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Hypertension

(High Blood Pressure)

Key points

High blood pressure (hypertension) is consistently at or above 130/80 mm Hg.

High blood pressure typically has no signs or symptoms but can cause problems for your heart, brain, kidneys, and eyes.

No matter your age, you can take steps each day to keep your blood pressure in a healthy range.

Some people may be able to control their blood pressure by making lifestyle changes or taking blood pressure medicines.

Definition of high blood pressure

High blood pressure, also known as hypertension, happens when it takes too much force to push your blood through your arteries, making your heart work too hard. More than 1.2 billion adults worldwide have high blood pressure and almost half don't know they have the condition.

High blood pressure raises your chances of having heart attacks and strokes. It’s important to know your numbers, because if you have high blood pressure, you’ll want to bring those numbers down. You can take your blood pressure at home with a blood pressure cuff, or get it taken at your doctor's office. Blood pressure is measured in millimeters of mercury (mm Hg).

The American Heart Association ranks high blood pressure in four categories:

Normal: Lower than 120/80 mm Hg

Elevated: The top number (systolic – how much force is put on your blood vessels when your heart beats) is 120-129 mm Hg and the bottom number (diastolic – the force on blood vessels between beats) is less than 80 mm Hg

Stage 1 hypertension: The top number is 130-139 mm Hg and the bottom number is 80-89 mm Hg.

Stage 2 hypertension: The top number is 140-179 mm Hg and the bottom number is 90-119 mm Hg.

If you blood pressure is ever greater than 180/120 mm Hg, it is considered a medical emergency, and you should get care right away.

Learn about how you can prevent and treat high blood pressure during pregnancy, which can put you and your baby at risk for health problems.

When the heart pumps blood through the arteries, the blood puts pressure on the artery walls. This is called blood pressure.

High blood pressure is very common. It affects 47% of adults in the U.S. This equals about 116 million people. Of those, 37 million have a blood pressure of at least 140/90 mmHg.

High blood pressure caused or contributed to over 670,000 deaths in the U.S. in 2020.

The World Health Organization estimates that globally, over 1.2 billion people ages 30 to 79 have hypertension. About 2 in 3 of those individuals live in low- or middle-income countries.

What are the types of high blood pressure?

Your provider will diagnose you with one of two types of high blood pressure:

Primary hypertension. Causes of this more common type of high blood pressure (about 90% of all adult cases in the U.S.) include aging and lifestyle factors like not getting enough exercise.

Secondary hypertension. Causes of this type of high blood pressure include different medical conditions or a medication you’re taking.

Primary and secondary high blood pressure (hypertension) can co-exist. For example, a new secondary cause can make blood pressure that’s already high get even higher.

You might also hear about high blood pressure that comes or goes in certain situations. These hypertension types are:

White coat hypertension: Your BP is normal at home but elevated in a healthcare setting.

Masked hypertension: Your BP is normal in a healthcare setting but elevated at home.

Sustained hypertension: Your BP is elevated in healthcare settings and at home.

Nocturnal hypertension: Your BP goes up when you sleep.

Risk factors

High blood pressure has many risk factors, including:

Age. The risk of high blood pressure increases with age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.

Race. High blood pressure is particularly common among Black people. It develops at an earlier age in Black people than it does in white people.

Family history. You're more likely to develop high blood pressure if you have a parent or sibling with the condition.

Obesity or being overweight. Excess weight causes changes in the blood vessels, the kidneys and other parts of the body. These changes often increase blood pressure. Being overweight or having obesity also raises the risk of heart disease and its risk factors, such as high cholesterol.

Lack of exercise. Not exercising can cause weight gain. Increased weight raises the risk of high blood pressure. People who are inactive also tend to have higher heart rates.

Tobacco use or vaping. Smoking, chewing tobacco or vaping immediately raises blood pressure for a short while. Tobacco smoking injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your care provider for strategies to help you quit.

Too much salt. A lot of salt — also called sodium — in the body can cause the body to retain fluid. This increases blood pressure.

Low potassium levels. Potassium helps balance the amount of salt in the body's cells. A proper balance of potassium is important for good heart health. Low potassium levels may be due to a lack of potassium in the diet or certain health conditions, including dehydration.

Drinking too much alcohol. Alcohol use has been linked with increased blood pressure, particularly in men.

