High Blood Pressure (Hypertension)

Risk Factors for High Blood Pressure

There are many risk factors for 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. Heathy lifestyle changes can decrease 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 due to the 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. Research has identified many gene variations associated with small increases in the risk of developing high blood pressure. New research suggests that certain DNA changes during fetal development may also lead to the development of high blood pressure later in life. Some people have a high sensitivity to sodium. This can also run in families.

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

• Unhealthy eating patterns, such as eating too much sodium
• Drinking too much alcohol
• Being physically inactive

Race or ethnicity: High blood pressure is more common in African American adults than in white, Hispanic, 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.

Sex: Before age 55, men are more likely than women to develop high blood pressure. After age 55, women are more likely than men to develop 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 if you have consistently high blood pressure readings. Even small increases in systolic blood pressure can weaken and damage your blood vessels. Your doctor will recommend heart-healthy lifestyle changes to help control your blood pressure and prevent you from developing high blood pressure.

Screening for consistently high blood pressure readings

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 millimeters of mercury (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 consider you to have high blood pressure if you are an adult or child age 13 or older who has consistent systolic readings of 130 to 139 mm Hg or diastolic readings of 80 to 89 mm Hg and you have other cardiovascular risk factors.

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

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

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.

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

• You are excited or nervous. The phrase “white coat hypertension” refers to blood pressure readings that are only high when taken in a doctor’s office compared with readings taken in other places. Doctors can detect this type of high blood pressure by reviewing readings from the office and from other places.
• If your blood pressure tends to be lower when measured at the doctor’s office. This is called masked high blood pressure. 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.

Your doctor may run additional tests to confirm an initial reading. 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.

Healthy lifestyle changes to prevent high blood pressure

Healthy lifestyle changes can help prevent high blood pressure from developing. Healthy lifestyle changes include choosing a heart-healthy eating patterns such as the DASH eating plan, being physically active, aiming for a healthy weight, quitting smoking, and managing stress.

Signs, Symptoms, and Complications of 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 serious complications occur. Undiagnosed or uncontrolled high blood pressure can cause the following complications:

• Aneurysms
• Chronic kidney disease
• Eye damage
• Heart attack
• Heart failure
• Peripheral artery disease
• Stroke
• Vascular dementia

Diagnosis of High Blood Pressure

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. Diagnoses for children younger than 13 are based on typical readings for their sex, height, and age.

Confirming high blood pressure

To diagnose high blood pressure, your doctor will take two or more readings at separate medical appointments. 

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 consider you to have high blood pressure if you are an adult or child age 13 or older who has consistent systolic readings of 130 to 139 mm Hg or diastolic readings of 80 to 89 mm Hg and you have other cardiovascular risk factors.

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

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

Depending on the cause, your doctor could diagnose you with primary or secondary high blood pressure.

• Primary high blood pressure. Primary, or essential, high blood pressure is the most common type of high blood pressure. This type of high blood pressure tends to develop over years as a person ages.
• Secondary high blood pressure. Secondary high blood pressure is caused by another medical condition or occurs as a side effect of a medicine. Your blood pressure may improve once the cause is treated or removed.

Medical history

Your doctor will want to understand your risk factors, general information about your health—such as your eating patterns, your physical activity levels, and your family’s health history. This information can help your doctor develop a treatment plan.

Tests to identify other medical conditions

Your doctor may order additional tests to see if another condition or medicine is causing your high blood pressure. Doctors can use this information to develop your treatment plan.

Treatment of High Blood Pressure

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. Heart-healthy lifestyle changes, such as heart-healthy eating, can be highly effective in treating high blood pressure.

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

Healthy lifestyle changes

If you have high blood pressure, your doctor may recommend that you adopt lifelong heart-healthy lifestyle changes to help lower and control high blood pressure. These include:

• Heart-healthy eating patterns such as 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. 
• Being physically active. 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. Before starting any exercise program, ask your doctor what level of physical activity is right for you.
• Aiming for a healthy weight. If you are an adult who is living with overweight or obesity, losing 5 to 10 percent of your initial weight over about six months can improve your health. Even losing just 3 to 5 percent of your weight can improve blood pressure readings.
• Quitting 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).
• Managing stress.

To help make lifelong heart-healthy lifestyle changes, try making one change at a time and add another change when you feel that you have successfully adopted the earlier changes. When you practice several healthy lifestyle habits, you are more likely to lower or control your high blood pressure and maintain normal blood pressure.

