What to know about high blood pressure

The heart is a muscle that pumps blood around the body. As it travels, the blood delivers oxygen to the body's vital organs.

Sometimes, a problem in the body makes it harder for the heart to pump the blood. This could happen, for example, if an artery becomes too narrow.

Persistent high blood pressure can put a strain on the walls of the arteries. This can lead to a variety of health problems, some of which can be life threatening.

High blood pressure chart

The chart below shows measures for normal and high blood pressure, according to the American Heart Association (AHA).

Doctors measure blood pressure in millimeters of mercury (mm Hg).

Systolic pressure measures the pressure in the arteries as the heart contracts and is the top number on a blood pressure reading. Diastolic, which is the lower number, represents the blood pressure when the heart is resting between beats.

	Systolic (mm Hg)	Diastolic (mm Hg)
Normal	Below 120	Below 80
Elevated (hypertension)	120–129	Below 80
Stage 1 hypertension	130–139	80–90
Stage 2 hypertension	140 or above	90 or above
Hypertensive crisis	Over 180	Over 120

 

Most people with high blood pressure will not experience any symptoms, which is why people often call hypertension the "silent killer."

However, once blood pressure reaches about 180/120 mm Hg, it becomes a hypertensive crisis, which is a medical emergency.

At this stage, a person may have:

• a headache
• nausea
• vomiting
• dizziness
• blurred or double vision
• nosebleeds
• heart palpitations
• breathlessness

Anybody who experiences these symptoms should see their doctor immediately.

Symptoms in women

Hormonal factors mean that the risk of high blood pressure may be different in males and females.

Factors that can increase the risk of high blood pressure in females include:

• pregnancy
• menopause
• the use of birth control pills

During pregnancy, high blood pressure can be a sign of preeclampsia, a potentially dangerous condition that can affect the woman and her unborn baby.

Symptoms of preeclampsia include:

• headaches
• vision changes
• abdominal pain
• swelling due to edema

All women should follow the guidelines for screening and attend all health checks, especially during pregnancy.

Symptoms in teens

Teenagers can develop high blood pressure due to obesity or an underlying medical condition.

Possible medical factors include:

• aspects of metabolic syndrome, such as type 2 diabetes
• kidney disease
• endocrine disease, which affects the hormones
• vascular disease, which affects the blood vessels
• a neurological condition

These conditions may have symptoms of their own.

The symptoms of high blood pressure, if they occur, will be the same as for other groups.

Symptoms in children

High blood pressure can affect children. Having obesity and diabetes increases the risk, but it can also be a sign of:

• a tumor
• heart problems
• kidney problems
• thyroid problems
• a genetic condition, such as Cushing's syndrome

As with adults, high blood pressure often does not cause symptoms in children.

However, if symptoms do occur, they may include:

• a headache
• fatigue
• blurred vision
• nosebleeds

They may also have signs of another condition.

Symptoms in babies

Newborns and very young babies can sometimes have high blood pressure due to an underlying health condition, such as kidney or heart disease.

Symptoms may include:

• a failure to thrive
• seizures
• irritability
• lethargy
• respiratory distress

Other symptoms will depend on the condition that is causing the high blood pressure.

High blood pressure can occur when certain changes happen in the body or if a person is born with specific genetic features that cause a health condition.

It can affect people with:

• obesity
• type 2 diabetes
• kidney disease
• obstructive sleep apnea
• lupus
• scleroderma
• underactive or overactive thyroid
• congenital conditions, such as Cushing's syndrome, acromegaly, or pheochromocytoma

Sometimes, there is no apparent cause. In this case, a doctor will diagnose primary hypertension.

Consuming a high fat diet, carrying excess weight, drinking a lot of alcohol, smoking tobacco, and the use of some medications also increase the risk.

Treatment will depend on several factors, including:

• how high the blood pressure is
• the risk of cardiovascular disease or a stroke

The doctor will recommend different treatments as blood pressure increases. For slightly high blood pressure, they may suggest making lifestyle changes and monitoring the blood pressure.

If blood pressure is high, they will recommend medication. The options may change over time, according to how severe the hypertension is and whether complications arise, such as kidney disease. Some people may need a combination of several different medications.

Medications

Conventional drugs for treating high blood pressure include:

1) Angiotensin converting enzyme inhibitors

Angiotensin converting enzyme (ACE) inhibitors block the actions of some hormones that regulate blood pressure, such as angiotensin II. Angiotensin II causes the arteries to constrict and increases blood volume, resulting in increased blood pressure.

