Heart Health High Blood Pressure An Overview of High Blood Pressure By Karen Shackelford, MD Karen Shackelford, MD LinkedIn Karen Shackelford, MD, is an emergency medicine physician with years of experience helping patients dealing with blood pressure issues. Learn about our editorial process Updated on January 20, 2022 Medically reviewed by Yasmine S. Ali, MD, MSCI Medically reviewed by Yasmine S. Ali, MD, MSCI Facebook LinkedIn Twitter Yasmine S. Ali, MD, MSCI, is a board-certified preventive cardiologist and lipidologist. Dr. Ali is also an award-winning writer. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment High blood pressure is exactly what the term suggests: blood pressure that is more intense than is normal or healthy. Although blood pressure can be elevated temporarily—in response to anxiety, for example—chronically high blood pressure (hypertension) is a medical condition that can cause serious complications such as heart attack, stroke, and kidney disease. High blood pressure rarely causes symptoms, but it's easily diagnosed after several readings are taken at your healthcare provider's office or through the use of ambulatory monitoring. Some 103 million American adults have high blood pressure, which can vary in degree from relatively mild to life-threatening. Treatment typically involves dietary changes, exercise, and other lifestyle adjustments, and/or medications such as calcium channel blockers or beta-blockers. Wutthichai Luemuang / EyeEm / Getty Images Symptoms Hypertension has earned a descriptive—and important—nickname: "the silent killer." This is because, aside from elevated blood pressure readings, it does not cause noticeable symptoms. The American Heart Association (AHA) does, however, recognize a handful of symptoms that may be associated with high blood pressure. Blood spots in the eyes, for example, are common in people with high blood pressure (but also in those with diabetes). When blood pressure is chronically high, there is relentless pressure against artery walls, causing them to weaken, tear, or rupture; develop scar tissue that can attract cholesterol debris and contribute to the buildup of blood-vessel blocking plaques; or to become stiff and unyielding, forcing the heart to work beyond normal capacity. Over time the heart muscle can become weak and floppy, and the cumulative damage to the arteries and heart can lead to numerous serious complications, such as heart attack, stroke, and vision loss. The exception to hypertension's insidious reputation is when the condition reaches crisis level. This is often is a medical emergency that can bring on noticeable symptoms such as headache, shortness of breath, anxiety, chest pain, neurological deficits, and effects related to organ damage. Causes High blood pressure occurs when the force that blood exerts on the walls of arteries is stronger than normal. There are two types: Primary hypertension: An elevation in blood pressure without an obvious cause that tends to develop over the course of several years, going unnoticed until detected during a blood pressure reading Secondary hypertension: Secondary hypertension is hypertension that is caused by an identifiable medical condition. Common causes include thyroid disorder, kidney disease, obstructive sleep apnea, alcohol abuse, illegal drugs, or adrenal gland tumor. Some factors associated with increased susceptibility to high blood pressure are unavoidable. In particular, men over 45 and women over 65 are at higher risk, as are people of both sexes who are black. However, many risk factors for chronic high blood pressure can be modified with diet and lifestyle, including: Being overweightSedentary lifestyleTobacco useHigh sodium or low potassium dietExcessive drinkingLow levels of vitamin DChronic stress Hypertension: Causes and Risk Factors Diagnosis To measure someone's blood pressure, a healthcare provider uses a sphygmomanometer, a medical instrument with a cuff that gets fitted around your upper arm and inflated, then slowly deflated as your healthcare provider listens to your pulse with a stethoscope and a gauge displays two measurements: Systolic blood pressure: The amount of force on the arteries generated by each contraction of the heart Diastolic pressure: The amount of pressure against the walls of the arteries when the heart is resting between contractions The unit of measurement used to evaluate blood pressure is millimeters of mercury (mmHg). Normal blood pressure is less than 120/80 mmHg, with 120 being the systolic pressure and 80 the diastolic pressure. Although a single high reading is not sufficient for a definitive diagnosis, depending on a person's medical history and risk factors, it may be a signal that their pressure is chronically high. Given that regular check-ups are key to detecting the possibility of high blood pressure, it's essential to follow the recommendations for age and stage of life: A child's blood pressure should be measured at each annual check-up and compared to other children of the same age group. After age 20, adults should have their blood pressure monitored at regular healthcare visits. People over 40 or those who have risk factors for hypertension should have their blood pressure checked in both arms at least once a year by a healthcare provider. If at such a visit a healthcare provider suspects a high blood pressure reading may indicate a chronic problem, they will likely order ambulatory blood monitoring, as