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High Blood Pressure

March 10, 2021

High blood pressure is a common disease that develops when blood flows through your arteries at higher-than-normal pressures. Your blood pressure is made up of two numbers: systolic and diastolic. Systolic pressure is the pressure when the ventricles pump blood out of the heart. Diastolic pressure is the pressure between heartbeats, when the heart is filling with blood. For most adults, a healthy blood pressure is usually less than 120 over 80 millimeters of mercury, which is written as your systolic pressure reading over your diastolic pressure reading—120/80 mm Hg.

You usually don’t have symptoms from high blood pressure until it has caused serious health problems. That is why it is important to have your blood pressure checked regularly. Your doctor will diagnose you with high blood pressure if you have consistently high blood pressure readings.

To control or lower high blood pressure, your doctor may recommend that you adopt a heart-healthy lifestyle. This includes choosing heart-healthy foods such as those in the DASH eating plan. You may also need to take medicines. Controlling or lowering blood pressure can help prevent or delay serious health problems such as chronic kidney disease, heart attack, heart failure, stroke, and possibly vascular dementia.

Explore this Health Topic to learn more about high blood pressure, our role in research and clinical trials to improve health, and where to find more information. During High Blood Pressure Education Month in May and throughout the year, the NHLBI features research findings that help advance our understanding of high blood pressure, materials to share in person or on social media, and resources for managing your condition. Find research studies and get resources on high blood pressure.

Risk Factors

Many factors raise your risk of high blood pressure. Some risk factors, such as unhealthy lifestyle habits, can be changed. Other risk factors, such as age, family history and genetics, race and ethnicity, and sex, cannot be changed. A healthy lifestyle can lower your risk for developing high blood pressure.

Age

Blood pressure tends to increase with age. Our blood vessels naturally thicken and stiffen over time. These changes increase the risk for high blood pressure.

However, the risk of high blood pressure is increasing for children and teens, possibly because of rise in the number of children and teens who are living with overweight or obesity.

Family history and genetics

High blood pressure often runs in families. Much of the understanding of the body systems involved in high blood pressure has come from genetic studies. Many different genes are linked to a small increase in the risk of developing high blood pressure. Research suggests that certain DNA changes as an unborn baby grows in the womb may also lead to high blood pressure later in life.

Some people have a high sensitivity to salt in their diet. This can also run in families.

Lifestyle habits

Lifestyle habits can increase the risk of high blood pressure. These habits include:

  • Eating unhealthy foods often, especially those with too much sodium and not enough potassium. Some people, including African Americans, older adults, and people who have chronic kidney disease, diabetes, or metabolic syndrome, are more sensitive to salt in their diet.

  • Drinking too much alcohol or caffeine.

  • Not getting enough physical activity.

  • Smoking or using illegal drugs such as cocaine, “bath salts,” and methamphetamine.

  • Not getting enough good-quality sleep.

Medicines

Some prescription and over-the-counter medicines can make it more difficult for your body to control your blood pressure. Medicines that can raise your blood pressure include antidepressants, decongestants (medicines to relieve a stuffy nose), hormonal birth control pills, and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen.

Other medical conditions

Other medical conditions change the way your body controls fluids, sodium, and hormones in your blood. Other medical causes of high blood pressure include:

  • Certain tumors

  • Chronic kidney disease

  • Metabolic syndrome

  • Overweight and obesity

  • Sleep apnea

  • Thyroid problems

Race or ethnicity

High blood pressure is more common in African American and Hispanic adults than in white or Asian adults. Compared with other racial or ethnic groups, African Americans tend to have higher average blood pressure numbers and get high blood pressure earlier in life. Experiencing discrimination has been tied to high blood pressure. In addition, some high blood pressure medicines may not work as well in African Americans.

During pregnancy, African American women are more likely than white women to develop preeclampsia. Preeclampsia is a pregnancy disorder that causes sudden high blood pressure and problems with the kidneys and liver.

Sex

Men are more likely than women to develop high blood pressure throughout middle age. But in older adults, women are more likely than men to develop high blood pressure.

Women who have high blood pressure during pregnancy are more likely to have high blood pressure later in life.

Social and economic factors

Recent research has shown that factors such as income, your education, where you live, and the type of job you have may contribute to your risk of developing high blood pressure. For example, working early or late shifts can raise your risk.