ACE inhibitors can reduce the blood supply to the kidneys, making them less effective. As a result, it is necessary for people taking ACE inhibitors to have regular blood tests.

People should not use ACE inhibitors if they:

• are pregnant
• have a condition that affects the blood supply to the kidneys

ACE inhibitors may cause the following side effects, which usually resolve after a few days:

• dizziness
• fatigue
• weakness
• headaches
• a persistent dry cough

If the side effects are persistent or too unpleasant to manage, a doctor may prescribe an angiotensin II receptor antagonist instead.

These alternative medications often cause fewer side effects, but they may include dizziness, headaches, and increased potassium levels in the blood.

2) Calcium channel blockers

Calcium channel blockers (CCBs) aim to decrease calcium levels in the blood vessels. This will relax the vascular smooth muscle, causing the muscle to contract less forcefully, the arteries to widen, and blood pressure to go down.

CCBs may not always be suitable for people with a history of heart disease, liver disease, or circulation issues. A doctor can advise on taking CCBs and which type of CCB is safe to use.

The following side effects may occur, but they usually resolve after a few days:

• redness of the skin, generally on the cheeks or neck
• headaches
• swollen ankles and feet
• dizziness
• fatigue
• skin rash
• swollen abdomen, in rare cases

3) Thiazide diuretics

Thiazide diuretics help the kidneys get rid of sodium and water. This lowers blood volume and pressure.

The following side effects can occur, and some of them may persist:

• low blood potassium, which can affect heart and kidney function
• impaired glucose tolerance
• erectile dysfunction

People taking thiazide diuretics should have regular blood and urine tests to monitor their blood sugar and potassium levels.

4) Beta-blockers

Beta-blockers were once popular for treating hypertension, but doctors only tend to prescribe them now when other treatments have not been successful.

Beta-blockers slow the heart rate and reduce the force of the heartbeat, causing a drop in blood pressure.

Side effects may include:

• fatigue
• cold hands and feet
• slow heartbeat
• nausea
• diarrhea
• Less common side effects are:
• disturbed sleep
• nightmares
• erectile dysfunction

Beta-blockers are often the standard medication for a person with very high blood pressure, known as a hypertensive crisis.

5) Renin inhibitors

Aliskiren (Tekturna, Rasilez) reduces the production of renin, an enzyme that the kidneys produce.

Renin helps produce a hormone that narrows blood vessels and raises blood pressure. Reducing this hormone causes the blood vessels to widen and blood pressure to fall.

This drug is relatively new, and healthcare professionals are still determining its optimal use and dosage.

Possible side effects include:

• diarrhea
• dizziness
• flu-like symptoms
• fatigue
• a cough

It is essential to read the packaging of any medication to check for interactions with other drugs.

Diet

Managing the diet can be an effective way of both preventing and treating high blood pressure.

Plant-based foods

A healthful, balanced diet includes plenty of fruits and vegetables, vegetable and omega oils, and good quality, unrefined carbohydrates, such as whole grains. People who include animal products in their diet should trim all the fat off and avoid processed meats.

Lowering salt intake

Experts recommend reducing salt consumption and increasing potassium intake to manage or prevent high blood pressure. Limiting salt intake to less than 5–6 grams per day could help improve cardiovascular health and reduce systolic blood pressure by 5.6 mm Hg in people with hypertension.

Healthful fats

In moderation, plant sources of fats, such as avocados, nuts, olive oil, and omega oils, can be healthful. People should limit their intake of saturated fats and trans fats, common in animal-sourced and processed foods.

The DASH diet

Health experts recommend the DASH diet for people with high blood pressure. The DASH diet focuses on an eating plan that emphasizes whole grains, fruits, vegetables, nuts, seeds, beans, and low-fat dairy products.

Food groups	Number of weekly servings for those eating 1,600–3,100 calories a day	Number of weekly servings for those on a 2,000-calorie diet
Grains and grain products	6–12	7–8
Fruits	3–6	3–5
Vegetables	4–6	4–5
Mostly low-fat or non-fat dairy foods	2–4	2–3
Lean meat, fish, or poultry	1.5–2.5	2
Nuts, seeds, and legumes	3–6	4–5
Fats and candy	2–4	Limited

Alcohol

Some studies indicate that consuming some alcohol may help lower blood pressure. However, others report the opposite, noting that even drinking a moderate amount might increase blood pressure levels.

People who regularly drink more than moderate amounts of alcohol will almost always experience elevated blood pressure levels.

Caffeine

Studies into the relationship between caffeine and blood pressure have produced conflicting results. A report published in 2017 concluded that a moderate intake of coffee appears to be safe for people with high blood pressure.

