dangerous because there are rarely any signs or symptoms to indicate you have it, meaning it typically develops over many years. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to manage it.

This section on high blood pressure has all the information you need to understand and control your blood pressure. Learn all about symptoms, diagnosis, treatment, and prevention, as well as what your blood pressure numbers mean. You can even discover small but effective lifestyle changes you can make to manage your blood pressure and stay well. 

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One of the most dangerous aspects of high blood pressure is that you may not know that you have it. In fact, you can have high blood pressure for years without knowing it. This is because high blood pressure itself usually has no signs or symptoms. Rarely, dull headaches or dizzy spells may occur.

The only way to know if your blood pressure is high is through regular checkups. This is especially important if you have a close relative who has high blood pressure. Mayo Clinic recommends asking your doctor for a blood pressure reading at least every two years starting at age 18. He or she will likely suggest more frequent readings if you've already been diagnosed with high blood pressure or other risk factors for cardiovascular disease. Children age 3 and older will usually have their blood pressure measured as a part of their yearly checkups.

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High blood pressure, also known as hypertension, is a common condition in which the force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.

High blood pressure means that your heart is working far beyond its capacity to pump blood through your body. This extra work can result in a weaker heart muscle and potential organ damage in the future. Your arteries also suffer when your blood pressure is high as the persistent pounding of the blood against the arterial walls causes them to become hard and narrow, which can lead to stroke, kidney failure, and cardiovascular disease.

Blood Pressure Numbers

A blood pressure reading appears as 2 numbers. The first (systolic) number represents the pressure in the arteries when the heart beats and fills them with blood. The second (diastolic) number measures the pressure in the arteries when the heart rests between beats.

You will most often see blood pressure numbers written with the systolic number above or before the diastolic number, such as 120/80 mmHg (millimeters of mercury).

It's natural for blood pressure to rise and fall with changes in activity or emotional state. But when blood pressure remains consistently high, you will need to talk with your doctor about treatment.

The table below shows normal blood pressure numbers for adults. It also shows which numbers put you at greater risk for health problems.

Category

Systolic
(top number)

 

Diastolic
(bottom number)

Normal

Less than 120

And

Less than 80

Prehypertension

120–139

Or

80–89

  High Blood Pressure

  Stage 1

140–159

Or

90–99

  High Blood Pressure

  Stage 2

160 or higher

Or

100 or higher

 

Understanding the Numbers

  • Normal: If your blood pressure is in the normal range, this is where you want to keep it. If you are already committed to a healthy lifestyle, keep it up. If you've managed to keep within the normal range without much thought about your health habits, you should start making healthy lifestyle changes, including following a diet rich in fruits and vegetables and low in salt, using alcohol moderately, and maintaining a healthy weight.
  • Prehypertension: Prehypertension is when blood pressure is elevated above normal, but not high enough to be classified as high blood pressure. If your blood pressure falls into this category and you do not have any other risk factors, lifestyle changes are the recommended treatment at this stage. If you have diabetes or chronic kidney disease, you may need to start drug therapy.
  • High Blood Pressure – Stage 1: If you have high blood pressure in this category but don't have any accompanying conditions such as heart disease, diabetes, kidney disease, or a history of stroke, you will usually start with lifestyle modifications and a single medication. You may have to try several drugs to find one that works best.
  • High Blood Pressure – Stage 2: High blood pressure at this stage is the highest. In addition to lifestyle modifications, you will probably need to take at least 2 medications. 
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To diagnose high blood pressure, a doctor will wrap an inflatable cuff with a pressure gauge around your arm to squeeze the blood vessels. The gauge will then give a blood pressure reading that can determine whether or not you have high blood pressure. For more information about what your blood pressure reading means, see Blood Pressure Numbers.

To prevent a false high reading, you should prepare for the test by:

  • Avoiding caffeine or cigarettes for 30 minutes prior to the test. These actions may cause a short-term rise in your blood pressure.
  • Going to the bathroom before the test. Having a full bladder can change your blood pressure reading.
  • Resting quietly for 5 minutes before the test, as movement can cause short-term rises in blood pressure.
  • As blood pressure normally varies throughout the day, your doctor will likely take 2 to 3 blood pressure readings, each at separate appointments, before diagnosing you with high blood pressure.

