Blood pressure is a measure of how hard the blood pushes against the walls of your arteries as it moves through your body. It's normal for blood pressure to go up and down throughout the day, but if it stays up, you have high blood pressure. Another name for high blood pressure is hypertension.
When blood pressure is high, it starts to damage the blood vessels, heart, and kidneys. This can lead to heart attack, stroke, and other problems. High blood pressure is called a "silent killer,'' because it doesn't usually cause symptoms while it is causing this damage.
Your blood pressure consists of two numbers: systolic and diastolic. Someone with a systolic pressure of 120 and a diastolic pressure of 80 has a blood pressure of 120/80, or "120 over 80." Blood pressure is measured in millimetres of mercury (mm Hg).
High blood pressure is 140/90 or higher. You have high blood pressure if your top number is 140 or higher or your bottom number is 90 or higher, or both.footnote 1
People with diabetes should have a blood pressure of less than 130/80.footnote 1
In most cases, doctors can't point to the exact cause. But several things are known to raise blood pressure, including being very overweight, drinking too much alcohol, having a family history of high blood pressure, eating too much salt, and getting older.
Your blood pressure may also rise if you are not very active, you don't eat enough potassium and calcium, or you have a condition called insulin resistance.
High blood pressure doesn't usually cause symptoms. Most people don't know they have it until they go to the doctor for some other reason.
Very high blood pressure can cause severe headaches and vision problems. These symptoms can also be caused by dangerously high blood pressure called malignant high blood pressure. It may also be called a hypertensive crisis or hypertensive emergency. Malignant high blood pressure is a medical emergency.
Most people find out that they have high blood pressure during a routine doctor visit. For your doctor to confirm that you have high blood pressure, your blood pressure must be at least 140/90 on three or more separate occasions. It is usually measured 1 to 2 weeks apart.
Instead of having you come back to the office several times, your doctor may have you measure your blood pressure at home. You may have what is called white-coat hypertension, which is blood pressure that goes up just because you're at the doctor's office.
If you have high blood pressure, your doctor will give you a blood pressure goal. Your goal will be based on your health.
You can help lower your blood pressure by making healthy changes in your lifestyle. If those lifestyle changes don't work well enough, you may also need to take pills. Either way, you will need to control your high blood pressure throughout your life.
Treatment depends on how high your blood pressure is, whether you have other health problems such as diabetes, and whether any organs have already been damaged. Your doctor will also consider how likely you are to develop other diseases, especially heart disease.
Most people take more than one pill for high blood pressure. Work with your doctor to find the right pill or combination of pills that will cause the fewest side effects.
Making lifestyle changes can help you to prevent high blood pressure. You can:
Health Tools help you make wise health decisions or take action to improve your health.
Learning about high blood pressure:
Living with high blood pressure:
Experts know that many things are linked to high blood pressure. But experts still don't fully understand the exact cause. Things that are linked to high blood pressure include:
Primary, or essential, high blood pressure is the most common type of high blood pressure. Most people who have high blood pressure have primary high blood pressure.
Secondary high blood pressure, which is caused by another disease or medicine, is less common.
Elevated blood pressure readings may not always mean that you have high blood pressure. For some people, just being in a medical setting causes their blood pressure to rise. This is called white-coat hypertension.
People who have high blood pressure usually don't have any symptoms. Most people who have high blood pressure feel fine. It's during a routine examination or a doctor visit for another problem that they find out that they have high blood pressure.
Very severe high blood pressure (such as 180 over 110 or higher) may lead to malignant high blood pressure. This is also called hypertensive emergency or hypertensive crisis. Very severe high blood pressure is a medical emergency. Symptoms of very severe high blood pressure include:
Healthy arteries have smooth inner walls. Your blood flows through them without a problem. The blood vessels stay strong and flexible.
But when you have high blood pressure, blood flows through your arteries with too much force, even though you can't feel it. Over time, this pressure damages the walls of your arteries. They aren't smooth anymore. They get rough spots on them where fat and calcium start to build up. This buildup is called plaque (say "plak").
Plaque is part of atherosclerosis, sometimes called "hardening of the arteries." Over time, the plaque narrows the artery and blocks blood flow through it.
Atherosclerosis makes your arteries narrower. It also makes them stiffer. Blood can't flow through them as easily. This lack of good blood flow starts to damage some of the organs in your body.
