What Is High Blood Pressure??

High blood pressure (HBP) is a serious condition that can lead to coronary heart disease (also called coronary artery disease), heart failure, stroke,
kidney failure, and other health problems.

"Blood pressure" is the force of blood pushing against the walls of the arteries as the heart pumps blood. If this pressure rises and stays high over time, it can damage the body in many ways.

Overview

About 1 in 3 adults in the United States has HBP. The condition itself usually has no symptoms. You can have it for years without knowing it. During this time, though, HBP can damage the heart, blood vessels, kidneys, and other parts of your body.

Knowing your blood pressure numbers is important, even when you're feeling fine. If your blood pressure is normal, you can work with your health care team to keep it that way. If your blood pressure is too high, treatment may help prevent damage to your body's organs.

Blood Pressure Numbers

Blood pressure is measured as systolic (sis-TOL-ik) and diastolic (di-a-STOL-ik) pressures. "Systolic" refers to blood pressure when the heart beats while pumping blood. "Diastolic" refers to blood pressure when the heart is at rest between beats.

You most often will see blood pressure numbers written with the systolic number above or before the diastolic number, such as 120/80 mmHg. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)

The table below shows normal blood pressure numbers for adults. It also shows which numbers put you at greater risk for health problems.

Categories for Blood Pressure Levels in Adults (measured in millimeters of mercury, or mmHg)

Category	Systolic (top number)		Diastolic (bottom number)
Normal	Less than 120	And	Less than 80
Prehypertension	120–139	Or	80–89
High blood pressure
Stage 1	140–159	Or	90–99
Stage 2	160 or higher	Or	100 or higher

The ranges in the table apply to most adults (aged 18 and older) who don't have short-term serious illnesses.

Blood pressure doesn't stay the same all the time. It lowers as you sleep and rises when you wake up. Blood pressure also rises when you're excited, nervous, or active. If your numbers stay above normal most of the time, you're at risk for health problems.

All levels above 120/80 mmHg raise your risk, and the risk grows as blood pressure numbers rise. "Prehypertension" means you're likely to end up with HBP, unless you take steps to prevent it.

If you're being treated for HBP and have repeat readings in the normal range, your blood pressure is under control. However, you still have the condition. You should see your doctor and follow your treatment plan to keep your blood pressure under control.

Your systolic and diastolic numbers may not be in the same blood pressure category. In this case, the more severe category is the one you're in. For example, if your systolic number is 160 and your diastolic number is 80, you have stage 2 HBP. If your systolic number is 120 and your diastolic number is 95, you have stage 1 HBP.

If you have diabetes or chronic kidney disease, HBP is defined as 130/80 mmHg or higher. HBP numbers also differ for children and teens. (For more information, go to "How Is High Blood Pressure Diagnosed?")

Outlook

Blood pressure tends to rise with age. Following a healthy lifestyle helps some people delay or prevent this rise in blood pressure.

People who have HBP can take steps to control it and reduce their risk of related health problems. Key steps include following a healthy lifestyle, having ongoing medical care, and following your treatment plan.

Other Names for High Blood Pressure

High blood pressure (HBP) also is called hypertension (HI-per-TEN-shun).

When HBP has no known cause, it may be called essential hypertension, primary hypertension, or idiopathic (id-ee-o-PATH-ick) hypertension.

When another condition causes HBP, it's sometimes called secondary high blood pressure or secondary hypertension.

In some cases of HBP, only the systolic blood pressure number is high. This condition is called isolated systolic hypertension (ISH). Many older adults have this condition. ISH can cause as much harm as HBP in which both numbers are too 

What Causes High Blood Pressure?

Blood pressure tends to rise with age, unless you take steps to prevent or control it.

Some medical problems, such as chronic kidney disease, thyroid disease, andsleep apnea, may cause blood pressure to rise. Some medicines also may raise your blood pressure. Examples include asthma medicines (for example, corticosteroids) and cold-relief products.

In some women, blood pressure can rise if they use birth control pills, become pregnant, or take hormone therapy.

Women taking birth control pills usually have a small rise in both systolic and diastolic blood pressures. If you already have high blood pressure (HBP) and want to use birth control pills, make sure your doctor knows about your HBP. Talk with him or her about how often you should have your blood pressure checked and how to control it while taking the pill.

Taking hormones to reduce the symptoms of menopause can cause a small rise in systolic blood pressure. If you already have HBP and want to start using hormones, talk with your doctor about the risks and benefits. If you decide to take hormones, find out how to control your blood pressure and how often you should have it checked.

