What to know about high blood pressure

High blood pressure starts when the systolic, or upper number is between 130 and 139 or the diastolic, or lower number is between 80 and 89, according to the American Heart Association.

If blood pressure is too high for too long, it can cause serious damage to the blood vessels.

This can lead to various complications, some of which can be life threatening. They include:

• heart failure
• vision loss
• stroke
• kidney disease

There are ways of managing high blood pressure, or hypertension. The condition does not often cause symptoms, but regular screening can help a person know if preventive measures are necessary.

The United States Preventive Services Task Force (USPSTF) estimates that high blood pressure affects around 45% of adults in the U.S.

In this article, we look at the causes of high blood pressure and how to treat it. We also explain the blood pressure measurements that health authorities consider to be typical or too high.

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The heart is a muscle that pumps blood around the body. As it travels, the blood delivers oxygen to the body’s vital organs.

Sometimes, a problem in the body makes it harder for the heart to pump blood. For example, this could occur if an artery becomes too narrow.

Persistent high blood pressure can place strain on the walls of the arteries. This can lead to various health problems, some of which can be life threatening.

The chart below shows measures for typical and high blood pressure, according to the American Heart Association (AHA).

Doctors measure blood pressure in millimeters of mercury (mm Hg).

There are two parts to a blood pressure measurement: Systolic pressure, the top number on a blood pressure reading, is the blood pressure when the heart contracts. Diastolic pressure is the blood pressure between heartbeats. It is the lower number of the measurement and represents the blood pressure when the heart rests between beats.

Therefore, if blood pressure is 120/80 mm Hg, the systolic pressure is 120 mm Hg and the diastolic pressure is 80 mm Hg.

A blood pressure monitor works by stopping the blood flow, usually to the lower arm, and then letting it start again. If a doctor uses a manual sphygmomanometer with a stethoscope, they will not hear any sounds until the blood starts to flow. The first sound they will hear is when the pressure approaches systolic blood pressure. When the sound disappears again, it marks diastolic blood pressure.

Learn more about systolic and diastolic pressure.

The table below shows how doctors interpret a person’s blood pressure:

What is typical blood pressure? Find out here.

You can buy a blood pressure monitor for home use here.

Most people with high blood pressure will not experience any symptoms, which is why people often call hypertension the “silent killer.”

However, once blood pressure reaches about 180/120 mm Hg, it becomes a hypertensive crisis, which constitutes a medical emergency.

At this stage, a person may have:

• a headache
• nausea
• vomiting
• dizziness
• blurred or double vision
• nosebleeds
• heart palpitations
• breathlessness

Anybody who experiences these symptoms should seek immediate medical attention.

Symptoms in females

Hormonal factors mean that the risk of high blood pressure may be different in males and females.

Factors that can increase the risk of high blood pressure in females include:

• pregnancy
• menopause
• using birth control pills

During pregnancy, high blood pressure can indicate preeclampsia, a potentially dangerous condition that can affect both the person and their fetus.

Symptoms of preeclampsia include:

• headaches
• vision changes
• abdominal pain
• swelling due to edema

All people should follow the guidelines for screening and attend all health checks, especially during pregnancy.

Is menopause a key risk factor?

Research shows that before middle age, males are more likely to experience high blood pressure than females. Then, around the time of menopause, the reverse becomes true. However, health experts disagree on whether this is due to menopause.

Some argue that, until menopause, hormonal factors — and specifically the presence of estrogen — helps protect people from high blood pressure. When menopause occurs, individuals lose this protection, effectively making menopause the main risk factor for cardiovascular disease among females.

However, some suggest that other factors may increase the risk around this time, such as increased body mass index, aging, and dietary changes, whether hormonal changes also play a role or not.

Symptoms in teens and people in their early 20s

Teenagers can develop high blood pressure due to obesity or an underlying medical condition.

Possible medical factors include:

• aspects of metabolic conditions, such as type 2 diabetes
• kidney disease
• endocrine disease, which affects the hormones
• vascular disease, which affects the blood vessels
• a neurological condition

These conditions may have symptoms of their own.

The symptoms of high blood pressure, if they occur, will be the same as for other groups.

A 2021 study notes that, while death rates from cardiovascular disease have fallen among older adults, the reduction has been less dramatic in those aged 18–39 years. The author suggests there are lower rates of awareness, treatment, and management of high blood pressure in those aged 20–39. With this in mind, they call for more effective identification of high blood pressure in these age groups to help reduce the risk of cardiovascular problems later in life.

Symptoms in children

High blood pressure can affect children. Having obesity and diabetes increases the risk, but other underlying causes include:

• a tumor
• heart problems
• kidney problems
• obstructive sleep apnea
• a rheumatologic disorder
• thyroid problems
• a genetic condition, such as Cushing’s syndrome
• the use of certain drugs
• a diet high in fat and salt

As with adults, high blood pressure does not often cause symptoms in children.