Stress. High levels of stress can lead to a temporary increase in blood pressure. Stress-related habits such as eating more, using tobacco or drinking alcohol can lead to further increases in blood pressure.

Certain chronic conditions. Kidney disease, diabetes and sleep apnea are some of the conditions that can lead to high blood pressure.

Pregnancy. Sometimes pregnancy causes high blood pressure.

High blood pressure is most common in adults. But kids can have high blood pressure too. High blood pressure in children may be caused by problems with the kidneys or heart. But for a growing number of kids, high blood pressure is due to lifestyle habits such as an unhealthy diet and lack of exercise.

Complications

The excessive pressure on the artery walls caused by high blood pressure can damage blood vessels and body organs. The higher the blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to complications including:

Heart attack or stroke. Hardening and thickening of the arteries due to high blood pressure or other factors can lead to a heart attack, stroke or other complications.

Aneurysm. Increased blood pressure can cause a blood vessel to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.

Heart failure. When you have high blood pressure, the heart has to work harder to pump blood. The strain causes the walls of the heart's pumping chamber to thicken. This condition is called left ventricular hypertrophy. Eventually, the heart can't pump enough blood to meet the body's needs, causing heart failure.

Kidney problems. High blood pressure can cause the blood vessels in the kidneys to become narrow or weak. This can lead to kidney damage.

Eye problems. Increased blood pressure can cause thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.

Metabolic syndrome. This syndrome is a group of disorders of the body's metabolism. It involves the irregular breakdown of sugar, also called glucose. The syndrome includes increased waist size, high triglycerides, decreased high-density lipoprotein (HDL or "good") cholesterol, high blood pressure and high blood sugar levels. These conditions make you more likely to develop diabetes, heart disease and stroke.

Changes with memory or understanding. Uncontrolled high blood pressure may affect the ability to think, remember and learn.

Dementia. Narrowed or blocked arteries can limit blood flow to the brain. This can cause a certain type of dementia called vascular dementia. A stroke that interrupts blood flow to the brain also can cause vascular dementia.

High blood pressure dangers

Hypertension's effects on your body

High blood pressure is a risk factor for more than heart disease. Learn what other health conditions high blood pressure can cause.

High blood pressure, also called hypertension, can quietly damage the body for years before symptoms appear. Without treatment, high blood pressure can lead to disability, a poor quality of life, or even a deadly heart attack or stroke.

Blood pressure is measured in millimeters of mercury (mm Hg). In general, hypertension is a blood pressure reading of 130/80 mm Hg or higher.

Treatment and lifestyle changes can help control high blood pressure to lower the risk of life-threatening health conditions.

Damage to the arteries

Healthy arteries are flexible, strong and elastic. Their inner lining is smooth so that blood flows freely, supplying vital organs and tissues with nutrients and oxygen.

Over time, high blood pressure increases the pressure of blood flowing through the arteries. This may cause:

Damaged and narrowed arteries. High blood pressure can damage the cells of the arteries' inner lining. When fats from food enter the bloodstream, they can collect in the damaged arteries. In time, the artery walls become less elastic. This limits blood flow throughout the body.

Aneurysm. Over time, the constant pressure of blood moving through a weakened artery can cause part of the artery wall to bulge. This is called an aneurysm. An aneurysm can burst open and cause life-threatening bleeding inside the body. Aneurysms can form in any artery. But they're most common in the body's largest artery, called the aorta.

Damage to the heart

High blood pressure can cause many heart conditions, including:

Coronary artery disease. High blood pressure can narrow and damage the arteries that supply blood to the heart. This damage is known as coronary artery disease. Too little blood flow to the heart can lead to chest pain, called angina. It can lead to irregular heart rhythms, called arrhythmias. Or it can lead to a heart attack.

Heart failure. High blood pressure strains the heart. Over time, this can cause the heart muscle to weaken or become stiff and not work as well as it should. The overwhelmed heart slowly starts to fail.

Enlarged left heart. High blood pressure forces the heart to work harder to pump blood to the rest of the body. This causes the lower left heart chamber, called the left ventricle, to thicken and to enlarge. A thickened and enlarged left ventricle raises the risk of heart attack and heart failure. It also increases the risk of death when the heart suddenly stops beating, called sudden cardiac death.