Children younger than 10 years old who have HBP often have another condition that's causing it (such as kidney disease). Treating the underlying condition may resolve the HBP.

The older a child is when HBP is diagnosed, the more likely he or she is to have essential hypertension. This means that doctors don't know what's causing the HBP.

Who Is at Risk for High Blood Pressure?

High blood pressure (HBP) is a common condition. In the United States, about 1 in 3 adults has HBP.

Certain traits, conditions, and habits—known as risk factors—can raise your risk for HBP. The major risk factors for HBP are described below.

Older Age

Blood pressure tends to rise with age. If you're a male older than 45 or a female older than 55, you're at increased risk for HBP. Over half of all Americansaged 60 and older have HBP.

Isolated systolic hypertension (ISH) is the most common form of HBP in older adults. ISH occurs when only systolic blood pressure (the top number) is high. About 2 out of 3 people over age 60 with HBP have ISH.

HBP doesn't have to be a routine part of aging. You can take steps to keep your blood pressure at a normal level. (For more information, go to "How Is High Blood Pressure Treated?")

Race/Ethnicity

HBP can affect anyone. However, it's more common in African American adults than in Caucasian or Hispanic American adults. In relation to these groups, African Americans:

• Tend to get HBP earlier in life
• Often have more severe HBP
• Are more likely to be aware that they have HBP and to get treatment
• Are less likely than Caucasians and about as likely as Hispanic Americans to achieve target control levels with HBP treatment
• Have higher rates than Caucasians of early death from HBP-related problems, such as coronary heart disease, stroke, and kidney failure

HBP risks vary among different groups of Hispanic American adults. For instance, Puerto Rican American adults have higher rates of HBP-related death than all other Hispanic groups and Caucasians. However, Cuban Americans have lower rates of HBP-related death than Caucasians.

Overweight or Obesity

You're more likely to develop prehypertension or HBP if you're overweight or obese. The terms "overweight" and "obesity" refer to body weight that's greater than what is considered healthy for a certain height.

Gender

Fewer adult women have HBP than adult men. But, younger women (aged 18–59) are more likely than men to be aware of and get treatment for HBP.

Women aged 60 and older are as likely as men to be aware of and treated for HBP. However, among treated women aged 60 and older, blood pressure control is lower than it is in men in the same age group.

Unhealthy Lifestyle Habits

Many unhealthy lifestyle habits can raise your risk for HBP, including:

• Eating too much sodium (salt)
• Drinking too much alcohol
• Not getting enough potassium in your diet
• Not doing enough physical activity
• Smoking

Other Risk Factors

A family history of HBP raises your risk for the condition. Long-lasting stress also can put you at risk for HBP.

You're also more likely to develop HBP if you have prehypertension. Prehypertension means that your blood pressure is in the 120–139/80–89 mmHg range.

Risk Factors for Children and Teens

Overweight is on the rise in youth younger than 18 years old. As a result, prehypertension and HBP also are becoming more common in this age group.

African American and Mexican American youth are more likely to have HBP and prehypertension than Caucasian youth. Also, boys are at higher risk for HBP than girls.

Like adults, children and teens need to have routine blood pressure checks, especially if they're overweight.

What Are the Signs and Symptoms of High Blood Pressure?

High blood pressure (HBP) itself usually has no signs or symptoms. Rarely, headaches may occur.

You can have HBP for years without knowing it. During this time, the condition can damage your heart, blood vessels, kidneys, and other parts of your body.

Some people only learn that they have HBP after the damage has caused problems, such as coronary heart disease, stroke, or kidney failure.

Knowing your blood pressure numbers is important, even when you're feeling fine. If your blood pressure is normal, you can work with your health care team to keep it that way. If your blood pressure is too high, you can take steps to lower it. Lowering your blood pressure will help reduce your risk for related health problems.

Complications of High Blood Pressure

When blood pressure stays high over time, it can damage the body. HBP can cause:

• The heart to get larger or weaker, which may lead to heart failure. Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs.
• Aneurysms (AN-u-risms) to form in blood vessels. An aneurysm is an abnormal bulge in the wall of an artery. Common spots for aneurysms are the main artery that carries blood from the heart to the body; the arteries in the brain, legs, and intestines; and the artery leading to the spleen.
• Blood vessels in the kidney to narrow. This may cause kidney failure.
• Arteries throughout the body to narrow in some places, which limits blood flow (especially to the heart, brain, kidneys, and legs). This can cause aheart attack, stroke, kidney failure, or amputation of part of the leg.
• Blood vessels in the eyes to burst or bleed. This may lead to vision changes or blindness.