This damage doesn't happen all at once. It happens slowly over time. But you can't tell that it's happening, because you don't feel anything. It can lead to:
Things that increase your risk (risk factors) for high blood pressure include:
Other possible risk factors include:
Call 911 anytime you think you may need emergency care. This may mean having symptoms that suggest that your blood pressure is causing a serious heart or blood vessel problem. Your blood pressure may be over 180/110.
For example, call 911 if:
Do not wait until your blood pressure comes down on its own. Get help right away.
Call your doctor now or seek immediate care if:
Watch closely for changes in your health, and be sure to contact your doctor if:
Your blood pressure can be checked:
For diagnosis and management of high blood pressure, see:
The main test for high blood pressure is simple, fast, and painless. Your blood pressure may be measured by an automatic device or manually.
With an automatic device:
With the manual method:
If this test shows that your blood pressure is high, your doctor will likely have you come in two more times to be tested or have you wear a device that automatically tests your blood pressure while you are at home or work. This is called ambulatory blood pressure monitoring. If there is some reason you are not able to do ambulatory blood pressure monitoring, your doctor may have you take your blood pressure at home.
Some people only have high blood pressure when they're at the doctor's office. This is called white-coat hypertension. Using ambulatory or home blood pressure testing is a way to see if you actually have high blood pressure.
All adults should have their blood pressure checked regularly.footnote 1
Your doctor can let you know how often you should get your blood pressure checked. It may depend on what your blood pressure is and your risk for heart disease. You can get your blood pressure checked during any routine medical visit.
The automated devices you find in grocery stores or drugstores may not be accurate. Having your blood pressure checked at the doctor's office is best.
A home blood pressure monitor makes it easy to keep track of your blood pressure. It's a good idea to bring your home monitor to the doctor's office to check its accuracy.
Besides taking your blood pressure, your doctor will do a physical examination and medical history. Your doctor may also have you get other tests to find out whether high blood pressure has damaged any organs or caused other problems. These tests may include:
Your doctor may also check your risk of coronary artery disease.
If your doctor recommends a test, ask what it is for and why you need it. You can help decide if a test is right for you. Talk with your doctor to make that decision. For more information, see Heart Tests: When Do You Need Them?
Untreated high blood pressure can lead to heart attacks or strokes. The higher your blood pressure, the greater your risk. Lowering blood pressure lowers the risk of damaging blood vessels and getting atherosclerosis.
High blood pressure usually can't be cured. But it can be controlled. The two types of treatment for high blood pressure are:
Your doctor will give you a blood pressure goal. Your goal will be based on your health. Your blood pressure goal can help you prevent problems caused by high blood pressure.
Your doctor may suggest that you make one or more of the following changes:
For tips on how to do these things, see the Living With High Blood Pressure section of this topic.
One Woman's Story:
"I could never have imagined I could get (my blood pressure) down so low by losing weight. I feel sure it was the WAY I lost weight, with DASH."—Izzy
Read more about Izzy and how she uses the DASH eating plan.
If lifestyle changes don't lower your blood pressure to your goal, you may need to take daily medicines as well.
Medicines control—but usually don't cure—high blood pressure. So you will probably need to take them for the rest of your life. Most people need to take two or more medicines.
Some people find it hard to take their medicines properly. They may feel it's too much trouble—especially when they don't feel sick. Or they're worried about side effects. Some people find it hard to keep track of when and how to take their medicines.
If you have trouble taking high blood pressure medicines for any reason, talk to your doctor.
One Man's Story:
"I learned that it doesn't matter how healthy you feel—if you have high blood pressure, you're sick and you'd better do something about it."—Tyrell
Read more about Tyrell and why he started taking his medicines properly.
A heart-healthy lifestyle can help you prevent high blood pressure. These changes are especially important for people who have risk factors for high blood pressure that cannot be changed, including family history, race, or age.
Here are some things you can do:
For help with all of these, see the Living With High Blood Pressure section of this topic.
Lifestyle changes are important to help control high blood pressure, especially if you have other risk factors for coronary artery disease and stroke.
Even if your doctor has prescribed medicine for you, you can still take many steps at home to lower your blood pressure and reduce your risk. Some people can even take less medicine after making these changes.