Metabolic syndrome. High blood pressure raises the risk of metabolic syndrome. This syndrome is a cluster of health conditions that can lead to can lead to heart disease, stroke and diabetes. The health conditions that make up metabolic syndrome are high blood pressure, high blood sugar, high levels of blood fats called triglycerides, low levels of HDL cholesterol, which is the "good" cholesterol, and too much body fat around the waist.

Damage to the brain

The brain depends on a nourishing blood supply to work right. High blood pressure may affect the brain in the following ways:

Transient ischemic attack (TIA). Sometimes this is called a ministroke. A TIA happens when the blood supply to part of the brain is blocked for a short time. Hardened arteries or blood clots caused by high blood pressure can cause TIAs. A TIA is often a warning sign of a full-blown stroke.

Stroke. A stroke happens when part of the brain doesn't get enough oxygen and nutrients. Or it can happen when there is bleeding inside or around the brain. These problems cause brain cells to die. Blood vessels damaged by high blood pressure can narrow, break or leak. High blood pressure also can cause blood clots to form in the arteries leading to the brain. The clots can block blood flow, raising the risk of a stroke.

Dementia. Narrowed or blocked arteries can limit blood flow to the brain. This could lead to a certain type of dementia, called vascular dementia. A single stroke or multiple tiny strokes that interrupt blood flow to the brain also can cause vascular dementia.

Mild cognitive impairment. This condition involves having slightly more troubles with memory, language or thinking than other adults your age have. But the changes aren't major enough to impact your daily life, as with dementia. High blood pressure may lead to mild cognitive impairment.

Damage to the kidneys

Kidneys filter extra fluid and waste from the blood — a process that requires healthy blood vessels. High blood pressure can damage the blood vessels in and leading to the kidneys. Having diabetes along with high blood pressure can worsen the damage.

Damaged blood vessels prevent the kidneys from being effective at filtering waste from the blood. This allows dangerous levels of fluid and waste to collect. When the kidneys don't work well enough on their own, it's a serious condition called kidney failure. Treatment may include dialysis or a kidney transplant. High blood pressure is one of the most common causes of kidney failure.

Damage to the eyes

High blood pressure can damage the tiny, delicate blood vessels that supply blood to the eyes, causing:

Damage to the blood vessels in the retina, also called retinopathy. The retina is a layer of light-sensing cells at the back of the eye. Damage to the blood vessels in the retina can lead to bleeding in the eye, blurred vision and complete loss of vision. Having diabetes along with high blood pressure raises the risk of retinopathy.

Fluid buildup under the retina, also called choroidopathy. This condition can result in distorted vision or sometimes scarring that makes vision worse.

Nerve damage, also called optic neuropathy. Blocked blood flow can damage the nerve that sends light signals to the brain, called the optic nerve. The damage can lead to bleeding within the eye or vision loss.

Sexual conditions

Trouble getting and keeping an erection is called erectile dysfunction. It becomes more and more common after age 50. But people with high blood pressure are even more likely to have erectile dysfunction. That's because limited blood flow caused by high blood pressure can block blood from flowing to the penis.

High blood pressure can reduce blood flow to the vagina. Reduced blood flow to the vagina can lead to less sexual desire or arousal, vaginal dryness, or trouble having orgasms.

High blood pressure emergencies

High blood pressure usually is an ongoing condition that slowly causes damage over years. But sometimes blood pressure rises so quickly and seriously that it becomes a medical emergency. When this happens, treatment is needed right away, often with hospital care.

In these situations, high blood pressure can cause:

Blindness.

Chest pain.

Complications in pregnancy, such as the blood pressure-related conditions preeclampsia or eclampsia.

Heart attack.

Memory loss, personality changes, trouble concentrating, irritable mood or gradual loss of consciousness.

Serious damage to the body's main artery, also called aortic dissection.

Stroke.

Sudden impaired pumping of the heart, leading to fluid backup in the lungs that results in shortness of breath, also called pulmonary edema.

Sudden loss of kidney function.

Management and Treatment

What are the treatments for high blood pressure?

High blood pressure treatments include lifestyle changes and medications. Healthcare providers recommend treatment based on your blood pressure readings, the causes of your high blood pressure and your underlying conditions.

Lifestyle changes to lower your blood pressure

You may be wondering if you can lower your blood pressure naturally. Yes, in some cases, it’s possible to lower your blood pressure without medication. For example, your provider may recommend starting with lifestyle changes if you have elevated blood pressure or stage 1 hypertension.