Medicines

When healthy lifestyle changes alone do not control or lower high blood pressure, your doctor may change or update your treatment plan by prescribing medicines to treat your condition. 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. Possible high blood pressure medicines include:

• Angiotensin-converting enzyme (ACE) inhibitors: Block the production of the angiotensin II hormone, one part of the basic system the body uses to control blood pressure. When angiotensin II is blocked, the blood vessels do not narrow.
• Angiotensin II receptor blockers (ARBs): Block angiotensin II hormone from binding with receptors in the blood vessels. ARBs work the same way as ACE inhibitors to keep blood vessels from narrowing.
• Calcium channel blockers: Keep calcium from entering the muscle cells of your heart and blood vessels. This allows blood vessels to relax.
• Diuretics (water or fluid pills): Flush excess sodium 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.

If your doctor prescribes medicines as a part of your treatment plan, keep up your healthy lifestyle changes. The combination of the medicines and the heart-healthy lifestyle changes can help control and lower your high blood pressure and prevent heart disease.

If you have concerns about any side effects from your medicine, talk with your doctor to see if he or she can change the dose or prescribe a new medicine.

What should I know about high blood pressure medicines in children, women, and African Americans?

The type or amount of blood pressure medicine that works best can vary depending on age and other factors. For example:

• Doctors prescribe children and teens medicines at special doses that are safe and effective in children.
• Some types of medicine are not appropriate for women during pregnancy or may affect women and men differently.
• To lower and control blood pressure, many people, especially African American adults, may need to take two or more medicines. African Americans taking ACE inhibitors have a higher risk of a potentially serious side effect called angioedemaexternal link that causes swelling under the skin.

Living With High Blood Pressure

If you have been diagnosed with high blood pressure, it is important that you continue your treatment plan. Following your treatment plan, getting regular follow-up care, and learning how to monitor your condition at home are important. Let your doctor know if you are planning to become pregnant. These steps can help prevent or delay complications that high blood pressure can cause. Your doctor may adjust your treatment plan as needed to lower or control your high blood pressure.

Receive routine follow-up care

Check your blood pressure and have regular medical checkups or tests as your doctor advises. Your doctor may suggest ways for you to monitor your blood pressure at home. During checkups, talk to your doctor about these important topics:

• Blood pressure readings
• Your overall health
• Your treatment plan

Your doctor may need to change or add medicines to your treatment plan over time. To help control your blood pressure and prevent heart disease, keep up your healthy lifestyle changes. You can ask questions and discuss your progress as part of your follow-up.

Monitor your condition yourself

Your doctor may ask you to check readings at home or at other locations that have blood pressure equipment. You may be able to send readings to your doctor’s office electronically, or you can keep a written log of all your results.

Keeping track of your blood pressure is important. Your doctor can help you learn how to check your blood pressure at home. Each time you check your own blood pressure, record your numbers and the date. Send or take the log of your blood pressure readings with you for appointments with your doctor.

Pregnancy planning

High blood pressure can cause problems for a mother and her baby. High blood pressure can harm a mother’s kidneys and other organs and can cause early birth and low birth weight. If you are thinking about having a baby and have high blood pressure, talk with your doctors so you can take steps to lower or control your high blood pressure before and during the pregnancy.

Some medicines used to treat high blood pressure are not recommended during pregnancy. If you are taking medicines to lower or control your high blood pressure, talk with your doctor about your choices for safely managing high blood pressure during pregnancy.

Some women with normal blood pressure develop high blood pressure during pregnancy. As part of your regular prenatal care, your doctor will measure your blood pressure at each visit. If you develop high blood pressure, your doctor will closely monitor you and your baby and provide special care to lower the chance of complications. With such care, most women and babies have good outcomes.

Prevent worsening high blood pressure or complications over your lifetime

If you have high blood pressure, it is important to get routine medical care and to follow your prescribed treatment plan, which will include heart-healthy lifestyle changes and possibly medicines. Heart-healthy lifestyle changes can prevent high blood pressure, reduce elevated blood pressure, help control existing high blood pressure, and prevent complications, such as heart attack, heart failure, stroke, vascular dementia, or chronic kidney disease.

Learn the warning signs of serious complications and have a plan

High blood pressure can lead to serious complications such as heart attack or stroke. Call 911 if you suspect any of the following in you or someone else:

• Heart attack. Signs of heart attack include mild or severe chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, heartburn, or indigestion. There may also be pain down the left arm. Women may also have chest pain and pain down the left arm, but they are more likely to have less typical symptoms, such as shortness of breath, nausea, vomiting, unusual tiredness, and pain in the back, shoulders, or jaw. Read more about the signs and symptoms of a heart attack.
• 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.
• Dangerously high blood pressure. Readings above 180 over 120 are dangerously high and require immediate medical attention.