What is high blood pressure (hypertension)?
Blood pressure measures the force inside the body’s arteries that happens with each heartbeat as blood delivers oxygen-rich blood to every organ and cell.
There are two numbers used to measure pressure during the heartbeat cycle:
- Systole measures the pressure inside an artery when the heart is pumping blood to the body.
- Diastole is the pressure inside the artery when the heart has relaxed to allow blood return.
- Blood pressure is measured in millimeters of mercury (mmHg)
The definition of hypertension is complicated. You can have systolic hypertension, diastolic hypertension, or both.
According to the American Heart Association, in an adult, normal blood pressure is 120/80 or less, but there are different categories of high blood pressure:
- Normal blood pressure – Systolic less than 120 mmHg and diastolic less than 80 mmHg
- Elevated blood pressure – Systolic 120 to 129 mmHg and diastolic less than 80 mmHg
- Hypertension:
In Europe, hypertension is defined differently. The recommendations of the European Society of Cardiology and the National Institute for Health and Care Excellence in England, hypertension is defined as a systolic blood pressure of 140 mmHg or greater, or a diastolic pressure of 90 mmHg or greater.
What causes high blood pressure?
Primary hypertension
For most people, the cause of high blood pressure is not known. There are risk factors associated with developing high blood pressure, but it is unknown why.
Secondary hypertension
There are some medical conditions where high blood pressure develops as a complication of that illness, or may be due to a medication intolerance or interaction. A few causes include the following:
- Pregnancy
- Kidney disease
- Diabetes
- Polycystic kidney disease
- Glomerular kidney disease
- Renal artery stenosis
- Thyroid disease
- Cushing’s Disease
- Hyperaldosteronism
- Sleep apnea
- Coarctation of the aorta
- Obesity
- Medications
- Prescription pain relievers or birth control pills
- Over the counter medications
- Dietary supplements
- Illegal drugs
- cocaine
- methamphetamine
- PCP
What are the signs and symptoms of high blood pressure?
Hypertension by itself has NO symptoms. Only when other organs are put under stress because of exposure to elevated blood pressure, either suddenly or chronically, may symptoms arise. High blood pressure is known as the “silent killer” because the damage that is caused to many organs in the body occurs slowly and without the patient’s knowledge. The diagnosis is made by routinely checking and monitoring blood pressure readings over time.
Blood pressure in pregnancy
The body changes in the pregnant woman and so does its response to changes in blood pressure. Normal blood pressure in pregnancy is 120/80, but because of physiologic changes, 90/60 may also be normal. Blood pressures of 130/90, or a systolic reading of 15 mmHg higher than before pregnancy, is concerning. After 20 weeks of pregnancy, a blood pressure reading of 140/90 may signal the presence of preeclampsia, a life-threatening condition.
IMAGES
See a medical illustration of high blood pressure (HBP) plus our entire medical gallery of human anatomy and physiology See ImagesHow is blood pressure measured?
There are many home blood pressure machines that can be used that can automatically measure blood pressure, but to make the initial diagnosis, blood pressure needs to be measured by a health care provider, ideally in a quiet setting.
While blood pressure is often measured quickly in the office with a provider inflating a blood pressure cuff on the upper arm and listening with a stethoscope to blood flow at the crook of the elbow, accurate blood pressure measurements take time. There are specific steps to be taken by both the patient and provider to take an accurate measurement of the blood pressure.
- The patient should avoid caffeine, exercise, and smoking for at least 30 minutes before measurement.
- The patient should have an empty bladder.
- The patient should relax and sit in a chair with their feet on floor and back supported for at least 5 minutes.
- All clothing covering the location of cuff placement should be removed so that the cuff is resting on bare skin and the cuff should fit appropriately.
- There should be no talking either by patient or the provider during the rest period or during the measurement.
- Blood pressure readings that are taken while the patient is sitting or lying on an examining table are not valid.
- When blood pressure is being taken for the first time, it should be recorded in both arms.