recommended by the United States Preventive Services Task Force. This involves wearing a special blood pressure cuff attached to a small device that takes a reading every 15 or 30 minutes over the course of 24 or 48 straight hours in order to find out if blood pressure stays elevated and at what level. In 2017, the American College of Cardiology and the AHA revised the guidelines for diagnosing and treating high blood pressure, lowering the definition of high blood pressure and changing the names of the stages of hypertension and what each means. Stage Reading Normal Less than 120/80 mmHg Elevated Systolic between 120 and 126 and diastolic less than 80 Stage 1 Systolic between 130 and 139 or diastolic between 80 and 89 Stage 2 Systolic at least 140 or diastolic at least 90 mm Hg Hypertensive Crisis Systolic over 180 and/or diastolic over 120 If blood pressure is found to be elevated, further diagnostic tests may be necessary to assess the possibility or risk of issues such as cardiovascular disease, a thyroid disorder, retinal damage, or more. These tests include, but are not limited to, blood tests, lipid profiles, imaging studies, and echocardiograms. How Hypertension Is Diagnosed Treatment The initial treatment for hypertension includes changes in lifestyle, diet (for example, lowering sodium intake), and physical activity to eliminate or reduce contributing factors such as obesity. Other important steps include smoking cessation and cutting back on alcohol to one drink a day for women and two drinks a day for men. If these measures are not sufficient to manage high blood pressure, there are four classes of drugs commonly used to treat hypertension: Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACE inhibitors or ARBs) Calcium channel blockers Beta blockers Thiazide diuretics Which medication a healthcare provider prescribes may be influenced by your patient's age and race. People with stage II hypertension may need to take two medications or a combination drug. In the event of hypertensive crisis, treatment typically requires an immediate change in medication if there are no indications of problems other than extremely high blood pressure. Hospitalization is necessary if there are signs of organ damage, according to American College of Cardiology. Complications of High Blood Pressure A Word From Verywell Hypertension is a chronic disorder that can cause many serious health problems, some life-threatening. However, if diagnosed early and treated promptly and properly, high blood pressure can be managed and serious complications prevented. Since there are no discernible symptoms to alert you that your blood pressure is elevated, the best way to prevent hypertension is to have regular physical exams and eliminate as many modifiable risk factors as you can. Bettering My Health by Lowering My Blood Pressure 8 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Benjamin EJ, Virani SS, Callaway CW, et al. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation. 2018;137(12):e67-e492. doi:10.1161/CIR.0000000000000558 Mensah GA. Hypertension and Target Organ Damage: Don't Believe Everything You Think! Ethn Dis. 2016;26(3):275–278. doi:10.18865/ed.26.3.275 InformedHealth.org. High blood pressure: Overview. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG). Puar TH, Mok Y, Debajyoti R, Khoo J, How CH, Ng AK. Secondary hypertension in adults. Singapore Med J. 2016;57(5):228–232. doi:10.11622/smedj.2016087 Steyn K, Damasceno A. Lifestyle and Related Risk Factors for Chronic Diseases. In: Jamison DT, Feachem RG, Makgoba MW, et al., editors. Disease and Mortality in Sub-Saharan Africa. 2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006. Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S76-99. doi:10.1161/01.cir.0000437740.48606.d1 Ahluwalia M, Bangalore S. Management of hypertension in 2017: targets and therapies. Curr Opin Cardiol. 2017;32(4):413-421. doi:10.1097/HCO.0000000000000408 Abel N, Contino K, Jain N, et al. Eighth Joint National Committee (JNC-8) Guidelines and the Outpatient Management of Hypertension in the African-American Population. N Am J Med Sci. 2015;7(10):438–445. doi:10.4103/1947-2714.168669 Additional Reading American Heart Association. What Are the Symptoms of High Blood Pressure? Centers for Disease Control and Prevention. High Blood Pressure Frequently Asked Questions (FAQs). Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63:2960. doi:10.1161/01.cir.0000437740.48606.d1 Hsu CY, McCulloch CE, Darbinian J, et al. Elevated Blood Pressure and Risk of End-stage Renal Disease in Subjects Without Baseline Kidney Disease. Arch Intern Med. 2005 Apr 25;165(8):923-928. doi:10.1001/archinte.165.8.923 Siu AL. U.S. Screening for High Blood Pressure in Adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015 Nov 17;163(10):778-86. doi:10.7326/M15-2223 Taylor BC, Wilt TJ, Welch HG. Impact of Diastolic and Systolic Blood Pressure on Mortality: Implications for the Definition of "Normal". J Gen Intern Med. 2011 Jul;26(7):685-90. doi:10.1007/s11606-011-1660-6 Vakili BA, Okin PM, Devereux RB. Prognostic Implications of Left Ventricular Hypertrophy. Am Heart J. 2001 Mar;141(3):331-334. doi:10.1067/mhj.2001.113218 By Karen Shackelford, MD Karen Shackelford, MD, is an emergency medicine physician with years of experience helping patients dealing with blood pressure issues. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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