Home remedies

The AHA recommend a range of lifestyle adjustments that can help reduce blood pressure, such as:

• managing stress
• quitting smoking
• eating healthfully
• getting exercise
• following any treatment plan the doctor prescribes

Discuss any planned lifestyle changes with a healthcare professional before introducing them.

Regular exercise

The AHA note that most healthy people should do at least 150 minutes of moderate intensity physical exercise a week. This could be 30 minutes — or three lots of 10 minutes a day — on 5 days of the week.

This amount of exercise is also appropriate for people with high blood pressure.

However, a person who has not exercised for a while or who has a new diagnosis should talk to their doctor before starting a new physical activity program to ensure the choices they make are suitable for them.

Losing weight

Studies have revealed that losing as little as 5–10 pounds in weight can help reduce blood pressure.

Weight loss will also improve the effectiveness of blood pressure medications.

Ways of achieving and maintaining a healthy weight include:

• getting regular exercise
• following a diet that emphasizes plant-based foods and limits the intake of fat and added sugars

Sleep

Increasing sleep alone cannot treat hypertension, but too little sleep and poor sleep quality may make it worse.

A 2015 analysis of data from a Korean national health survey found that people who had less than 5 hours of sleep per night were more likely to have hypertension.

In this article, you can find more tips on how to manage high blood pressure.

Natural remedies

According to the National Center for Complementary and Integrative Health (NCCIH), the following may help lower blood pressure:

• meditation, yoga, qi gong, and tai chi
• biofeedback and transcendental meditation
• supplements such as garlic, flaxseed, green or black tea, probiotics, cocoa, and roselle (Hibiscus sabdariffa)

The NCCIH add, however, that there is not yet enough evidence to confirm that these can make a difference.

They also warn that:

Some supplements can have adverse effects. They may raise blood pressure or interact with medications.

Meditation and exercise therapies are usually safe, but some poses may not be suitable for people with high blood pressure.

Anyone who is considering an alternative therapy should speak to their doctor first.

There are two parts to a blood pressure measurement:

Systolic pressure: This is the blood pressure when the heart contracts.

Diastolic pressure: This is the blood pressure between heartbeats.

If blood pressure is 120/80 mm Hg, it means that the systolic pressure is 120 mm Hg and the diastolic pressure is 80 mm Hg.

There are different devices for measuring blood pressure. A doctor will often use a manual sphygmomanometer with a stethoscope. This has a pressure cuff that they put around the person's arm.

Digital devices are suitable for home use, and they available from pharmacies and for purchase online.

Read our review of the best home blood pressure monitors currently available for home use.

When a person gets a blood pressure reading, they will have one of the following:

Normal: Less than 120/80 mm Hg.

Elevated: 120–129/80 mm Hg. At this stage, a doctor will advise the individual to make lifestyle changes to return their blood pressure to the normal range.

Stage 1 hypertension: 130–139/80–89 mm Hg.

Stage 2 hypertension: Over 140/90 mm Hg.

Hypertensive crisis: 180/120 mm Hg or above.

A person with a hypertensive crisis needs immediate medical attention.

A person will typically need more than one reading to confirm a diagnosis, as various factors can affect the result.

Blood pressure can fluctuate:

• according to the time of day
• when a person feels anxiety or stress
• after eating

However, a doctor will take immediate action if a reading shows very high blood pressure or if there are signs of organ damage or other complications.

Additional tests

Other tests can help confirm a diagnosis.

Urine and blood tests: These can check for underlying problems, such as a urine infection or kidney damage.

Exercise stress test: A healthcare professional will measure a person's blood pressure before, during, and after using a stationary bicycle or a treadmill. The results can give important clues about heart health.

Electrocardiogram (ECG): An ECG tests electrical activity in the heart. For a person with hypertension and high cholesterol levels, a doctor may order an ECG as a baseline for comparing future results.

Changes in future results might show that coronary artery disease is developing or that the heart wall is thickening.

Holter monitoring: For 24 hours, the individual carries an ECG portable device that connects to their chest through electrodes. This device can provide an overview of blood pressure throughout the day and show how it changes as the level of activity varies.

Echocardiogram: Ultrasound waves show the heart in motion. The doctor will be able to detect problems, such as thickening of the heart wall, defective heart valves, blood clots, and excessive fluid around the heart.

A healthy blood pressure is essential for maintaining bodily functions.

High blood pressure can have a severe impact on:

The cardiovascular system: High blood pressure can cause the arteries to harden, increasing the risk of a blockage.