- Blood pressure may be measured either manually, listening with a stethoscope, or by automated machine.
What blood pressure number is more important, systolic or diastolic?
Both systolic and diastolic blood pressure readings are important. Historically, the systolic reading was thought to be more important when it came to risk of complications, like heart attack or stroke. However, current research suggests that both blood pressure numbers are important and blood pressure control should include both systolic and diastolic hypertension.
Health News
- Wegovy, Ozempic Lower Risk of Many Obesity-Related Cancers
- Soy Foods May Be Good for Kids' Brains
- Air Pollution Exposure Tied to 40% Drop in Live Births Among IVF Patients
- Postpartum Urinary Incontinence Takes Physical, Mental Toll
- Could a Cancer Drug Curb the Organ Damage of Severe COVID?
- More Health News »
Diagnosis of high blood pressure
The diagnosis of hypertension should be made based on blood pressure readings taken by a health care provider. It is recommended that elevated blood pressure readings be documented on at least two separate visits to make the diagnosis.
Can blood pressure spike for no reason?
The blood pressure in the body changes routinely during the day as it reacts and adapts to the environment around it. Blood pressure is affected by the diurnal variation, the routine day/night cycle the body experiences, by emotional and physical stresses of routine daily activity and exercise, by food and drink, and by medication.
- White coat hypertension is the patient’s equivalent of performance anxiety. The worry that accompanies having blood pressure measured, either at a doctor’s office or even at home, may cause blood pressure readings to rise, as a normal response to a surge of adrenaline in the body. The new guidelines on how to take a blood pressure reading are meant to address white coat hypertension.
- Labile hypertension describes the situation where blood pressure increases for a brief period of time due to an outside stress, like anxiety, exercise, or trauma. The rise in blood pressure is short lived.
When is the best time to measure blood pressure?
Once the diagnosis is established, home monitoring is reasonable. Since there is routine and normal fluctuation of blood pressure readings during the day, there is no “best” time to measure it. Instead, it is best to take blood pressure readings at the same time each day to help monitor how well any treatment is working.
What is the treatment for high blood pressure?
The first step in treating high blood pressure is making the diagnosis. Once the diagnosis of hypertension is established, the treatment will be individualized for the patient and will include lifestyle modifications with or without medications.
Blood pressure control is a lifelong commitment to help minimize the risk of complications like heart disease, stroke, and peripheral artery disease. Over that lifetime, treatment may add or subtract medications, but non-medication treatments will always be necessary.
How do you lower blood pressure without medications?
Keeping high blood pressure under control decreases the risk of developing many diseases. It is a lifelong commitment to living a healthy lifestyle and may include the following:
- Weight loss is key to blood pressure control in those who are obese. Blood pressure will fall up to 2 mmHg for every 1 kg (2.2 pounds) lost.
- Aerobic exercise for 40 minutes, 3-4 times per week, plus resistance training (weightlifting and isometrics) will result in lower blood pressure readings within 12 weeks.
- Diet
- A low salt diet will significantly lower blood pressure. The effect is most pronounced in the middle-aged or elderly, but the beneficial effects of the low sodium diet are seen in all people regardless of age, sex, race, diabetes, or body mass index. The effect is then whether a person takes blood pressure medication or not.
- Potassium supplement in the diet may be helpful in controlling blood pressure. However, this should be avoided in those with kidney disease, or who are taking medications that affect potassium excretion in the body.
- The DASH diet (Dietary Approaches to Stop Hypertension) is a healthy diet that can help control blood pressure.
- high in vegetables, fruits and nuts, fish and poultry, and low-fat dairy
- low in added sugar and red meat and cholesterol
- rich in potassium, magnesium, calcium, protein, and fiber
- low in saturated fat, total fat, and cholesterol.
- Limiting alcohol intake
Subscribe to MedicineNet's Heart Health Newsletter
By clicking "Submit," I agree to the MedicineNet Terms and Conditions and Privacy Policy. I also agree to receive emails from MedicineNet and I understand that I may opt out of MedicineNet subscriptions at any time.