Once a diagnosis of high blood pressure is confirmed, your doctor may recommend tests to determine whether target-organ damage has occurred and to rule out any disorder that could be to blame for your high blood pressure. Routine tests may include a urine test (urinalysis), blood tests and an electrocardiogram (ECG), a test that measures your heart's electrical activity. Exams to check for more signs of heart disease, such as a cholesterol test, may also be recommended.

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High blood pressure is treated with lifestyle changes and medicines. The goal of high blood pressure treatment is to lower blood pressure and protect important organs, like the brain, heart, and kidneys from damage.

Most people who have high blood pressure will need lifelong treatment. Sticking to your treatment plan is extremely important, as it can help you live a healthier and more active life, as well as prevent or delay problems related to high blood pressure.

Lifestyle changes

A critical step in preventing and treating high blood pressure is a healthy lifestyle. Eating a heart healthy diet, exercising regularly and avoiding cigarettes and alcohol go a long way towards fighting against high blood pressure. For more information about lifestyle changes to treat high blood pressure, see High Blood Pressure Prevention.

Medications

When lifestyle changes aren't enough, your doctor may recommend medication in addition to lifestyle changes to lower your blood pressure. There are several types of drugs used to treat high blood pressure. The category of medication your doctor prescribes depends on your stage of high blood pressure and whether you also have other medical problems.

  • Diuretics: Diuretics are often the first choice in high blood pressure medications. Diuretics are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume.
  • Beta blockers: These medications help your heart to beat slower and with less force. As a result, your heart pumps less blood through your blood vessels, causing your blood pressure to go down. Beta blockers are usually most effective when combined with a diuretic.
  • Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels.
  • Angiotensin II receptor blockers (ARBs): These newer medications help relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels. As a result, your blood pressure goes down.
  • Calcium channel blockers: Calcium channel blockers keep calcium from entering the muscle cells of your blood vessels, allowing blood vessels to relax, and your blood pressure goes down. Some also slow your heart rate.
  • Alpha blockers: These medications reduce nerve impulses that tighten blood vessels, allowing blood to flow more freely.
  • Alpha-beta blockers: In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels.
  • Nervous system inhibitors: Nervous system inhibitors increase nerve impulses from the brain to relax and widen blood vessels.
  • Vasodilators: These medications work directly on the muscles in the walls of your arteries to relax them, and to cause blood pressure to go down.

After starting high blood pressure drug therapy, you should see your doctor at least once a month until the blood pressure goal is reached. After the blood pressure goal is reached, you should continue to see your doctor every 3 to 6 months, depending on whether you have other diseases such as heart failure.

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These lifestyle changes can help you both prevent and control high blood pressure:

  • Eat healthy foods: Eating healthfully can help keep your blood pressure down. Eat lots of fresh fruits and vegetables, which provide nutrients such as potassium and fiber. Also, eat foods that are low in salt, saturated fat and cholesterol. If you’d like a more detailed guide, try the Dietary Approaches to Stop Hypertension (DASH) eating plan by the National Heart, Lung, and Blood Institute .
  • Maintain a healthy weight: Being overweight increases your risk of high blood pressure. If you're overweight, losing even 5 pounds (2.3 kilograms) can lower your blood pressure.
  • Increase physical activity: Regular physical activity can lower your blood pressure, keep your weight under control and reduce your risk for other health problems. As a general guide, strive for at least 30 minutes of moderate-intensity activity a day.
  • Limit alcohol: Drinking too much alcohol is also associated with high blood pressure. If you choose to drink alcohol, you should do so in moderation—no more than 1 drink per day for women or two drinks per day for men.
  • Don't smoke: Smoking can damage your blood vessels and raise your risk for high blood pressure. Smoking also can worsen health problems related to high blood pressure.
  • Reduce or manage stress: Learn to manage and cope with stress to improve both your emotional and physical health. Practice stress management techniques, such as deep breathing, meditation and muscle relaxation. Getting the recommended 7 to 9 hours of sleep per night can help too.
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