However, if they occur, they may include:

• a headache
• fatigue
• cognitive changes or changes in mental status
• vomiting

These symptoms are likely to indicate severe hypertension.

They may also have signs of another condition.

Symptoms in babies

Newborns and very young babies can sometimes have high blood pressure due to an underlying health condition, such as kidney or heart disease.

Clinical tests may show there are problems with blood pressure or the cardiopulmonary system.

Any symptoms may be non-specific or not noticeable, or hypertension may occur alongside symptoms of other conditions.

An infant with high blood pressure may also experience:

• seizures
• irritability
• lethargy
• feeding problems
• rapid breathing
• apnea

Other symptoms will depend on the condition causing the high blood pressure.

High blood pressure can occur when certain changes happen in the body or if a person is born with specific genetic features that cause a health condition.

It can affect people with:

• obesity
• type 2 diabetes
• kidney disease
• obstructive sleep apnea
• lupus
• scleroderma
• underactive or overactive thyroid
• congenital conditions, such as Cushing’s syndrome, acromegaly, or pheochromocytoma

Sometimes, there is no apparent cause. In this case, a doctor will diagnose primary hypertension.

Consuming a low fat diet, maintaining a moderate weight, reducing alcohol consumption, stopping smoking tobacco, will help lower the risk of high blood pressure.

Treatment will depend on several factors, including how high the blood pressure is and the risk of cardiovascular disease or a stroke.

The doctor will recommend different treatments as blood pressure increases. For slightly high blood pressure, they may suggest making lifestyle changes and monitoring the blood pressure.

If blood pressure is high, they will recommend medication. The options may change over time, according to how severe the hypertension is and whether complications arise, such as kidney disease. Some people may also need a combination of several different medications.

Medications

Conventional drugs for treating high blood pressure include:

Angiotensin converting enzyme inhibitors

Angiotensin converting enzyme (ACE) inhibitors block the actions of some hormones that regulate blood pressure, such as angiotensin II. Angiotensin II causes the arteries to constrict and increases blood volume, increasing blood pressure.

ACE inhibitors can reduce the blood supply to the kidneys, making them less effective. As a result, people taking them need to undergo regular blood tests.

Additionally, individuals should not use ACE inhibitors if they are pregnant or have a condition that affects the blood supply to the kidneys.

ACE inhibitors may cause the following side effects, which usually resolve after a few days:

• dizziness
• fatigue
• weakness
• headaches
• a persistent dry cough

If the side effects are persistent or too unpleasant to manage, a doctor may prescribe an angiotensin II receptor antagonist instead.

These alternative medications often cause fewer side effects, but they may include dizziness, headaches, and increased potassium levels in the blood.

Calcium channel blockers

Calcium channel blockers (CCBs) aim to decrease calcium levels in the blood vessels. This will relax the vascular smooth muscle, causing the muscle to contract less forcefully, the arteries to widen, and blood pressure to reduce.

However, CCBs may not always be suitable for people with a history of heart disease, liver disease, or blood circulation issues. A doctor can advise on taking CCBs and which type is safe to use.

The following side effects may occur with CCBs, but they usually resolve after a few days:

• skin redness, generally on the cheeks or neck
• headaches
• swollen ankles and feet
• dizziness
• fatigue
• skin rash
• swollen abdomen, in rare cases

Learn more about CCBs.

Thiazide diuretics

Thiazide diuretics help the kidneys remove sodium and water, lowering blood volume and pressure.

The following side effects of taking them can occur, and some may persist:

• low blood potassium, which can affect heart and kidney function
• impaired glucose tolerance
• erectile dysfunction

People taking thiazide diuretics should undergo regular blood and urine tests to monitor their blood sugar and potassium levels.

Beta-blockers

Beta-blockers were once popular for treating hypertension, but doctors now only tend to prescribe them when other treatments are ineffective.

These medications slow the heart rate and reduce the force of the heartbeat, causing a drop in blood pressure.

Side effects from beta-blockers may include:

• fatigue
• cold hands and feet
• slow heartbeat
• nausea
• diarrhea

Less common side effects are:

• disturbed sleep
• nightmares
• erectile dysfunction

Beta-blockers are often the standard medication for a person with very high blood pressure, known as a hypertensive crisis.

Renin inhibitors

Aliskiren (Tekturna, Rasilez) reduces the production of renin, an enzyme that the kidneys produce.

Renin helps produce a hormone that narrows blood vessels and raises blood pressure. Reducing this hormone causes the blood vessels to widen and blood pressure to fall.

Possible side effects include:

• diarrhea
• dizziness
• flu-like symptoms
• fatigue
• a cough

It is essential to read the packaging of any medication to check for interactions with other drugs.