What medications are used to treat high blood pressure?
Which medication is best to treat hypertension needs to be individualized for each patient. Medical history, current illnesses, other medications and allergies, and lifestyle all need to be considered. As well, there will be trial and error to determine whether a medication is effective and whether there are side effects. Sometimes, more than one medication needs to be prescribed to lower blood pressure to the goal of a normal reading.
The different classes of medication include the following:
- Calcium helps heart muscle contract (squeeze) strongly and narrows arteries. These medications block calcium from entering heart and artery cells. This allows the heart to squeeze less aggressively and arteries to relax and dilate.
- E.g., amlodipine, diltiazem, nicardipine
Angiotensin-converting enzyme (ACE) inhibitors
- Angiotensin is made in the liver and then converted in the kidneys to cause blood vessels to narrow. Ace inhibitors relax blood vessels causing blood pressure to lower.
- E.g., lisinopril, enalapril, captopril
Angiotensin II receptor blockers (ARBs)
- These medications block the receptors in heart and artery cells preventing angiotension attaching to those cells. The effect of the angiotensin is blocked and blood pressure decreases.
- Eg. losartan, valsartab
Diuretics
- These medications cause the kidneys to remove water and salt from the body; less fluid in the arteries and veins, lowers blood pressure.
- E.g., hydrochlorothiazide, furosemide
- These medications block the adrenalin receptors in the heart, causing it to beat more slowly and less aggressively. As well, they cause arteries to dilate.
- E.g., metoprolol, atenolol, nadolol
- Beta blockers are no longer recommended to be used as single drug control of hypertension.
How is diastolic hypertension treated?
Isolated diastolic hypertension occurs when the systolic blood pressure reading is normal (120mm Hg or less), but the diastolic reading is greater than 80 mmHg. In younger patients, under the age of 50, diastolic hypertension alone increases the risk of heart disease.
The treatment approach to this condition is the same as systolic high blood pressure.
From
Heart Health Resources
What are the complications of high blood pressure?
There are two types of complications related to hypertension, the first is due to a rapid spike in the blood pressure, and the second because of chronic changes that occur in organs subjected to longstanding elevated blood pressures.
Chronic, poorly-controlled hypertension causes damage to the arteries in the body, from the largest, the aorta, to the smallest arterioles that supply blood to every organ in the body. Over time, the risk of damage to every organ increases. Hypertension is one of the major risk factors that can lead to heart attack, congestive heart failure, stroke, peripheral vascular disease, eye, and kidney damage among others.
In a hypertensive emergency, when blood pressure spirals upward out of control, damage to target organs can happen within minutes. There is no threshold blood pressure reading that can trigger organ damage. The diagnosis is made based on the symptoms that present in the patient.
Historically, a blood pressure of 180/120 was considered dangerous and in need of treatment to lower it immediately. That is no longer the approach to care for people whose blood pressure is markedly elevated without symptoms. To be more judicious, treating the blood pressure as an outpatient by gradually lowering the readings using medications.
An exception is made for pregnancy, where an elevated blood pressure of 140/90 needs to be evaluated for the risk of preeclampsia and quickly treated to avoid injury to mother and fetus.
For those who have markedly elevated blood pressures and target organs are acutely failing (e.g., heart attacks, aortic dissections, strokes, kidney failure, eye damage), emergent blood pressure control is a priority. In these situations, there often is no cure, but rather the goal is to minimize the amount of damage that has already occurred.
Can high blood pressure hurt my eyes?
Longstanding, poorly-controlled hypertension can damage the arterioles that supply the eye with blood. This can cause damage to the retina, (hypertensive retinopathy) where the nerves for sight reside. Other retinal diseases can also be caused by chronic hypertension, including occlusion of arteries and veins that supply the eye. Diabetic retinopathy can be made worse by chronic hypertension, and hypertension is also a risk factor for glaucoma and macular degeneration.
Is it possible to prevent high blood pressure?
