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High Blood Pressure (Hypertension)

 

What is high blood pressure?

Blood pressure is the force (pressure) of your blood against the walls of your arteries. Blood pressure is measured with 2 numbers:

  • The top number (systolic pressure) is the pressure measured while your heart pumps blood to your body.

  • The bottom number (diastolic pressure) is the pressure measured while your heart rests between beats.

A normal blood pressure number is less than 120/80 mm Hg (millimeters of mercury). If your number is usually 140/90 or higher, you have high blood pressure.

Hypertension is the medical word for high blood pressure. It doesn't mean you're a tense person. It only means your blood pressure is high.

Quick facts

  • Blood pressure is the force of blood in your arteries. Your blood pressure is high if it is 140/90 mm Hg or higher. If you have diabetes or chronic kidney disease, 130/80 mm Hg or higher is considered high blood pressure.

  • Your blood pressure changes all the time, depending on what you're doing. It must be measured several times before you can know for sure that it's high.

  • High blood pressure is called the "silent killer" because there are no symptoms you can feel. The only way to know your blood pressure is high is to measure it.

  • High blood pressure is dangerous because it makes your heart work too hard and damages your arteries. It can also damage your brain, heart, kidneys and other organs. It can lead to stroke, angina, heart attack, peripheral artery disease (PAD) and kidney failure.

  • If you are inactive or overweight, exercising and losing weight can help lower your blood pressure to a normal level. If you develop healthier habits but still have high blood pressure, you may need medicines.

 

What is the connection between high blood pressure and heart problems?

High blood pressure damages the walls of your arteries. This leads to:

  • Fatty deposits (plaque) in the inner lining of your arteries

  • Bulges (aneurysms) in your arteries resulting from weak spots in the artery wall

High blood pressure makes the main pumping chamber of your heart (the left ventricle) work harder. Eventually, the left ventricle grows thicker and doesn't pump properly. This is called heart failure. Symptoms of heart failure include shortness of breath, fatigue, and swelling in the legs and feet.

Without treatment, high blood pressure can also damage your kidneys, brain, and eyes, and can lead to other serious health problems.

 

High blood pressure can damage your heart, brain, eyes, kidneys and other parts of your body.
High blood pressure can damage your heart, brain, eyes, kidneys, and other parts of your body.

 

What causes high blood pressure?

High blood pressure is very common, especially as people get older. But this is not a part of healthy aging. About 1 in 3 American adults has high blood pressure. In more than 90 percent of cases, doctors don't know a specific cause. If you have certain traits known as risk factors, you're more likely to develop high blood pressure. You can control some of these risk factors. Others you can't.

Risk factors you can't control:

  • In general, the older you get, the greater your chance of developing high blood pressure. It occurs most often in people over age 35. Men seem to develop it most often between age 35 and 55. Women are more likely to develop it after menopause. Having parents, brothers, or sisters who have high blood pressure.

  • Being African American. High blood pressure occurs at a younger age and is usually more severe in African Americans than in whites.

Risk factors you can control:

  • Being overweight

  • Eating too much salt

  • Drinking more than 2 alcoholic drinks a day if you're a man or more than 1 if you're a woman

  • Lack of physical activity (less than 30 minutes of moderate physical activity 5 days a week)

  • Stress — This is often mentioned as a risk factor, but stress levels are hard to measure, and responses to stress vary from person to person.

 

What does high blood pressure feel like?

You may have high blood pressure for years and never feel it. There are no signs or symptoms. But blood pressure is easy to check. Doctors and nurses use a blood pressure cuff and a stethoscope to measure it.

"I was so surprised when my doctor said my blood pressure was high. I didn't feel sick at all. I started taking my blood pressure at home and it was always around 150/90."  Frances, age 55

 

How do I know if I have high blood pressure?

Your blood pressure varies during the day, so your doctor or nurse may check it several times on different days. Some people tend to have high blood pressure only when they visit the doctor. That's why your doctor may ask you to measure your blood pressure at home, or wear a device that automatically measures it over 24 hours.

Before measuring blood pressure, sit for 2 to 5 minutes. Be sure to use the best cuff size for you (normal or large).

Doctors use national guidelines to help judge whether you have high blood pressure. These guidelines are based on extensive research showing that people with lower blood pressure have better health.