Experiencing danger or harm as a child has also been tied to a higher risk of developing high blood pressure.

Screening and Prevention

Everyone age 3 or older should have their blood pressure checked by a healthcare provider at least once a year. Your doctor will use a blood pressure test to see whether you have consistently high blood pressure readings. Your doctor will talk to you about heart-healthy lifestyle changes to help prevent or manage your blood pressure.

Get your blood pressure checked regularly and understand what your numbers mean to better manage your heart disease risk. Watch the video to learn more.

 

How to prepare for a blood pressure test

Your doctor will use a blood pressure test to see if you have higher-than-normal blood pressure readings. The reading is made up of two numbers, with the systolic number above the diastolic number. These numbers are measures of pressure in mm Hg.

A blood pressure test is easy and painless and can be done in a doctor’s office or clinic. A healthcare provider will use a gauge, stethoscope, or electronic sensor and a blood pressure cuff to measure your blood pressure. To prepare, take the following steps:

  • Do not exercise, drink coffee, or smoke cigarettes for 30 minutes before the test.

  • Go to the bathroom before the test.

  • For at least 5 minutes before the test, sit in a chair and relax.

  • Make sure your feet are flat on the floor.

  • Do not talk while you are relaxing or during the test.

  • Uncover your arm for the cuff.

  • Rest your arm on a table so it is supported and at the level of your heart.

If it is the first time your provider has measured your blood pressure, you may have readings taken on both arms.

What the numbers mean

For most adults, healthy blood pressure is usually less than 120/80 mm Hg. Your blood pressure is considered high when you have consistent systolic readings of 140 mm Hg or higher or diastolic readings of 90 mm Hg or higher. Based on research, your doctor may also determine that you have high blood pressure if you are an adult or child age 13 or older who consistently has systolic readings of 130 to 139 mm Hg or diastolic readings of 80 to 89 mm Hg and you have other risk factors for heart or blood vessel disease.

For children younger than 13, blood pressure readings are compared with readings common for children of the same, age, sex, and height. Read more about blood pressure readings for children.

Talk to your doctor if your blood pressure readings are consistently higher than 120/80 mm Hg. Note that readings above 180/120 mm Hg are dangerously high and require immediate medical attention.

How to prevent high blood pressure

A heart-healthy lifestyle can help prevent high blood pressure from developing. To live a healthy lifestyle:

  • Choose heart-healthy foods that are lower in sodium (salt) and are rich in potassium. Fruits and vegetables are high in potassium. For more ways to limit your sodium, visit the DASH eating plan page or print our Tips to Reduce Salt and Sodium handout.

  • Avoid or limit alcohol

  • Get regular physical activity. Even modest amounts can make a difference.

  • Aim for a healthy weight

  • Quit smoking

  • Manage stress

  • Get enough good-quality sleep

Signs, Symptoms, and Complications- High Blood Pressure

It is important to have regular blood pressure readings taken and to know your numbers, because high blood pressure usually does not cause symptoms until it has caused serious problems.

Diagnosis

Your doctor may diagnose you with high blood pressure based on your medical history and if your blood pressure readings are consistently at high levels. Your doctor may do more tests to look for medical conditions that could cause high blood pressure, or to see if high blood pressure has affected your kidneys.

Medical history

Your doctor will want to understand your risk factors and get general information about your health—such as your eating patterns, your physical activity level, and your family’s health history to develop a treatment plan for you. Your doctor also will ask questions to see if high blood pressure has caused you any health problems. This will help your doctor determine if you need to undergo any tests.

Confirming high blood pressure

To diagnose high blood pressure, your doctor will take two or more readings at separate medical appointments. Learn more about screening for high blood pressure, including how to take it yourself.

Your doctor may diagnose you with high blood pressure when you have consistent systolic readings of 140 mm Hg or higher or diastolic readings of 90 mm Hg or higher. Based on research, your doctor may also determine you have high blood pressure if you are an adult or child age 13 or older who consistently has systolic readings of 130 to 139 mm Hg or diastolic readings of 80 to 89 mm Hg and you have other risk factors for heart or blood vessel disease. For most adults, healthy blood pressure is usually less than 120/80 mm Hg.