It is difficult to prevent hypertension since the cause is uncertain. That said, living a healthy lifestyle, eating well, sleeping well, exercising routinely, avoiding tobacco, and limiting alcohol, may decrease the risk of developing high blood pressure. As well, living healthily, will help minimize the risk of chronic disease should hypertension develop.
Can exercise help lower blood pressure?
Exercise is one of the main ways a person with hypertension can lower high blood pressure, even without taking medications. Recommendations include aerobic exercise for 40 minutes three times a week. In addition, resistance and isometric exercises are helpful in lowering blood pressure.
Can you be physically fit and have high blood pressure?
Hypertension does not discriminate. Being physically fit is an important part of a healthy lifestyle, but it does not prevent high blood pressure.
QUESTION
See Answerhttps://www.healthquality.va.gov/guidelines/CD/htn/VADoDHypertensionCPG508Corrected792020.pdf Updated Mar 2020Accessed 11Nov2023
Stergiou GS Palatini P, etal., on behalf of the European Society of Hypertension Council and the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. Journal of Hypertension: 2021. 39(7):p 1293-1302.
Whelton PK, Carey RM, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 7(6):e1-115
Hypertension in adults: diagnosis and management: NICE guideline.
https://www.nice.org.uk/guidance/ng136/resources Updated 18Mar2022. Accessed 10Nov2023
Muntner P, Shimbo D, etal. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension. 2019;73(5):e35-e66
Sonne-Holm S, Sørensen TI, etal. Independent effects of weight change and attained body weight on prevalence of arterial hypertension in obese and non-obese men. BMJ.
Carnethon MR, Evans NS, etal. Joint associations of physical activity and aerobic fitness on the development of incident hypertension: coronary artery risk development in young adults. Hypertension.
Williams B, Mancia G, etal. ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018: 39(33):3021-3104.
US Preventive Services Task Force; Krist AH, Davidson KW, etal. Screening for Hypertension in Adults: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA. 2021;325(16):1650-1656.
Elmer PJ, Obarzanek E, etal.PREMIER Collaborative Research Group. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med.
James PA, Oparil S, etal. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA.
Blood Pressure Lowering Treatment Trialists' Collaboration. Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet. 2021; 398 (10305):1053-1064.
Wong TY, Mitchell P. The eye in hypertension. Lancet.
Gupta DK, Lewis CE, et al. Effect of Dietary Sodium on Blood Pressure: A Crossover Trial. JAMA. Published online 11Nov2023. Accessed 12Nov 2023
Top High Blood Pressure Hypertension Related Articles
Understanding Blood Pressure Chart Readings by Age
Blood pressure is the force applied by the blood over the inner walls of the arteries. Although the average blood pressure for a person remains constant, it shows minor fluctuations throughout the day—declining while relaxing and momentarily increasing while being excited or under stress. An increase in resting blood pressure can scar, stiffen, or harden the arteries.Blood Pressure Picture
The blood pressure is the pressure of the blood within the arteries. See a picture of Blood Pressure and learn more about the health topic.What Does it Mean When the Bottom Number of Your Blood Pressure is Over 100?
Diastolic blood pressure (DBP) is the pressure exerted on the walls of the arteries when the heart muscle relaxes between beats. When the bottom number of blood pressure (diastole) is over 100 mmHg, it may be called diastolic hypertension (DHT). Diastolic blood pressure means the blood pressure reading during the phase when your heart relaxes (diastole). Force of the blood against the walls of the arteries (the blood vessels carrying blood from the heart to other sites) in the body is called blood pressure. The heart pumps the blood into the arteries as it contracts (systole).Common Medical Abbreviations & Terms
Doctors, pharmacists, and other health-care professionals use abbreviations, acronyms, and other terminology for instructions and information in regard to a patient's health condition, prescription drugs they are to take, or medical procedures that have been ordered. There is no approved this list of common medical abbreviations, acronyms, and terminology used by doctors and other health- care professionals. You can use this list of medical abbreviations and acronyms written by our doctors the next time you can't understand what is on your prescription package, blood test results, or medical procedure orders. Examples include:
- ANED: Alive no evidence of disease. The patient arrived in the ER alive with no evidence of disease.