Here are some proven ways to lower your blood pressure naturally:

Keep a weight that’s healthy for you. Your healthcare provider can give you a target range.

Eat a healthy diet. An example is the DASH diet. This is a way of eating that’s full of fruits, vegetables, whole grains and low-fat dairy.

Cut down on salt. Ideally, limit your sodium intake to no more than 1,500 milligrams (mg) per day. If this is too difficult at first, you can start by reducing your daily intake by at least 1,000 milligrams.

Get enough potassium. Try to consume 3,500 to 5,000 milligrams per day, ideally through the foods you eat rather than supplements. Some foods high in potassium include bananas, avocados and potatoes (with skin).

Exercise. Ask your healthcare provider for tips to get started. In general, start slow and work your way up to 150 minutes of aerobic exercise per week. Resistance training (like lifting light weights) is also helpful.

Limit alcohol. If you choose to drink beverages containing alcohol, do so in moderation.

Sometimes, providers recommend lifestyle changes along with medications to lower your blood pressure.

Medications to lower your blood pressure

Four classes of blood pressure medications are “first-line” (most effective and commonly prescribed) when starting treatment:

Angiotensin-converting enzyme (ACE) inhibitors block the production of the angiotensin II hormone, which the body naturally uses to manage blood pressure. When the medicine blocks angiotensin II, your blood vessels don’t narrow.

Angiotensin II receptor blockers (ARBs) block this same 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 prevent calcium from entering the muscle cells of your heart and blood vessels, allowing these vessels to relax.

Diuretics (water or fluid pills) flush excess sodium from your body, reducing the amount of fluid in your blood. People often take diuretics with other high blood pressure medicines, sometimes in one combined pill.

Your provider may couple other medications with these first-line drugs to better manage your blood pressure.

Talk to your provider about possible side effects. If you get side effects that concern you, call your provider. They may change your dose or try a different medication. Don’t stop taking the medicine on your own.

You should avoid some medications during pregnancy. So, be sure to tell your provider if you’re pregnant or could become pregnant.

Prevention

Can I prevent high blood pressure?

No matter your age, you can take steps each day to keep your blood pressure in a healthy range.

Fortunately, there are things you can do to reduce your risk of developing high blood pressure. These include:

Follow a healthy eating plan. This is an important step in keeping your blood pressure normal. The DASH diet (Dietary Approaches to Stop Hypertension) emphasizes adding fruits, vegetables and whole grains to your diet.

Cut down on sodium. To prevent hypertension, you should reduce the amount of sodium in your diet. Try to keep it below 1,500 milligrams a day.

Keep a healthy weight. Going hand-in-hand with a proper diet is keeping a weight that’s healthy for you. Losing excess weight with diet and exercise will help lower your blood pressure to healthier levels.

Keep active. Even simple physical activities, such as walking, can lower your blood pressure (and your weight).

Drink alcohol in moderation. Having more than one drink a day (for women) or more than two drinks a day (for men) can raise blood pressure. One drink is defined as 1 ounce (oz) of alcohol, 5 ounces of wine or 12 ounces of beer.

By taking action to lower your blood pressure, you can help protect yourself against heart disease and stroke, also called cardiovascular disease (CVD).

Living With Hypertension

Should I check my blood pressure at home?

Your provider may recommend you check your blood pressure regularly with a home blood pressure monitor. These are automated electronic monitors you can purchase at most pharmacies or online. For some people, 24-hour ambulatory blood pressure monitoring is necessary.

Purchase a blood pressure monitor for yourself here at iHealth Labs Inc

Print a copy of the Blood Pressure Log for your use

When should I see my healthcare provider?

See your provider for yearly checkups. They’ll monitor your blood pressure and recommend treatment, if needed, to help you stay healthy.

When should I go to the ER?

Call 911 or your local emergency number if you have sudden symptoms of a hypertensive crisis. These include:

Shortness of breath.

Headache.

Chest pain.

Blurry vision.

Heart palpitations.

Anxiety.

Dizziness.

Nosebleed.

Vomiting.

What questions should I ask my doctor?

Questions that can help you learn more about your risk for high blood pressure or ways to manage existing high blood pressure include:

What’s my average blood pressure reading?

What’s an ideal blood pressure reading for me?

Should I use a home blood pressure monitor?

What lifestyle changes should I make?

What kinds of exercise should I do?

Do I need medications? If so, which ones and what are the side effects?

Can I keep taking these medications if I get pregnant?