Find out more detail about blood pressure medications.

Diet

Managing the diet can be an effective way of preventing and treating high blood pressure.

Plant-based foods

A nutritious, balanced diet includes plenty of fruits and vegetables, vegetable and omega oils, and good quality, unrefined carbohydrates, such as whole grains. People who include animal products in their diet should trim the fat off and avoid processed meats.

Lowering salt intake

Experts recommend reducing salt consumption and increasing potassium intake to manage or prevent high blood pressure. Limiting salt intake to less than 5–6 grams per day could help improve cardiovascular health and reduce systolic blood pressure by 5.6 mm Hg in people with hypertension.

Nutritious fats

In moderation, plant-based sources of fats, such as avocados, nuts, olive oil, and omega oils, can provide benefits. People should limit their intake of saturated fats and trans fats, common in animal-sourced and processed foods.

The DASH diet

Health experts recommend the DASH diet for people with high blood pressure. The DASH diet focuses on an eating plan that emphasizes whole grains, fruits, vegetables, nuts, seeds, beans, and low fat dairy products.

Which foods are good for reducing blood pressure? Find out here.

Alcohol

One study in women indicated that consuming some alcohol may help lower blood pressure. However, others report the opposite, noting that even drinking a moderate amount might increase blood pressure levels.

People who regularly drink more than moderate amounts of alcohol will almost always experience elevated blood pressure levels.

Caffeine

Studies into the relationship between caffeine and blood pressure have produced conflicting results. A report published in 2017 concluded that a moderate intake of coffee appears to be safe for people with high blood pressure.

Home remedies

The AHA recommends a range of lifestyle adjustments that can help reduce blood pressure, such as:

• managing stress
• quitting smoking
• consuming a nutritious diet
• getting exercise
• following any treatment plan the doctor prescribes

Discuss any planned lifestyle changes with a healthcare professional before introducing them.

Regular exercise

The AHA notes that most healthy people should do at least 150 minutes of moderate-intensity physical exercise a week. This could be 30 minutes — or three sessions of 10 minutes a day — 5 days per week.

This amount of exercise is also appropriate for those with high blood pressure.

However, a person who has not exercised for a while or who has a new diagnosis should speak with their doctor before starting a new physical activity program to ensure it is suitable.

Losing weight

Studies have revealed that losing as little as 5–10 pounds in weight can help reduce blood pressure.

Weight loss will also improve the effectiveness of blood pressure medications.

Methods of achieving and maintaining a moderate weight include getting regular exercise and following a diet that emphasizes plant-based foods. A person should also limit their intake of fat and added sugars.

Learn about maintaining weight loss.

Sleep

Increasing sleep alone cannot treat hypertension, but too little sleep and reduced sleep quality may make it worse.

A 2015 analysis of data from a Korean national health survey found that people who had under 5 hours of sleep per night were more likely to have hypertension.

Find more tips on how to manage high blood pressure.

Natural remedies

According to the National Center for Complementary and Integrative Health (NCCIH), the following may help lower blood pressure:

• meditation, yoga, qi gong, and tai chi
• biofeedback and transcendental meditation
• supplements such as garlic, flaxseed, green or black tea, probiotics, cocoa, and roselle (Hibiscus sabdariffa)

However, the NCCIH adds that there is insufficient evidence to confirm that these can make a difference.

It also warns that some supplements can have adverse effects, such as raising blood pressure or interacting with medications. The organization states that meditation and exercise therapies are usually safe, but some poses may not be suitable for people with high blood pressure.

Anyone considering an alternative therapy should speak with their doctor first.

Get some tips for lowering blood pressure naturally.

There are different devices for measuring blood pressure. A doctor may use a digital device or a manual sphygmomanometer with a stethoscope. This has a pressure cuff that they put around the person’s arm.

Digital blood pressure-measuring devices suitable for home use are also available for purchase online.

A person will typically need more than one reading to confirm a diagnosis, as various factors can affect the result.

Blood pressure can fluctuate:

• according to the time of day
• during feelings of anxiety or stress
• after eating

However, a doctor will take immediate action if a reading shows very high blood pressure or if there are signs of organ damage or other complications.

Additional tests

Other tests can help confirm a diagnosis, including those below.

Healthy blood pressure is essential for maintaining bodily functions.

High blood pressure can have a severe effect on:

• The cardiovascular system: High blood pressure can cause the arteries to harden, increasing the risk of a blockage.
• The heart: A blockage can reduce blood flow to the heart, increasing the risk of angina, heart failure, or a heart attack.
• The brain: A blockage in the arteries can lower or prevent blood flow to the brain, leading to a stroke.
• The kidneys: High blood pressure can result in kidney damage and chronic kidney disease.

All of these effects can be life threatening.