How Is High Blood Pressure Diagnosed?

High blood pressure (HBP) is diagnosed using a blood pressure test. This test will be done several times to make sure the results are correct. If your numbers are high, your doctor may have you return for repeat tests to check your blood pressure over time.

If your blood pressure is 140/90 mmHg or higher over time, your doctor will likely diagnose you with HBP. If you have diabetes or chronic kidney disease, a blood pressure of 130/80 mmHg or higher is considered HBP.

The ranges for HBP in children are different, as discussed below.

How Is Blood Pressure Tested?

A blood pressure test is easy and painless. This test is done at a doctor's office or clinic.

To prepare for the test:

• Don't drink coffee or smoke cigarettes for 30 minutes prior to the test. These actions may cause a short-term rise in your blood pressure.
• Go to the bathroom before the test. Having a full bladder can change your blood pressure reading.
• Sit for 5 minutes before the test. Movement can cause short-term rises in blood pressure.

To measure your blood pressure, your doctor or nurse will use some type of a gauge, a stethoscope (or electronic sensor), and a blood pressure cuff.

Most often, you will sit or lie down with the cuff around your arm as your doctor or nurse checks your blood pressure. If he or she doesn't tell you what your blood pressure numbers are, you should ask.

Diagnosing High Blood Pressure in Children and Teens

Doctors measure blood pressure in children and teens the same way they do in adults. Your child should have routine blood pressure checks starting at 3 years of age.

Blood pressure normally rises with age and body size. Newborn babies often have very low blood pressure numbers, while older teens have numbers similar to adults.

The ranges for normal blood pressure and HBP generally are lower for youth than for adults. To find out whether a child has HBP, a doctor will compare the child's blood pressure numbers to average numbers for his or her age, gender, and height.

For more information, go to the National Heart, Lung, and Blood Institute's "A Pocket Guide to Blood Pressure Measurement in Children."

What Does a Diagnosis of High Blood Pressure Mean?

If you're diagnosed with HBP, your doctor will prescribe treatment. You'll need to have your blood pressure tested again to see how the treatment affects it.

Once your blood pressure is under control, you'll still need treatment. "Under control" means that your blood pressure numbers are in the normal range. You also will need regular blood pressure tests. Your doctor can tell you how often you should be tested.

The sooner you find out about HBP and treat it, the better. Early treatment may help you avoid problems such as heart attack, stroke, and kidney failure.

How Is High Blood Pressure Treated?

High blood pressure (HBP) is treated with lifestyle changes and medicines.

Most people who have HBP will need lifelong treatment. Sticking to your treatment plan is important. It can help prevent or delay problems related to HBP and help you live and stay active longer.

For more tips on controlling your blood pressure, go to the National Heart, Lung, and Blood Institute's (NHLBI's) "Your Guide to Lowering Blood Pressure."

Goals of Treatment

The treatment goal for most adults is to get and keep blood pressure below140/90 mmHg. For adults who have diabetes or chronic kidney disease, the goal is to get and keep blood pressure below 130/80 mmHg.

Lifestyle Changes

Healthy lifestyle habits can help you control HBP. These habits include:

• Following a healthy diet
• Being physically active
• Maintaining a healthy weight
• Quitting smoking
• Managing your stress and learning to cope with stress

If you combine healthy lifestyle habits, you can achieve even better results than taking single steps. Making lifestyle changes can be hard. Start by making one healthy lifestyle change and then adopt others.

Some people can control their blood pressure with lifestyle changes alone, but many people can't. Keep in mind that the main goal is blood pressure control.

If your doctor prescribes medicines as a part of your treatment plan, keep up your healthy lifestyle habits. They will help you better control your blood pressure.

Following a Healthy Diet

Your doctor may recommend the DASH (Dietary Approaches to Stop Hypertension) eating plan if you have HBP. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium (salt).

DASH also focuses on fat-free or low-fat milk and dairy products, fish, poultry, and nuts. The DASH eating plan is reduced in red meats (including lean red meats), sweets, added sugars, and sugar-containing beverages. It's rich in nutrients, protein, and fiber.

To help control HBP, you should limit the amount of salt that you eat. This means choosing low-sodium and "no added salt" foods and seasonings at the table or when cooking. The Nutrition Facts label on food packaging shows the amount of sodium in an item. You should eat no more than about 1 teaspoon of salt a day.

