High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.
Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.
You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.
High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.
A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren't specific and usually don't occur until high blood pressure has reached a severe or life-threatening stage.
When to see a doctor
You'll likely have your blood pressure taken as part of a routine doctor's appointment.
Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you're age 40 or older, or you're 18 to 39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year.
Blood pressure generally should be checked in both arms to determine if there's a difference. It's important to use an appropriate-sized arm cuff.
Your doctor will likely recommend more frequent readings if you've already been diagnosed with high blood pressure or have other risk factors for cardiovascular disease. Children age 3 and older will usually have blood pressure measured as a part of their yearly checkups.
If you don't regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free.
Public blood pressure machines, such as those found in pharmacies, may provide helpful information about your blood pressure, but they may have some limitations. The accuracy of these machines depends on several factors, such as a correct cuff size and proper use of the machines. Ask your doctor for advice on using public blood pressure machines.
There are two types of high blood pressure.
Primary (essential) hypertension
For most adults, there's no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.
Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:
High blood pressure has many risk factors, including:
Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.
Sometimes pregnancy contributes to high blood pressure, as well.
Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.
The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.
Uncontrolled high blood pressure can lead to complications including:
To measure your blood pressure, your doctor or a specialist will usually place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge.
A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).
Blood pressure measurements fall into four general categories:
Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is even more significant. Isolated systolic hypertension is a condition in which the diastolic pressure is normal (less than 80 mm Hg) but systolic pressure is high (greater than or equal to 130 mm Hg). This is a common type of high blood pressure among people older than 65.
Your doctor will likely take two to three blood pressure readings each at three or more separate appointments before diagnosing you with high blood pressure. This is because blood pressure normally varies throughout the day, and it may be elevated during visits to the doctor (white coat hypertension).
Your blood pressure generally should be measured in both arms to determine if there is a difference. It's important to use an appropriate-sized arm cuff.
Your doctor may ask you to record your blood pressure at home to provide additional information and confirm if you have high blood pressure.
Your doctor may recommend a 24-hour blood pressure monitoring test called ambulatory blood pressure monitoring to confirm if you have high blood pressure. The device used for this test measures your blood pressure at regular intervals over a 24-hour period and provides a more accurate picture of blood pressure changes over an average day and night. However, these devices aren't available in all medical centers, and they may not be reimbursed.
If you have any type of high blood pressure, your doctor will review your medical history and conduct a physical examination.
Your doctor may also recommend routine tests, such as a urine test (urinalysis), blood tests, a cholesterol test and an electrocardiogram — a test that measures your heart's electrical activity. Your doctor may also recommend additional tests, such as an echocardiogram, to check for more signs of heart disease.
Taking your blood pressure at home
An important way to check if your blood pressure treatment is working, to confirm if you have high blood pressure, or to diagnose worsening high blood pressure, is to monitor your blood pressure at home.
Home blood pressure monitors are widely available and inexpensive, and you don't need a prescription to buy one. Home blood pressure monitoring isn't a substitute for visits to your doctor, and home blood pressure monitors may have some limitations.
Make sure to use a validated device, and check that the cuff fits. Bring the monitor with you to your doctor's office to check its accuracy once a year. Talk to your doctor about how to get started with checking your blood pressure at home.
Devices that measure your blood pressure at your wrist or finger aren't recommended by the American Heart Association.
Changing your lifestyle can go a long way toward controlling high blood pressure. Your doctor may recommend you make lifestyle changes including:
But sometimes lifestyle changes aren't enough. In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure.
Your blood pressure treatment goal depends on how healthy you are.
Your blood pressure treatment goal should be less than 130/80 mm Hg if:
Although 120/80 mm Hg or lower is the ideal blood pressure goal, doctors are unsure if you need treatment (medications) to reach that level.
If you're age 65 or older, and use of medications produces lower systolic blood pressure (such as less than 130 mm Hg), your medications won't need to be changed unless they cause negative effects to your health or quality of life.
The category of medication your doctor prescribes depends on your blood pressure measurements and your other medical problems. It's helpful if you work together with a team of medical professionals experienced in providing treatment for high blood pressure to develop an individualized treatment plan.
Medications to treat high blood pressure
Your doctor or hypertension specialist may:
If you don't take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you can't afford the medications, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions. Don't change your treatment without your doctor's guidance.
Lifestyle and home remedies
Lifestyle changes can help you control and prevent high blood pressure, even if you're taking blood pressure medication. Here's what you can do:
Although diet and exercise are the most appropriate tactics to lower your blood pressure, some supplements also may help lower it. However, more research is needed to determine the potential benefits. These include:
You can also practice relaxation techniques, such as deep breathing or meditation, to help you relax and reduce your stress level. These practices may temporarily reduce your blood pressure.
Coping and support
High blood pressure isn't a problem that you can treat and then ignore. It's a condition you need to manage for the rest of your life. To keep your blood pressure under control:
Sticking to lifestyle changes can be difficult, especially if you don't see or feel any symptoms of high blood pressure. If you need motivation, remember the risks associated with uncontrolled high blood pressure. It may help to enlist the support of your family and friends as well.
Preparing for your appointment
If you think you may have high blood pressure, make an appointment with your family doctor to have your blood pressure checked.
No special preparations are necessary to have your blood pressure checked. You might want to wear a short-sleeved shirt to your appointment so that the blood pressure cuff can fit around your arm properly. Avoid eating, drinking caffeinated beverages and smoking right before your test. Plan to use the toilet before having your blood pressure measured.
Because some medications, such as over-the-counter cold medicines, pain medications, antidepressants, birth control pills and others, can raise your blood pressure, it might be a good idea to bring a list of medications and supplements you take to your doctor's appointment. Don't stop taking any prescription medications that you think may affect your blood pressure without your doctor's advice.
Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Write down any symptoms you're experiencing. High blood pressure seldom has symptoms, but it's a risk factor for heart disease. Letting your doctor know if you have symptoms like chest pains or shortness of breath can help your doctor decide how aggressively your high blood pressure needs to be treated.
Write down key personal information, including a family history of high blood pressure, high cholesterol, heart disease, stroke, kidney disease or diabetes, and any major stresses or recent life changes.
Make a list of all medications, vitamins or supplements that you're taking.
Take a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Be prepared to discuss your diet and exercise habits. If you don't already follow a diet or exercise routine, be ready to talk to your doctor about any challenges you might face in getting started.
Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For high blood pressure, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
What you can do in the meantime
It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against high blood pressure and its complications, including heart attack and stroke.