  • A blood pressure reading below 120/80 mm Hg is normal.

  • A reading between 120 and 139 systolic (the top number) and between 80 and 89 diastolic (the bottom number) means you have prehypertension. This means you have a greater chance of developing high blood pressure and the problems it causes.

  • A reading of 140/90 mm Hg or higher is high blood pressure. If you have diabetes or chronic kidney disease, 130/80 mm Hg or higher is considered high.

  • If only one of the numbers is high, you still have high blood pressure. The majority of people older than 60 who have high blood pressure have isolated systolic high blood pressure where only the top number of their blood pressure is high. This condition is just as harmful as when both numbers are high.

  • Your tendency for high blood pressure doesn't go away. If you take medicine to lower your blood pressure, don't stop. Your blood pressure will rise again if you don't continue to take your medicine.

 

How is high blood pressure treated?

Healthy habits help you control high blood pressure.

  • Eat healthy foods, including fruits, vegetables, and low-fat dairy products.

  • Cut back on salt.

  • Lose weight if you are overweight and stay at a healthy weight.

  • Engage in moderate physical activity for at least 30 minutes five days a week.

  • If you drink alcohol, have only 1 drink a day if you're a woman, 2 if you're a man.

Most people with high blood pressure need medicines to control it. Doctors use several types, alone or in combination, to lower blood pressure.

  • Diuretics help remove excess water and salt.

  • Beta blockers cause your heart to beat more slowly and with less force.

  • Calcium channel blockers (CCBs), angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBS) help relax the small arteries that regulate blood pressure.

"My blood pressure was lower after I lost weight, but I still needed medicine to get the systolic pressure down to normal. I want to keep my weight down so I don't need more medicine. It all works together."   Ron, age 58

Some medications taken for other conditions can raise blood pressure and/or interfere with the effectiveness of drugs used against high blood pressure. These include such drugs as steroids, nonsteroidal anti-inflammatory drugs (NSAIDs), nasal decongestants and other cold remedies, diet pills, cyclosporine, erythropoetin, tricyclic antidepressants, and monoamine oxidase inhibitors. Be sure to tell your doctor all of the prescribed and over-the-counter medicines you're taking.

 

What can I do to help myself?

Key steps to help you lower your blood pressure include:

  • Know your blood pressure numbers. Work with your doctor to reach a goal blood pressure of less than 120/80 mm Hg.

  • If you're overweight, set your initial goal at a loss of 5 to 10 pounds. If you need to lose more, a weight loss of 1 to 2 pounds per week is recommended until you reach a healthy weight.

  • Reduce the amount of sodium (salt) you eat. Limit sodium to 2,300 a day or less. Be sure to read food labels so you can avoid high salt foods. And don't add salt to your food.

  • Be physically active. Walk, ride a bicycle, or do other types of moderate physical activity for at least 30 minutes, 5 days a week.

  • If you smoke, quit. Smoking is another major risk factor for heart attack and stroke.

  • If you drink alcohol, have only 1 drink a day if you're a woman, 2 if you're a man.

It is also important for you to:

  • Lower your blood cholesterol levels by eating healthy foods (high in fiber and low in saturated fat, trans fat, and cholesterol) and taking your cholesterol medicine. Keep your LDL (bad cholesterol) below 100 mg/dL. People who are at very high risk for developing future heart problems may benefit from lowering LDL below 70 mg/dL.

  • If you have diabetes, work with your doctor to keep your blood sugar under control and reach and maintain an HbA1c of less than 7 percent. HbA1c (hemoglobin A1c) is a blood test that measures your average blood sugar level for the previous 2 to 3 months.

 

How can I learn more about high blood pressure?

Talk with your doctor. Here are some good questions to ask:

  • What is my blood pressure?

  • How can I lower my blood pressure?

  • Do I need medicine to lower my blood pressure?

  • How long do I need to take the medicine?

  • Is there a cure for high blood pressure?

  • How does high blood pressure affect my health?

 

How can I learn about related topics?

Related topics include:

 

Online Medical Reviewer: Ron White, PhD
Date Last Reviewed: 6/12/2008
© American Heart Association 2007. All rights reserved.
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