The heart: A blockage can reduce blood flow to the heart, increasing the risk of angina, heart failure, or a heart attack.

The brain: A blockage in the arteries can lower or prevent blood flow to the brain, leading to a stroke.

The kidneys: High blood pressure can result in kidney damage and chronic kidney disease.

All of these effects can be life threatening.

Decongestants are a useful over-the-counter remedy when people have a stuffy or runny nose, but some decongestants can raise blood pressure.

Ingredients that can have this effect include:

• oxymetazoline
• phenylephrine
• pseudoephedrine

A person should explain to their pharmacist that they have high blood pressure and ask them to recommend a suitable option.

The main risk factors for high blood pressure are likely to be environmental, but genetic factors may play a role. Hypertension can run in families, and people from certain ethnic and racial backgrounds appear to have a higher risk.

According to the CDC, however, people in a family often share similar lifestyles, such as dietary choices.

If a person has genetic factors that increase their susceptibility to high blood pressure, and they also make lifestyle choices that increase this risk, they will likely have a greater chance of developing hypertension.

The AHA recommend that people limit their salt intake to no more than 2,300 milligrams (mg) a day and preferably reducing it to 1,500 mg. On average, people in the U.S. currently consume more than 3,400 mg of sodium daily.

For most people, the natural sodium content in vegetables, for example, is enough for their body's needs. Avoiding the salt shaker and eating less processed and premade food are good ways to cut salt intake.

Without treatment or taking measures to manage blood pressure, excessive pressure on the artery walls can lead to damage of the blood vessels, which is a form of cardiovascular disease. It can also damage some vital organs.

Possible complications of high blood pressure include:

• stroke
• heart attack and heart failure
• blood clots
• aneurysm
• kidney disease
• thickened, narrow, or torn blood vessels in the eyes
• metabolic syndrome
• brain function and memory problems

Seeking early treatment and managing blood pressure can help prevent many health complications.

The risk factors for high blood pressure include the following:

Age: The risk increases with age because the blood vessels become less flexible.

Family history and genetic factors: People who have close family members with hypertension are more likely to develop it.

Ethnic background: African Americans have a higher risk of developing hypertension than other groups in the United States.

Obesity and being overweight: People with overweight or obesity are more likely to develop high blood pressure.

Physical inactivity: A sedentary lifestyle increases the risk.

Smoking: When people smoke, the blood vessels narrow, and blood pressure rises. Smoking also reduces the blood's oxygen content, so the heart pumps faster to compensate. This, too, increases blood pressure.

Alcohol intake: Drinking a lot of alcohol increases the risk of blood pressure and its complications, such as heart disease.

Diet: A diet that is high in unsaturated fat and salt increases the risk of high blood pressure.

High cholesterol: Over 50% of people with high blood pressure have high cholesterol. Consuming unhealthful fats can contribute to a buildup of cholesterol in the arteries.

Mental stress: Stress can have a severe impact on blood pressure, especially when it is chronic. It can occur as a result of both socioeconomic and psychosocial factors.

Stress: Persistent stress can lead to high blood pressure, and it may increase the risk of unhealthful choices, such as smoking.

Diabetes: High blood pressure often occurs alongside type 1 diabetes. Following a treatment plan to manage diabetes can reduce the risk.

Pregnancy: High blood pressure is more likely during pregnancy due to hormonal changes. Hypertension is also a symptom of preeclampsia, a potentially severe placental disorder.

Sleep apnea: People with sleep apnea momentarily stop breathing while they sleep. Experts say there are links with hypertension.

Many people with high blood pressure do not have symptoms. For this reason, they must have regular screening, especially those with a higher risk.

This group includes:

• people with obesity or overweight
• African Americans
• those with a previous history of high blood pressure
• those with blood pressure that is at the high end of normal (from 130–139/ 85–89 mm Hg)
• people with certain health conditions

The U.S. Preventive Services Task Force (USPSTF) recommend annual screening for:

• adults aged 40 years or older
• those with an elevated risk of high blood pressure
• Persons with a higher risk include those who:
• have high to normal blood pressure (130 to 139/85 to 89 mm Hg)
• have overweight or obesity
• are African Americans

Adults aged 18–39 years whose blood pressure is normal (less than 130/85 mm Hg) and who do not have other risk factors should have further screening every 3–5 years.

If rescreening in the doctor's office shows that blood pressure has risen, the USPSTF recommend that the person use an ambulatory blood pressure monitor for 24 hours to assess their blood pressure further. If this continues to show high blood pressure, the doctor will diagnose hypertension.

The USPSTF do not currently recommend routine screening for those aged 17 years and under.