Are there supplements or nonprescription medications I shouldn’t take?

High Blood Pressure Facts

What to know

Blood pressure is the pressure of blood pushing against the walls of your arteries.

Arteries carry blood from your heart to other parts of your body.

High blood pressure in the United States

Blood pressure is the pressure that occurs when blood pushes against the walls of your arteries. Learn more about the definition of blood pressure.

Having high blood pressure puts you at risk for heart disease and stroke, which are leading causes of death in the United States.

In 2022, high blood pressure was a primary or contributing cause of 685,875 deaths in the United States.

About 1 in 5 deaths related to COVID-19 were people who had a history of hypertensive disease.

Nearly half of adults have high blood pressure (48.1%, 119.9 million). This is defined as a systolic blood pressure greater than 130 mm Hg or a diastolic blood pressure greater than 80 mm Hg or are taking medication for high blood pressure.

About 1 in 4 adults with high blood pressure has their blood pressure under control (22.5%, 27.0 million).

About half of adults (45%) with uncontrolled high blood pressure have a blood pressure of 140/90 mmHg or higher. This includes 37 million U.S. adults.

About 34 million adults who should be taking medication according to hypertension guidelines may need a prescription or to fill their prescription and start taking it. Almost two out of three of this group (19 million) have a blood pressure of 140/90 mm Hg or higher.

High blood pressure costs the United States about $131 billion each year, averaged over 12 years from 2003 to 2014.

Blood pressure differences by sex and race

Uncontrolled high blood pressure is common, but some groups of people are more likely to have control over their high blood pressure than others.

A higher percentage of men (50%) have high blood pressure than women (44%).

High blood pressure is more common in non-Hispanic black adults (56%) than in non-Hispanic white adults (48%), non-Hispanic Asian adults (46%), or Hispanic adults (39%).

Among those recommended to take blood pressure medication, blood pressure control is higher among non-Hispanic white adults (32%) than in non-Hispanic black adults (25%), non-Hispanic Asian adults (19%), or Hispanic adults (25%).

Geographic rates of high blood pressure

Hypertension prevalence in adults aged 18 and older in the US by county, 2018-2020

The highest high blood pressure (hypertension) prevalence in 2021 for adults ages 18 and older are located primarily in Alabama, Arkansas, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, West Virginia, and Virginia. Pockets of high-rate counties also were found in Alaska, Maryland, Missouri, Ohio, North Dakota, and South Dakota. Insufficient data were provided from Florida and U.S. Territories.

High blood pressure is more common in some areas of the United States. Most statistics are underreported because about 1 in 5 adults with high blood pressure is unaware of it and would not report having it.

FAQs About Lowering Blood Pressure Quickly

How can I lower my blood pressure quickly? Lifestyle changes and medications can lower blood pressure, but it may take a month or so before you see major changes.

Can I reduce blood pressure from 140 mm Hg to 120 mm Hg? Yes. You can drop your blood pressure by as much as 20 points by losing 20 pounds. Lowering your sodium to 1,500 milligrams daily and following the DASH diet (ask your doctor if it is right for you) may also lower your numbers by 20 points.

Can supplements or foods lower blood pressure?
Research supports the DASH diet as a way to lower blood pressure naturally. Increasing potassium and reducing sodium through your food choices are specific strategies.

You may read about many other dietary methods for lowering your blood pressure. These methods don’t have the same level or quality of evidence to support their effectiveness. They include:

Probiotics.

Higher intake of protein, flaxseed, fish oil or fiber.

Garlic.

Dark chocolate.

Tea or coffee.

Calcium or magnesium supplements.

Low-carb, vegetarian or Mediterranean diets.

Be a cautious consumer, and talk with your healthcare provider to learn more.

Takeaways

Having high blood pressure, or hypertension, increases your risk of having a heart attack or stroke. But you can reduce your blood pressure by getting regular exercise and eating a diet full of fruits and vegetables, whole grains, and lean proteins. If your blood pressure is consistently high, talk to your doctor. They may recommend medications to keep it in check. High blood pressure is a serious but silent condition that can sneak up on you over the years. Seeing a healthcare provider for regular checkups can help you learn your numbers. If you don’t have access to care, learn about available community resources (such as wellness fairs) where blood pressure checks are available. Knowing your blood pressure levels is the first step toward making lifestyle changes that can help keep your arteries healthy.

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