You also should try to limit alcoholic drinks. Too much alcohol will raise your blood pressure. Men should have no more than two alcoholic drinks a day. Women should have no more than one alcoholic drink a day. One drink is a glass of wine, beer, or a small amount of hard liquor.

For more information, go to the NHLBI's "Your Guide to Lowering Your Blood Pressure With DASH."

Being Physically Active

Routine physical activity can lower HBP and reduce your risk for other health problems. Talk with your doctor before you start a new exercise plan. Ask him or her how much and what kinds of physical activity are safe for you.

People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. The more active you are, the more you will benefit.

For more information about physical activity, go to the U.S. Department of Health and Human Services' "2008 Physical Activity Guidelines for Americans," the Health Topics Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart."

Maintaining a Healthy Weight

Maintaining a healthy weight can help you control HBP and reduce your risk for other health problems.

If you're overweight or obese, aim to reduce your weight by 5 to 10 percent during your first year of treatment. This amount of weight loss can lower your risk for health problems related to HBP.

To lose weight, cut back your calorie intake and do more physical activity. Eat smaller portions and choose lower calorie foods. Don't feel that you have to finish the entrees served at restaurants. Many restaurant portions are oversized and have too many calories for the average person.

After your first year of treatment, you may have to continue to lose weight so you can lower your body mass index (BMI) to less than 25. BMI measures your weight in relation to your height and gives an estimate of your total body fat.

A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for controlling blood pressure.

You can use the NHLBI's online BMI calculator to figure out your BMI, or your doctor can help you.

For more information about losing weight and keeping it off, go to the Health Topics Overweight and Obesity article.

Quit Smoking

If you smoke or use tobacco, quit. Smoking can damage your blood vessels and raise your risk for HBP. Smoking also can worsen health problems related to HBP.

Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's "Your Guide to a Healthy Heart."

Managing Stress

Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.

Physical activity helps some people cope with stress. Other people listen to music or focus on something calm or peaceful to reduce stress. Some people learn yoga, tai chi, or how to meditate.

Medicines

Today's blood pressure medicines can safely help most people control their blood pressure. These medicines are easy to take. The side effects, if any, tend to be minor.

If you have side effects from your medicines, talk with your doctor. He or she might adjust the doses or prescribe other medicines. You shouldn't decide on your own to stop taking your medicines.

Blood pressure medicines work in different ways to lower blood pressure. Some remove extra fluid and salt from the body to lower blood pressure. Others slow down the heartbeat or relax and widen blood vessels. Often, two or more medicines work better than one.

Diuretics

Diuretics sometimes are called water pills. They help your kidneys flush excess water and salt from your body. This reduces the amount of fluid in your blood, and your blood pressure goes down.

Diuretics often are used with other HBP medicines and sometimes combined into one pill.

Beta Blockers

Beta blockers help your heart beat slower and with less force. As a result, your heart pumps less blood through your blood vessels. This causes your blood pressure to go down.

ACE Inhibitors

ACE inhibitors keep your body from making a hormone called angiotensin II. This hormone normally causes blood vessels to narrow. ACE inhibitors prevent this, so your blood pressure goes down.

Angiotensin II Receptor Blockers

Angiotensin II receptor blockers are newer blood pressure medicines that protect your blood vessels from the angiotensin II hormone. As a result, blood vessels relax and widen, and your blood pressure goes down.

Calcium Channel Blockers

Calcium channel blockers keep calcium from entering the muscle cells of your heart and blood vessels. This allows blood vessels to relax, and your blood pressure goes down.

Alpha Blockers

Alpha blockers reduce nerve impulses that tighten blood vessels. This allows blood to flow more freely, causing blood pressure to go down.

Alpha-Beta Blockers

Alpha-beta blockers reduce nerve impulses the same way alpha blockers do. However, they also slow the heartbeat like beta blockers. As a result, blood pressure goes down.

Nervous System Inhibitors

Nervous system inhibitors increase nerve impulses from the brain to relax and widen blood vessels. This causes blood pressure to go down.

Vasodilators

Vasodilators relax the muscles in blood vessel walls. This causes blood pressure to go down.

Treatment for Children and Teens

If another condition is causing your child's HBP, treating it often resolves the HBP. When the cause of a child or teen's HBP isn't known, the first line of treatment is lifestyle changes (as it is for adults).

If lifestyle changes don't control blood pressure, children and teens also may need to take medicines. Most of the medicines listed above for adults have special doses for children.

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