For children younger than 13, blood pressure readings are compared with readings common for children of the same, age, sex, and height. Read more about blood pressure readings for children.

Talk to your doctor if your blood pressure readings are consistently higher than 120/80 mm Hg. Note that readings above 180/120 mm Hg are dangerously high and require immediate medical attention.

Even after taking these steps, your blood pressure reading may not be accurate for other reasons.

  • You are excited or nervous. “White coat hypertension” refers to blood pressure readings that are higher in a doctor’s office than readings at home or in a pharmacy, for example. Doctors can detect this type of high blood pressure by reviewing readings from the office and from other places.

  • Your blood pressure tends to be lower when measured at the doctor’s office. This is called masked high blood pressure. Doctors can diagnose this type of high blood pressure by looking at readings taken at the office and at home, especially at night. When this happens, your doctor will have difficulty detecting high blood pressure.

  • The wrong blood pressure cuff was used. Your readings can appear different if the cuff is too small or too large. It is important for your healthcare team to track your readings over time and ensure the correct pressure cuff is used for your sex and age.

Diagnostic tests

  • Blood tests. Your doctor may recommend blood tests to check for kidney damage, high cholesterol or diabetes that may raise your risk of coronary heart disease, or other problems like thyroid disease that may be causing high blood pressure.

  • Blood pressure monitor. To gather more information about your blood pressure, your doctor may recommend wearing a blood pressure monitor to record readings over 24 hours. Your doctor may also teach you how to take blood pressure readings at home.

Treatment

For most people with high blood pressure, a doctor will develop a treatment plan that may include heart-healthy lifestyle changes alone or with medicines. A risk calculator can help your doctor estimate your risk of complications and choose the right treatment. A healthcare team can help you best manage your blood pressure and prevent complications. This team may include your doctor, a nutritionist, a pharmacist, and specialists for any conditions you may have, including those related to your heart.

If your high blood pressure is caused by another medical condition or medicine, it may improve once the cause is treated or removed.

Risk calculators

Your doctor may use a risk calculator to estimate your risk of having a stroke or heart attack or dying from a heart or blood vessel disease in the next 10 years or throughout your lifetime. This information can help your doctor choose the best treatment to prevent complications.

For example, the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimatorexternal link considers your cholesterol levels, age, sex, race, and blood pressure. It also factors in whether you smoke or take medicines to manage high blood pressure or cholesterol.

Healthy lifestyle changes

If you have high blood pressure, your doctor may recommend that you adopt a heart-healthy lifestyle to help lower and control high blood pressure.

  • Choose heart-healthy foods such as those in the DASH eating plan. NHLBI-funded research has shown that DASH combined with a low-salt eating plan can be as effective as medicines in lowering high blood pressure. Visit Living With the DASH Eating Plan or see Tips to Reduce Salt and Sodium.

  • Avoid or limit alcohol. Talk to your doctor about how much alcohol you drink. Your doctor may recommend that you limit or stop drinking alcohol. You can find resources and support at the Alcohol Treatment Navigator from the National Institute on Alcohol Abuse and Alcoholism.

  • Get regular physical activity. Many health benefits result from being physically active and getting the recommended amount of physical activity each week. Studies have shown that physical activity can help lower and control high blood pressure levels. Even modest amounts of physical activity may help. Before starting any exercise program, ask your doctor what level of physical activity is right for you

  • Aim for a healthy weight. If you are an adult who is living with overweight or obesity, losing 5% to 10% of your initial weight over about 6 months can improve your health. Even losing just 3% to 5% of your weight can improve blood pressure readings.

  • Quit smoking. Visit Smoking and Your Heart and our Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you can call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).

  • Manage stress. Learning how to manage stress and cope with problems can improve your mental and physical health. Learning relaxation techniques, talking to a counselor, and finding a support group can all help.

  • Get enough good-quality sleep. The recommended amount for adults is 7 to 9 hours of sleep a day. Develop healthy sleep habits by going to sleep and getting up at regular times, following a calming bedtime routine, and keeping your bedroom cool and dark.

Changing habits can be hard. To help make lifelong heart-healthy changes, try making one change at a time. Add another change when you feel comfortable with the previous one. You’re more likely to manage your blood pressure when you practice several of these healthy lifestyle habits together and can keep them up.