- ARF: Acute renal (kidney) failure
- cap: Capsule.
- CPAP: Continuous positive airway pressure. A treatment for sleep apnea.
- DJD: Degenerative joint disease. Another term for osteoarthritis.
- DM: Diabetes mellitus. Type 1 and type 2 diabetes
- HA: Headache
- IBD: Inflammatory bowel disease. A name for two disorders of the gastrointestinal (BI) tract, Crohn's disease and ulcerative colitis
- JT: Joint
- N/V: Nausea or vomiting.
- p.o.: By mouth. From the Latin terminology per os.
- q.i.d.: Four times daily. As in taking a medicine four times daily.
- RA: Rheumatoid arthritis
- SOB: Shortness of breath.
- T: Temperature. Temperature is recorded as part of the physical examination. It is one of the "vital signs."
Creatinine Blood Test
Creatinine is a chemical waste molecule that is generated from muscle metabolism. Creatinine is produced from creatine, a molecule of major importance for energy production in muscles. Creatinine has been found to be a fairly reliable indicator of kidney function. As the kidneys become impaired the creatinine level in the blood will rise. Normal levels of creatinine in the blood vary from gender and age of the individual.Cupping Therapy
Cupping therapy is a form of traditional Chinese medicine that aims to improve the flow of qi (energy) in the body. Learn more about the benefits and potential side effects of the various types of cupping therapy.Drug Interactions: What Foods, Drugs, Herbs Affect Medications?
What foods, drugs, and herbal supplements interact with your pharmaceuticals? Learn about grapefruit and other common drug interactions to medications like warfarin, tramadol, Zoloft, trazodone, gabapentin, melatonin, Xanax, Lexapro, lithium, Lisinopril, Mucinex, and more.Electrocardiogram (ECG or EKG)
What is an electrocardiogram (ECG, EKG)? Read about the ECG procedure used to reflect underlying heart conditions such as angina, occurrence of a prior heart attack or of an evolving heart attack, and more. Read about the ECG test, interpretation, results, definition, and more.Heart Disease: Causes of a Heart Attack
Heart disease prevention includes controlling risk factors like diet, exercise, and stress. Heart disease symptoms in women may differ from men. Use a heart disease risk calculator to determine your heart attack risk.Heart Disease Quiz
Take our Heart Disease Quiz to get answers and facts about high cholesterol, atherosclerosis prevention, and the causes, symptoms, treatments, testing, and procedures for medically broken hearts.High Blood Pressure & Body
High blood pressure puts you at risk for a number of other conditions. Here's what to look out for.What Is High Blood Pressure (Hypertension)? Symptoms, Treatments
What causes high blood pressure (hypertension)? What is normal blood pressure? Know the warning signs and symptoms of high blood pressure. Read about high blood pressure medications, diet, and long-term treatments.HBP Quiz
Take this quiz and test your IQ of high blood pressure (hypertension), the cardiovascular disease that causes most strokes and heart attacks. How are dizziness, snoring, and gout related to HBP? Find the answer and learn how medical treatments and lifestyle adjustments fight this common problem.Homocysteine Blood Test
Homocysteine is an amino acid produced by the body and also is in your blood. When homocysteine blood test levels are high, it indicates risk of heart disease, heart attack, and stroke. Learn about high levels, meaning, causes, and risk factors.How Can I Lower My Blood Pressure in Minutes?
Learn how to lower your high blood pressure quickly and fast in just minutes. Learn how to better manage high blood pressure.MRI (Magnetic Resonance Imaging Scan)
MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.What Is Considered Stroke-Level High Blood Pressure?
Blood pressure readings above 180/120 mmHg are considered stroke-level and require immediate medical attention. Check out the center below for more medical references on hypertension, including multimedia (slideshows, images, and quizzes), related diseases, treatment, diagnosis, medications, and prevention or wellness.