Decongestants are a useful over-the-counter remedy when people have a stuffy or runny nose, but some can raise blood pressure.

Ingredients that can have this effect include:

• oxymetazoline
• phenylephrine
• pseudoephedrine

A person should explain to their pharmacist that they have high blood pressure and ask them to recommend a suitable option.

The main risk factors for high blood pressure are likely to be environmental, but genetic factors may play a role. Hypertension can run in families, and people from certain ethnic and racial backgrounds appear to have a higher risk.

However, the Centers for Disease Control and Prevention (CDC) note that individuals within a family often share similar lifestyles, such as dietary choices.

If a person has genetic factors that increase their susceptibility to high blood pressure, and they make lifestyle choices that increase this risk, they will likely have a greater chance of developing hypertension.

The AHA recommends that people limit their salt intake to no more than 2,300 milligrams (mg) a day and preferably reduce it to 1,500 mg. On average, individuals in the U.S. currently consume more than 3,400 mg of sodium daily.

For example, the natural sodium content in vegetables is enough for most individuals’ bodily needs. With this in mind, avoiding the salt shaker and eating less processed and premade food are suitable ways to cut salt intake.

Without treatment or taking measures to manage blood pressure, excessive pressure on the artery walls can cause damage to the blood vessels, a form of cardiovascular disease. It can also damage vital organs.

Possible complications of high blood pressure include:

• stroke
• heart disease
• heart attack
• heart failure
• peripheral arterial disease
• aortic aneurysm
• kidney disease
• vascular dementia

Seeking early treatment and managing blood pressure can help prevent many health complications.

The risk factors for high blood pressure include the following:

• Age: The risk increases with age because the blood vessels become less flexible.
• Family history and genetic factors: People who have close family members with hypertension are more likely to develop it.
• Obesity and having excess weight: People with overweight or obesity are more likely to develop high blood pressure.
• Physical inactivity: A sedentary lifestyle increases the risk.
• Smoking: When people smoke, the blood vessels narrow, and blood pressure rises. Smoking also reduces the blood’s oxygen content, so the heart pumps faster to compensate, which also increases blood pressure.
• Alcohol intake: Drinking a lot of alcohol increases the risk of blood pressure and its complications, such as heart disease.
• Diet: A diet high in unsaturated fat and salt increases the risk of high blood pressure.
• High cholesterol: Over 50% of people with high blood pressure have high cholesterol. Consuming nonnutritious fats can contribute to a buildup of cholesterol in the arteries.
• Mental stress: Stress can have a severe effect on blood pressure, especially when it is chronic. It can occur due to both socioeconomic and psychosocial factors.
• Stress: Persistent stress can lead to high blood pressure. It may also increase the likelihood of practices that can affect health, such as smoking or drinking.
• Diabetes: High blood pressure often occurs alongside diabetes. However, following a treatment plan to manage diabetes can reduce the risk. Learn more about hypertension and diabetes.
• Pregnancy: High blood pressure is more likely during pregnancy due to hormonal changes. Hypertension is also a symptom of preeclampsia, a potentially severe placental disorder.
• Sleep apnea: People with sleep apnea momentarily stop breathing while they sleep. Health experts suggest there are links with hypertension.

Black Americans are 40% more likely to have hypertension and 30% more likely to die of heart disease than white Americans, studies show. A 2018 study finds that one reason for this is unequal access to high quality cardiovascular healthcare.

Learn more about how heart disease affects Black Americans.

Many people with high blood pressure do not have symptoms. For this reason, they must undergo regular screenings, especially those with a higher risk.

The USPSTF recommends annual screening for:

• adults aged 40 years or older
• those with an elevated risk of high blood pressure
• individuals with a higher risk, including those who:
  • have high to typical blood pressure: 130–139 to 80–89 mm Hg
  • have excess weight or obesity
  • are Black

Adults aged 18–39 years whose blood pressure is typical (less than 130/85 mm Hg) and who do not have other risk factors should have further screenings every 3–5 years.

If rescreening in the doctor’s office shows that blood pressure has risen, the USPSTF recommends using an ambulatory blood pressure monitor for 24 hours to assess blood pressure further. If this continues to show high blood pressure, the doctor will diagnose hypertension.

However, the USPSTF does not currently recommend routine screening for those aged 17 years and under.

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High blood pressure is a potentially dangerous condition that often has no symptoms but can lead to a heart attack, stroke, and other life threatening conditions. Health experts define healthy blood pressure as lower than 120 over 80 mm Hg.

Anyone who notices their blood pressure is 130–139 to 80–89 mm Hg or above should speak with a doctor. It may indicate an underlying health issue, such as hyperthyroidism or kidney disease.

People should ask their doctor how often they should undergo blood pressure screenings, as many factors can affect their blood pressure and heart health.