Medicines

When healthy lifestyle changes alone do not control or lower high blood pressure, your doctor may prescribe blood pressure medicines. These medicines act in different ways to lower blood pressure. When prescribing medicines, your doctor will also consider their effect on other conditions you might have, such as heart disease or kidney disease.

Keep up your healthy lifestyle changes while taking these medicines. The combination of the medicines and the heart-healthy lifestyle changes can help control and lower your high blood pressure and prevent heart disease.

Talk to your doctor if you have any concerns about side effects from the medicines. He or she may change the dose or prescribe a new medicine. To manage high blood pressure, many people need to take two or more medicines. This is more likely in African American adults.

Possible high blood pressure medicines include:

  • Angiotensin-converting enzyme (ACE) inhibitors to keep your blood vessels from narrowing as much.

  • Angiotensin II receptor blockers (ARBs) to keep blood vessels from narrowing.

  • Calcium channel blockers to prevent calcium from entering the muscle cells of your heart and blood vessels. This allows blood vessels to relax.

  • Diuretics to remove extra water and sodium (salt) from your body, reducing the amount of fluid in your blood. The main diuretic for high blood pressure treatment is thiazide. Diuretics are often used with other high blood pressure medicines, sometimes in one combined pill.

  • Beta blockers to help your heart beat slower and with less force. As a result, your heart pumps less blood through your blood vessels. Beta blockers are typically used only as a backup option or if you have other conditions.

Living With

If you have been diagnosed with high blood pressure, it is important that you continue your treatment plan. You will need regular follow-up care and may want to learn how to monitor your condition at home. Your doctor may need to change or add medicines to your treatment plan over time.

Let your healthcare team know if you are planning to become pregnant. Read the High Blood Pressure in Pregnancy section for more information.

Manage your condition

Keep up your treatment plan, including healthy lifestyle changes, to help control your blood pressure and prevent heart disease. Making lifestyle changes and remembering your medicine every day can be hard, but there are ways to help.

  • Ask your doctor, nurse, or pharmacist about apps for monitoring and tracking your blood pressure. They also may know a way to get texts to remind you to take your medicine every day and notify you when it’s time to fill your prescription.

  • Get support from loved ones and others in your community. You can share the Supporting Your Loved One with High Blood Pressureexternal link tip sheet with them.

  • Have regular medical checkups and tests, as your doctor advises. Ask questions and discuss your progress. Let your doctor know if you have any new conditions or have been taking new medicines since your last appointment.

  • Your doctor may want you to check your blood pressure at home or other locations that have blood pressure equipment. Return to Screening for reminders on how to prepare for blood pressure testing and how to take your blood pressure yourself.

  • Visit My Blood Pressure Wallet Card to print out and keep a written log of all your results. Take the log to your doctor’s appointments. You may be able to send the readings to your doctor’s office electronically.

Return to Treatment to review possible treatment options for your high blood pressure.

Know when to call for help for complications

Readings above 180/120 mm Hg are dangerously high and require immediate medical attention. Blood pressure this high can damage your organs. Call 9-1-1 if you experience:

  • A sudden, severe headache

  • Difficulty breathing

  • Sudden, severe pain in your abdomen, chest, or back

High blood pressure can also lead to heart attack or stroke. Call 9-1-1 if you suspect this is happening to you or someone else.

Heart attack

The signs and symptoms of a heart attack include:

  • Nausea, vomiting, light-headedness or fainting, or breaking out in a cold sweat. These symptoms of a heart attack are more common in women.

  • Prolonged or severe chest pain or discomfort not relieved by rest or nitroglycerin. This involves uncomfortable pressure, squeezing, fullness, or pain in the center or left side of the chest that can be mild or strong. This pain or discomfort often lasts more than a few minutes or goes away and comes back.

  • Shortness of breath. This may accompany chest discomfort or happen before it.

  • Upper body discomfort. This can be felt in one or both arms, the back, neck, jaw, or upper part of the stomach.

Stroke

If you think someone may be having a stroke, act F.A.S.T. and perform the following simple test.

  • F—Face: Ask the person to smile. Does one side of the face droop?

  • A—Arms: Ask the person to raise both arms. Does one arm drift downward?

  • S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?

  • T—Time: If you observe any of these signs, call for help immediately. Early treatment is essential.