Make these lifestyle changes to help lower your blood pressure:
Making any kind of change in the way you live your daily life is like being on a path. The path leads to success. Here are the first steps on that path:
For help making lifestyle changes, see the topic Change a Habit by Setting Goals.
"A big lesson I learned is that everything we do routinely is a habit. And habits can be changed. I'm living proof."—Izzy
Read more about Izzy and how she changed her eating habits.
"As soon as I mentioned [to my wife] that I needed help, she got out a pen and some paper and started writing out a walking schedule."—Arturo
Read more about Arturo and how he got support for his lifestyle changes.
Deciding whether to treat high blood pressure with medicine and choosing the best medicine are based mainly on:
Doctors usually prescribe a single, low-dose medicine first. If blood pressure is not controlled, your doctor may change the dosage or try a different medicine or combination of medicines. It is common to try several medicines before blood pressure is successfully controlled. Many people need more than one medicine to get the best results.
Medicine choices include:
All of these medicines are effective for lowering the risk of heart attack and stroke.
Work with your doctor to find the right medicine or combination of medicines that have the fewest side effects and work well for you. And be sure to take your medicines regularly as prescribed.
You may have regular blood tests to monitor how the medicine is working in your body. Your doctor will likely let you know when you need to have the tests.
"For a few months I was really good about taking (my pills) every day. But they made me a little tired, and I got tired of being tired."—Tyrell
Read more about Tyrell and why he returned to taking his medicine every day.
is treatment that you use in addition to your doctor's standard care. Tell your doctor if you are using, or if you plan to use, complementary medicine to help lower your blood pressure. These treatments do not replace lifestyle changes or medicine for high blood pressure. You and your doctor can decide which therapy might be best for you.
Complementary treatments that help manage stress and improve quality of life may help lower blood pressure. These treatments include:
Most mind and body practices—such as acupuncture, meditation, and yoga—are safe when used under the care of a well-trained professional. Choose an instructor or practitioner as carefully as you would choose a doctor.
There are some natural health products that you may hear about to lower the risk of heart disease, heart attack, and stroke. It is not clear if some vitamins, minerals, and multivitamins can lower risk. But it is clear that some natural health products, such as vitamin E and beta-carotene, do not lower risk.footnote 2
Talk with your doctor about the best ways to lower your risk of heart disease, heart attack, and stroke. Tell your doctor if you plan to use natural health products. Your doctor can make sure they are safe for you.
Leung AA, et al. (2017). Hypertension Canada's 2017 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults. Canadian Journal of Cardiology, 33(5): 557–576. DOI: 10.1016/j.cjca.2017.03.005. Accessed December 28, 2017.
U.S. Preventive Services Task Force (2014). Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsvita.htm. Accessed March 28, 2014.
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Cheriyan J, et al. (2010). Primary prevention of CVD: treating hypertension, search date December 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Diao D, et al. (2012). Pharmacotherapy for mild hypertension. Cochrane Database of Systematic Reviews (8).
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (2011). Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics, 128(Suppl 5): S213–S256.
Falkner B, Daniels SR (2004). Summary of the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Hypertension, 44(4): 387–388.
Henri HC, Rudd P (2007). Hypertension: Context and management. In EJ Topol, ed., Textbook of Cardiovascular Medicine, 3rd ed., pp. 88–108. Philadelphia: Lippincott Williams and Wilkins.
National Heart, Lung, and Blood Institute (2006). Your Guide to Lowering Your Blood Pressure With DASH (NIH Publication No. 06-4082). Available online: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf.
Pickering TG, et al. (2008). Call to action on use and reimbursement for home blood pressure monitoring. A joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension, 52(1): 10–29.
ByHealthwise StaffPrimary Medical ReviewerE. Gregory Thompson, MD - Internal MedicineBrian D. O'Brien, MD - Internal MedicineAdam Husney, MD - Family MedicineKathleen Romito, MD - Family MedicineMartin J. Gabica, MD - Family MedicineSpecialist Medical ReviewerRobert A. Kloner, MD, PhD - Cardiology
Current as ofJanuary 16, 2018
Current as of: January 16, 2018
E. Gregory Thompson, MD - Internal Medicine
& Brian D. O'Brien, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine & Robert A. Kloner, MD, PhD - Cardiology
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